Last night’s BlogTalkRadio show was alot of fun. I found an article about patient complaints but the neat thing about it was that it discussed complaints doctors had about patients.

Here’s a summary of each group’s complaints - in future posts I will discuss each of these:

Doctor Complaints                                            Patient Complaints

 Enjoy the show:

If you are or know of someone who is a Patient Advocate, I’m interested in hearing your experiences dealing with doctors from a more objective perspective than how we each deal with doctors when we’re having a problem.

Terrie

This is a really good article that I found in Science Daily (and they took it from a press release from Indiana University)

Doctor-Patient Communication Has A Real Impact On Health

Science Daily — Good doctor-patient communication makes a difference not only in patient satisfaction but in patient outcomes including resolution of chronic headaches, changes in emotional states, lower blood sugar values in diabetics, improved blood pressure readings in hypertensives, and other important health indicators.

"In looking at these 36 studies we learned many things. For example, research on non-adherence to doctor’s instructions has focused on bad or poor behavior by patients rather than on the clarity of the physician’s instructions or whether the physician actually checked to see if his or her instructions were understood by the patient. The physician assumed that the patient understands and thus will comply.

But is this a logical assumption? We don’t assume that when a pilot and an air traffic controller converse that they have understood each until there is an affirmation of understanding. That acknowledgement is lacking in most patient-physician encounters," said Richard Frankel, Ph.D., IU School of Medicine professor of medicine and Regenstrief Institute research scientist, senior author of the study. Dr. Frankel is a sociologist who studies ways to improve the doctor-patient relationship. He is currently investigating how behavioral changes by both doctors and patients impact medical care.

"From previous work, including a well regarded 1999 study from the University of Washington, we know that doctors ask patients whether they understand what was discussed during a medical appointment only about 1.5 percent of the time," said Dr. Frankel. "It is extremely important that a patient be given the opportunity and probably even encouraged to ask questions. Doctors should be trained to routinely check for understanding to ensure that there is neither miscommunication nor mismatch between what the patient wants and what doctors assume the patient wants."

Co-authors of "Communication Interventions Make A Difference in Conversations Between Physicians and Patients: A Systematic Review of the Evidence" are Jaya K. Rao, M.D., M.H.S. of the Centers for Disease Control; Lynda A. Anderson, Ph.D. of Emory University; Thomas S. Inui, M.D. and Richard M. Frankel, Ph.D., both of the IU School of Medicine and the Regenstrief Institute.

Note: This story has been adapted from a news release issued by Indiana University.

Last night’s radio show was great. We discussed the reason that angry and frustrated doctors pull even further into their communication shell and in so doing, they interfere with a patient’s adherence to instructions and modalities intended to get them well. This discussion was based on research done by Dr. Jodi Halpern

Then we discussed 5 mistakes effective patient advocates can avoid. This discussion came from an article by Dr. Vicki Rackner.

Enjoy the show and see you next Friday night!

Terrie

Although a company’s press release, this gives good information.

HealthMedia(R) Kicks Off National Campaign to Promote Better Doctor/Patient Communications

ANN ARBOR, Mich., May 21 /PRNewswire/ — As part of its ongoing initiative to promote health awareness and improve healthcare outcomes, HealthMedia(R), Inc., the global leader in the delivery of scalable behavior change interventions for health and wellness, disease management, behavioral health, and medication compliance, is kicking off the first annual Doctor/Patient Advocacy Week.

HealthMedia Inc.

 What a great article from About.com - even though it’s primarily about arthritis, the concepts are exactly the same for every patient-physician encounter. Read about it.

The Patient-Physician Encounter

From Carol & Richard Eustice 

The good physician treats the disease; the great physician treats the patient who has the disease ~ William Osler (Canadian Physician, 1849-1919) 

The Patient-Physician Encounter 

What do patients want from a medical encounter with a physician?

In the thoughts of one physician (Delbanco,1992): 

• Patients want to be able to trust the competence and efficacy of their caregivers.
• Patients want to be able to negotiate the health care system effectively and to be treated with dignity and respect.
• Patients want to understand how their sickness or treatment will affect their lives, and they often fear that their doctors are not telling them everything they want to know.
• Patients want to discuss the effect their illness will have on their family, friends, and finances.
• Patients worry about the future.
• Patients worry about and want to learn how to care for themselves away from the clinical setting.
• Patients want physicians to focus on their: 
                    pain
                    physical discomfort
                    functional disabilities  

The Relationship Between Patient And Physician 

The relationship between patient and physician has been analyzed since the early 1900’s. Prior to when medicine was more science than art, physicians worked to refine their bedside manner, as cures were often impossible and treatment had limited effect.

In the middle of the century when science and technology emerged, interpersonal aspects of health care were overshadowed. There is currently a renewed interest in medicine as a social process. A physician can do as much harm to a patient with the slip of a word as with the slip of a knife. 

Instrumental And Expressive Components 

The patient-physician encounter crosses two dimensions:

• expressive
• performing diagnostic tests
• physical examinations
• prescribing treatments

What Are The Effects Of An Effective Patient-Physician Relationship?

What are the effects of an effective patient-physician relationship? When the PATIENT-PHYSICIAN RELATIONSHIP includes:

These factors can provide for PATIENT SATISFACTION WITH CARE which leads to better ADHERENCE TO TREATMENT.

What a fun call tonight! Thanks to everyone who participated either before or during the show.

We talked about different needs that patients have and some complaints they’ve expressed online .

A caller wanted to know if you should list your herbals or supplements when you fill out the list of "stuff" you’re on. She also wanted to know how to approach asking doctors about herbals when you hear that certain things are good for you.

