Communication breakdown

The implications of poor communication touch nearly every aspect of health care. The AMA has created a number of efforts aimed at improving doctor-patient communication.

Editorial. March 6, 2000.

The undoing of modern medicine's marvels is all too often a problem as ancient as human interaction itself -- poor communication.

A recent reminder of the sorry state of communication comes from research published in the Dec. 22/29, 1999, Journal of the American Medical Association. The authors analyzed more than 1,000 audiotaped patient-physician discussions, involving more than 3,500 clinical decisions. Fewer than 10% met the study's criteria for informed patient decision-making.

Resources for better communication

Earlier during 1999, JAMA published an AMA Council on Scientific Affairs' report detailing the widespread problem of patients' medical illiteracy. More than 40% of patients couldn't comprehend instructions to take medications on an empty stomach.

Whether the problem is doctors or patients -- research tells us it's both -- the implications of poor communication touch nearly every aspect of health care. It has obvious implications for history-taking and diagnosis and is one of several key factors in the pervasive problem of poor patient compliance. It also plays an important role in patient safety, medicine's latest high-profile concern.

It even touches public policy and patient advocacy: What good is talk about patient choice if patients don't know or understand what they're choosing?

Certainly, managed care has been a major negative factor in all this. It relentlessly squeezes patient-doctor time. It pushes patients out of the hospital sooner, forcing them and their families to take a much more active role in treatment and monitoring. Managed care contracts encourage shifting patients among doctors; patients aren't allowed to sustain a long-term relationship with the same physician.

Even if physicians haven't created all the mess -- most patients will claim the medical profession has done its share -- it largely remains medicine's challenge to lead the way in repairing this problem.

The AMA is providing help to improve communication. The research and analysis it publishes in its clinical journals expand knowledge on the issue. AMA advocacy efforts on behalf of patient's rights will help lessen the intrusion of managed care (including AMA's support for barring of gag clauses -- managed care's ultimate assault on doctor-patient communication).

The AMA Foundation, formerly the AMA Education and Research Foundation, recently announced it has received $400,000 in grants to work on improving patient literacy. It's the first project in the foundation's new focus on the patient-physician relationship.

The AMA also recently released a 106-page guide, Communicating With Your Patients. It covers the basics as well as special issues such as breaking bad news and dealing with difficult patients and substance-abusers.

The AMA has also put together a wide range of resources on cultural competency and the ability to communicate across barriers of language, customs and traditions. The 460-page AMA Cultural Competence Compendium is available free on the Web or can be ordered in book form.

It all adds up to a simple message: More needs to be done to improve communication between patient and doctor, and resources are available to help get the job done.

ADDITIONAL INFORMATION:

Resources for better communication

Communicating With Your Patients is available from the AMA ($27.95 members, $34.95 nonmembers). Call (800) 621-8335.

AMA's Cultural Competence Compendium is free off the AMA's Web site (no longer available). It can also be purchased in book form for ($39.95 members, $49.95 nonmembers) by calling the telephone number above.