Friday, September 5, 2008

How doctors talk: Improving physician-patient communication

The heart of medicine is the personal encounter: the coming together of physician and patient with the shared aim to relieve suffering and ideally heal the whole patient. But all too often the forces of modern medicine conspire against this ideal, narrowing the physician's role to that of expert on the body and leaving no room for a curious and compassionate connection, clear instruction, or even the extra second of attentive listening that might lead to a more informed diagnosis.

The resulting distress is felt on both sides of the stethoscope. Certainly it is experienced by the woman told by her oncologist "I think I can keep you alive for five years," and the man who is interrupted 18 seconds into his story about how he injured himself. But the physician also suffers when he avoids a terminally ill patient out of awkwardness or guilt, or misses a life-saving window because he downplayed the results of an ambiguous pathology report.

Every practitioner carries his or her own anthology of stories, says David Browning, Senior Scholar at the Institute for Professionalism and Ethical Practice (IPEP) at Children's Hospital Boston and Harvard Medical School, which operates the Program to Enhance Relational and Communication Skills (PERCS). He adds that practitioners also carry within them an understanding of how to communicate and respond with empathy – that knowledge just gets lost in the time constraints and financial pressures of contemporary practice and education. As a result, while physicians may feel capable of managing a range of physical ailments, many feel less equipped to handle their patients' emotions.

Whether it's the need to tell someone he has a terminal disease, disclose a treatment error, explain the details of an unexpected condition, or simply take a thorough history during a routine physical exam, evidence shows that effective and empathic communication not only alleviates suffering, but it plays a role in the quality of care.

More ...

http://www.hmiworld.org/hmi/issues/sept-oct07/forum.php