We spent a fair amount of time talking about preventing prescription errors. I discussed Trisha Torrey’s recommendations from her website

Enjoy!

Here’s an interesting article that hinges around communication differences between men and women and the diagnosis of  complex pain conditions.

More Difficult For Doctors To Diagnose Complex Sources Of Pain In Women Than In Men

It is more difficult for doctors to diagnose complex sources of pain in women than in men and the reasons for this are rooted in language use. This finding, which is of major importance for both doctors and patients, is revealed by a now completed project by the FWF Austrian Science Fund. The results of this research into how the two genders typically describe pain are to be presented at the 2nd International Congress of Gender Medicine on 2nd and 3rd June in Vienna.

For quite some time, we have all known that men are from Mars and women from Venus, but scientific research has now proven that, when it comes to describing complex pain, men and women are worlds apart. This finding comes from studies that investigated patients suffering from complex headaches. While female patients give doctors brief and vague illustrations of their complaints, men describe their pain in an extremely concrete manner. This means that male patients are at an advantage when it comes to treatment as an accurate analysis of pain is essential for both diagnosis and therapy. 

{Terrie’s note - I do not necessarily agree with the statement that women give brief and vague illustrations of their complaints - or if they do, perhaps it’s for multiple, complex reasons - perhaps it’s perceptions of how the doctor is dealing with them or many other things…this statement is not well qualified to me and it gives women a bad "name" again}

LACK OF COMMUNICATION

A team headed by Prof. Florian Menz of the Department of Linguistics at the University of Vienna established that these different approaches to describing pain are caused by language barriers. Prof. Menz believes that "Women are rather vague and less detailed when portraying their pain, often focusing on the day-to-day situations in which the pain occurs. However, this does not constitute a description of pain in medical terms, as doctors develop a largely symptom-oriented language over the course of their careers. Men, on the other hand, describe their pain in very concrete terms focusing on their symptoms, which is very compatible with medical diagnostics and makes it easier for doctor and patient to understand one another."

{Terrie’s note - so maybe doctors need to be aware of this and change their approach to women?}

By investigating other patients suffering from chronic pain, the study showed that doctor-patient communication is also inadequate on other levels and leads to misunderstandings. While doctors are again primarily concerned with analysing pain when they speak to patients, the patients themselves ¬ who have lived with their pain for a number of years ¬ are more focused on treatment options for example. In such a scenario, doctor-patient discussions often fall short of patient expectations, as they are keen to be involved in the decision-making process.

This is very long but well worth the read (to me anyway). Although it’s about the mental health professionals, it could certainly be applied to any physician. Know anyone who fits this bill?

This article received a Thinking Blogger Award!

 This is my proposal for the DSM inclusion of a new section that outlines and categorizes the features of Mental Health Professional Personality Disorders or MHPPDs.

This proposal begins with a general definition of Mental Health Professional Personality Disorder that applies to each of the 4 specific MHPPDs. An MHPPD is an enduring pattern of inability to empathize with or understand the inner experience and behavior of certain patient populations that deviate markedly from the MHP’s own expectations, individual culture, life experience, values, and personal lifestyle preferences. MHPPD is pervasive, inflexible, prejudicial and has an onset upon reading educational psychiatric literature, engaging in disparaging prejudicial discussion with “more experienced” colleagues, may be triggered by reading a chart with which includes a previous undesirable diagnosis for a patient, is stable over time, and leads to further distress or impairment in the condition of the MHP’s patient. The Mental Health Professional Personality Disorders included in this proposal are listed below.

Mental Health Professional Paranoid Personality Disorder is a pattern of distrust and suspiciousness such that patients’ motives are interpreted as malevolent or manipulative.

Mental Health Professional Antisocial Personality Disorder is a pattern of disregard for and violation of the rights of patients.

Mental Health Professional Narcissistic Personality Disorder is a pattern of grandiosity, need for the compliance of one’s patients, and a lack of empathy for the experience or suffering of those patients.

Mental Health Professional Coercive Personality Disorder is a pattern of dominant and aggressive authoritarian behavior related to an excessive need to be in control of patient treatment decisions.

Mental Health Professional Personality Disorder Not Otherwise Specified is a category provided for two situations: 1) the MHP’s personality pattern meets the general criteria for an MHPPD and the traits of several different MHPPDs are present, but the criteria for any specific MHPPD are not met; or 2) the MHP’s personality pattern meets the general criteria for an MHPPD that is not included in the Classification (e.g., mental health professional passive-aggressive personality disorder). It should be noted that MHPs frequently present with co-occurring personality disorders.

More on Satire - But, Oh So True!

 Dr. Terrie Wurzbacher is a retired Naval Officer and an Emergency Physician. She spent 29 1/2 years in the Navy and devoted much of her time trying to teach interns and medical students the fine "art" of communicating with patients. She does NOT claim to be an expert in that field but knows that once she realized that she was not getting the point across to her patients and began to concentrate on ways to help them understand, she was way ahead of most of her peers. There are great doctors out there and some of that greatness is based on technical skill. However, the majority of the great doctors are great because they make the patient a big part of the entire gameplan. Dr. Wurzbacher has always aspired to be that kind of doctor. She knows she's not great but hopes that patients will help their own doctors get to "great".

Perhaps a more important qualification for authoring materials about doctor-patient communication is that she's been a patient herself. Although she is very fortunate to have had excellent health, she has had to visit the doctor for several things and has had a sampling of pretty poor physicians and also wonderful ones. So, she does have the "credentials" to talk about doctor-patient communication.