What Patients Say, What Doctors Hear- a book review

What Patients Say, What Doctors Hear

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.”

What Patients Say, What Doctors Hear- a book cover

written by Danielle Ofri, M.D.

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.

doctor talking to a woman

photo compliments American Academy of Family Physicians

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.

woman-sitting-in-front-of-a-tree-in-a-cemetery-grieving

photo from Lightstock.com, affiliate link

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.

Dr. Aletha talking to a mother and her son

Talking to a patient through an interpreter makes communication extra challenging. (photo from a volunteer medical trip to Ecuador)

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:

Do you know the best questions to ask about your healthcare?

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

Your expectations about your care,

Your concerns about your care,

Your obstacles to getting care,

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March- Match Day, Madness and More

Remember it’s Spring forward and Fall back to Daylight Saving Time

Most of the United States will change to Daylight Saving Time on Sunday March 10.2019.

So you will either be going to bed an hour later than usual, or awakening an hour earlier.

Either way, your body will tell the difference until your sleep cycle adjusts; I know mine always does.  WebMD offers these tips to make the change easier.

St. Patrick’s Day

Of course you know that March 17 is St. Patrick’s Day. Here is my previous post about one of my favorite places, Chicago, Illinois, where they dye the river green  to celebrate. 

The Chicago River is green on St. Patrick's Day
photo by Ryan Oglesby

Welcome Spring.

We will welcome the  first day of Spring, March 20,  in the northern hemisphere, with the occurrence of the vernal equinox.

This link to The Weather Channel explains what the vernal equinox means.

graphic of the earth explaining equinox and solstice
original source not known

 

Match Day

March 16 is Match Day. No, not the kind of match you light fires with.

It’s the day graduating medical students find out what residency program they will join through the National Resident Matching Program , which “matches” them with available positions in residencies all over the United States.

Why should you care? This matching process determines who will care for our medical needs in the next 30-40 years; our family physicians, internists, pediatricians, general surgeons, obstetricians, dermatologists, psychiatrists, and the multitude of other medical specialties. Most doctors will continue in the same specialty their entire career, although some  switch after a few or many years.

 

 

National Doctor’s Day

March 30 has been designated National Doctor’s Day in the United States. You may not have heard of  a day to honor doctors.

March 30 is Doctors' Day

The first Doctors’ Day observance was March 30, 1933, in Winder, Georgia. The idea came from a doctor’s wife, Eudora Brown Almond,  and the date was the anniversary of the first use of general anesthetic in surgery.

The Barrow County (Georgia) Medical Society Auxiliary proclaimed the day “Doctors’ Day,” which was celebrated by mailing cards to physicians and their wives and by placing flowers on the graves of deceased doctors.

In 1990, the U.S. Congress established a National Doctors’ Day first celebrated on March 30, 1991.

Of course, the most important physician for you to know is your own personal physician.

Learn how to choose a doctor and how to establish a good working relationship in this article by Dr. Danielle Ofri, author of

A Doctor’s Guide to a Good Appointment

 

 

Madness

And yes sports fans, I am aware that the NCAA Men’s Basketball tournament, aka March Madness, starts in March. Like many of you, I will be following my favorite regional teams. Good luck everyone.

 

basketfall goal
I wonder how many college basketball players started at one of these?

 

I invite you to follow Watercress Words as we explore spring and summer health challenges and opportunities. Don’t forget to share with your friends.

 

 

                              Dr. Aletha