by Danielle Ofri, M.D. , an associate professor of medicine at the New York University School of Medicine and staff physician at New York’s Bellevue Hospital . The book is published by Beacon Press
“What patients say and what doctors hear can be two very dissimilar things. The reverse is also quite true: what doctors say and what patients hear can be radically different.”
“For all of the sophisticated diagnostic tools of modern medicine, the conversation between doctor and patient remains the primary diagnostic tool. Even in fields that are visual (dermatology) or procedural(surgery), the patient’s verbal description of the problem and the doctor’s questions about it are critical to an accurate diagnosis.”
I am so convinced of the truth of these two statements, that I have written several blog posts about physician-patient communication. So when I learned of a book that delves into this subject in detail, I knew I needed to read it; I was not disappointed.
As a physician, this was not an easy book to read; Dr. Ofri does not hesitate to tell us physicians what we need to do better in our communication with our patients.
But she also makes it plain to patients that you have a role and a vested stake in communicating your concerns, questions, and even grievances to the physicians who care for you; that without such information, your physicians cannot provide optimal diagnosis and treatment for you.
Dr. Ofri bases her conclusions on her own encounters with patients over 20+ years of practice, interviews with other doctors and patients, and published research on communication. In her book she explains
- How the uniqueness and complexity of the physician-patient relationship impacts their communication
- Why patients’ less satisfactory encounters with the medical system are often due to poor communication, rather than lack of caring and competence, but can lead to lawsuits
- Why patients’ unfamiliarity of medical terms can hinder communication , and how differences in use of words between doctors and patients, and even between doctors can lead to misunderstanding
For example, Dr. Ofri relates an incident when she was still a medical student working in the hospital and came across the term “expired” to refer to a patient who had died. She had never heard the word used this way. Then years later, when she was an attending physician, she was confused when an intern from a southern state reported to her that a patient had passed during the previous night. Passed what?, she thought. In some areas of our country, “passed” is commonly used to mean someone has died, but Dr. Ofri had never heard this.
Dr. Ofri discusses the placebo effect of medicines and treatments, and how expectations affect response to treatment. (The placebo effect means responding to a treatment that contains no active medical substance. Interestingly, placebo treatments “work”.)
She details the many reasons patients have difficulty adhering to doctors’ recommended treatment plans, such as cost, inconvenience, distance, and other factors unrelated to not understanding the seriousness of their condition, as one might suppose.
I was intrigued by the story of a hospital in The Netherlands which hired a woman to be the “Chief Listening Officer.” Her only duty was to listen to patients talk about their complaints or grievances about their care, not to fix or solve problems, but just to listen. And it was successful; once patients felt they had been heard, they had no desire to pursue legal action and felt more satisfied with their care.
She also relates a program called Sorry Works!, a way to handle medical errors with mediation rather than lawsuits, also a successful program.
What Patients Say, What Doctors Hear helps patients understand the complexity of what physicians do in our encounters with patients and how that impacts our subsequent decision making and treatment decisions.
This book illustrates there are multiple detailed steps between
- A patient’s problem and the best solution
- The patient’s and family’s questions and the correct answers
- The final (or sometimes current) diagnosis and the definitive, best available ,or least toxic treatment.
“The biggest take-home message…is that both doctors and patients need to give communication its just due. Rather than ..the utilitarian humdrum of a visit, the conversation should be viewed as the single most important tool of medical care…a highly sophisticated technology.
The mere act of both parties taking this conversation more seriously will enhance communication and improve medical care. …effective communication needn’t take a long time, it just needs full and intense focus…and can yield an abundance of information.”
In this previous blog post I offer suggestions on physician-patient communication based on my years in practice:
You know it’s important to tell us details of your symptoms, medical history, family history, habits, and other medical facts. But besides medical information about you , we need to know