The People's Perspective on Medicine

Show 1088: How Good Communication Makes Health Care Better

Dr. Danielle Ofri suggests ways to improve doctor-patient communication. She is the author of What Patients Say, What Doctors Hear.
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How Good Communication Makes Health Care Better

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When your doctor speaks, do you understand what you are hearing? Do you know how to describe your health problem so your doctor will “get it”?

Why Communication Is Critical:

Communication between doctors and patients is at the heart of health care. It is essential for accurate diagnosis, and crucial for patients to understand the treatment being offered so they can follow it. Doctors may need to listen especially carefully to learn the reasons that a patient decided not to follow through.

The Value of Clear Communication:

Despite time pressure, careful communication can help reduce medical errors. Even when errors occur, honest explanations and apologies reduce the likelihood of malpractice suits.

How can you learn to communicate your questions and concerns more clearly? Dr. Danielle Ofri offers advice.

This Week’s Guest:

Danielle Ofri, MD, PhD, is a physician at Bellevue Hospital, the oldest public hospital in the country, and associate professor of medicine at NYU. She writes about medicine and the doctor-patient connection for the New York Times, and other publications.

Dr. Ofri is co-founder and Editor-in-Chief of the Bellevue Literary Review, the first literary journal to arise from a medical setting. She is the author of a collection of books about the world of medicine. Dr. Ofri’s most recent book is What Patients Say, What Doctors Hear. You can sign up to receive her monthly newsletter about medicine and the doctor-patient connection at DanielleOfri.com

Listen to the Podcast:

The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free. CDs may be purchased at any time after broadcast for $9.99.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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Re the patient not going to urgent care as suggested. Our local urgent care services refuse patients with heart issues. They even have it written in their patient info.

Great show. Just this past weekend, I went to a clinic thinking I had lyme disease. they gave me a “preventative” one time, double dose of antibiotics and bactroban for my rash. The next day I felt worse, so I went to the ED. The doctor there saw a red streak going up my leg and instead of giving me the usual 3 week dose of the antibiotic, they were giving me an IV antibiotic and asking me to come in at 8 hour intervals for more. At the next visit for the second dose, the doctor had a student to whom he explained why they treated so aggressively (something about the infection possibly going up to a heart valve). It was news to me because they hadn’t bothered to explain it to me before. It was nice to know what the excitement was all about.

I had a doctor who was intelligent and I respected him a lot. But during my appointments he tapped away on his laptop and seldom looked at me while I spoke. At one point I asked if he was listening to what I was saying. He seemed very offended and soon after ended the appointment. I never went back.

As a patient battling an intricate chronic pain case, I really connected with the significance of this episode. I am a 23 year old female with debilitating widespread internal & external chronic abdominal pain, accompanied by upper GI complications. I’ve also needed a cholecystectomy and parathyroidectomy. It all began about 5 years ago, and I have been seen by over 40 doctors. So, as expected, I have experienced the full spectrum of doctor-patient communication. 

One unexpected challenge I faced was thoroughly communicating the severity of my symptoms. My condition was not debilitating for the first few years, and I have an extremely high pain tolerance level. As the patient, I did not do a good enough job communicating how much pain I was experiencing (despite the endless normal imaging/labs/scopes/tests). Until I lost over 30 pounds that I couldn’t spare, and was wheelchair-bound, most doctors could not grasp the severity of my situation. Patients walk a fine line between accurately depicting their symptoms and over-exaggerating. Precise symptom severity representation is key to good doctor-patient communication. 

Another challenge was learning how to most concisely (yet accurately) describe my symptoms to a new doctor. As mentioned in the episode, it is very important to let the doctor do their inquiries and exams to fully grasp the situation. But, the patient has the responsibility to best communicate their symptoms thoroughly yet in a timely manner. When I am able to methodically go through my spiel in about 2 minutes or under, more times than not we have great doctor-patient communication for the remainder of the appointment.

Final note: if you are a patient seeing many different specialists, the best way to ensure efficient and good communication is to only see specialists within one network. Most network systems of doctors have an online platform of doctor-to-patient and doctor-to-doctor communication. For example, all specialists within the Mayo Clinic system can easily share patient history, notes, labs, etc. This is an easy way to save time for everyone, and induce better doctor-patient communication.   

I just listened to your show. While your guest makes some very good points, I was disappointed that she did not suggest something that I have found to be very effective since my mother and I have been dealing with doctors, particularly specialists (in my case, neurologist). I am referring to a written record.

I have found that if a patient keeps diary or calendar of when various physical events happen (in my case seizures) occur, side effects, what food was eaten, what activities being done before, and after the event, it is much easier to define the triggers, and isolate the problem. It is also something that cuts down on arguments. Doctors demand physical proof, so give it to them. It also puts the doctor and patient on more of a partnership relationship and holds the doctor and patient more accountable.

This probably would have been of assistance to the patient who was taking the blood pressure medication that caused his severe. As I recall, you said that the patient said he was switching doctors. Well, if the doctor had suggested this, he would have likely seen the manifestation of side effects and their problems that did not exist. As a result, the patient may have experienced fewer problems, and the doctor may not have lost a patient. As a volunteer patient advocate for people with epilepsy, and someone who volunteers with organizations that aid children autism, I always suggest keeping such calendars and diaries.

No, it was not a doctor who suggested this method. It was my mother. When I was five years old (I am now fifty) my mother was sick and tired of doctors telling her that she was exaggerating, or not telling them everything. So, she kept a calendar and diary for my seizures, medication, side effects, what I was doing before and after, etc. In college, I used the same method, and my doctor figured out that my seizures occurred always about the time of mid-terms. We identified the problems as sleep deprivation. The same with medication side effects.

I do also want to address the problem of doctors actually looking at their records prior to an appointment. Again, I will use myself as an example. When I was about four I had childhood accident that left the pupil in one of my eyes permanently dilated. So, when I see a new doctor, and he looks into my eye with that pen light, he notices it and asks me if I do drugs. When I explain why my eye pupil is like that he says he did not notice that in my records. My reply has always been, “If you would look on the inside cover where it says Birthmarks, scars, childhood injuries, which is located right beneath that paper that tells you how much my deductible is, you would have known this!” He looks and is embarrassed that I called him on his lack of attention.

I suffer from adverse effects of a fluoroquinolone antibiotic (levaquin), which appear to be permanent after 5 years. (Tremors, chronic tendon and muscle issues, peripheral neuropathy, tinnitus, chronic insomnia, multiple myalgias, gastrointestinal issues). I had an excellent PCP who recognized the issues right away, but subsequent specialists (and now, new PCPs since I have moved to a new state) are skeptical, even though the FDA has acknowledged that some people DO suffer long term and potentially adverse reactions that cross multiple organ systems, and the damage I suffer from is listed in the prescribing information for the drugs.

What bothers me the most is that so many doctors seem to be under the impression that the designation of an adverse reaction as “rare” means that it doesn’t actually exist. Even though the first adverse effects in my case began within 4 hours of the first pill (the tremors, audial hallucinations, peripheral neuropathy) and the tendon, muscle and joint issues began within 8 days ( while the known delayed reactions for musculoskeletal issues may be months and even a year or more), I am constantly told by doctors that “these antibiotics cannot possibly cause these issues”.

I see doctors ignoring the prescribing alerts through the new electronic records system. I no longer trust the medical profession. I still see doctors as necessary for acute issues, but I do my own research as well, and I will make my own decisions as to the risk/benefits of any potential treatment. I appreciated this show today, as it was acknowledged that the priorities/values of the patient may not be that of the doctor. But doctors need to respect the patient. If I choose to refuse a pharmaceutical medication because to me, the risks outweigh the benefits, the doctor needs to respect that, not berate me for “not following orders”.

I am an elderly patient, and I know I am going to die at some point. (We ALL are–and we cannot any of us predict exactly when or why that will occur). My priority is not an extension of life. It is experiencing life as comfortably and enjoyably as I can. I have yet to meet a doctor who doesn’t have the priority of extending my life as long as possible, with no regard to the actual quality of it because their idea of “quality” is not the same as mine, and because they are going to be judged by whether they prolonged my life or not. In this, it is both the doctors and the inurance industry that are to blame.

We MUST find a way to change the current practice of medicine away from “standardization” and expected outcomes back to the initial standards of medical care- a partnership between doctor and patient that provides respect for the patient as the primary expectation.

Enjoyed your letter, your thoroughness, and your last comment to the Dr!

At end Dr. said that conversation take the most time during visit – but she said 1 min to listen earlier in show.

How can someone spend really 20 minutes explaining pain?

She said Dr. needs to multi-task b/c time – how about allowing another minute to apptm. instead.

Could not the patient with heart problem has been ok had he gone to urgent care as Dr. kept suggesting?

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