A poll this past summer by SERMO, a global social network exclusively for physicians, found only 10% of doctors reporting that patients â€œfrequentlyâ€ arrive at an accurate diagnosis after researching their condition online.
A poll this past summer by SERMO, a global social network exclusively for physicians, found only 10% of doctors reporting that patients “frequently” arrive at an accurate diagnosis after researching their condition online.
In other words, lots of misdiagnoses on the part of patients before they even enter the exam room.
That disconnect is a challenge for physicians.
“Doctors really want their patients to understand,” says Bernard Bandman, PhD, executive director for the Vermont-based Center for Communication in Medicine. “They want them to have a sense of what their options are, and what those options means in terms of care.”
But often what patients and their loved ones hear is not what the doctor is intending them to hear.
Bridging the gap
Bandman explains that to many patients, doctors are speaking a foreign language. As a result, patients often leave the office after receiving a diagnosis, or a treatment plan, that they don’t fully understand.
“That doesn’t serve the doctor well,” Bandman says. “And it doesn’t serve patients well because they walk away, more often than not, confused.
The Center for Communication in Medicine has been working to bridge that communication gap. The Center’s SpeakSooner initiative, and Difficult Conversations Toolkit, which includes a video and workbook, was developed to help educate and prepare patients to identify their questions, concerns, and be able to make informed decisions.
“That takes the mind reading out of the equation for doctors and invites open and honest communication,” Bandman says.
The Toolkit takes what other patients have experienced beforehand and allows others to think about it, identify what they’re concerns are. So when they walk through the door, not only is it helpful in terms of the patients feeling like they’re clear about some of the questions they’d like to ask, it also helps the physician understand what the patient is ready to hear.
“It really takes that pressure off,” Bandman says.
Hearing the truth
How much information is too much information? Bandman says that some patients want to know more, while some want to know less.
“And who’s going to let the doctor know that other than the patients themselves?” Bandman asks, rhetorically.
Does that mean that physicians sometimes don’t give patients enough credit for already knowing, or being ready to hear the truth?
“I think that’s true,” Bandman says. “And it’s been verified in some studies that patients do want to know the truth. But sometimes patients do their homework in the wrong places, and physicians need to be able to try and correct that information.”
Bandman says that some health-related information on the Web can be “absolutely dangerous,” or at the very least, misleading.
“We hope we’re guiding them in a constructive direction,” he says.
Bandman says that in the ideal scenario, physicians invite their patients to use the Toolkit.
“Because what they’re really saying is, ‘I’m encouraging you to come to me and talk about whatever your concerns and questions are,’” he explains. “When patients come for an exam and they say, ‘I’m really ready to talk about difficult subjects,’ it’s a relief to the doctor.”
The Center also offers community education programs across Vermont that focus on the SpeakSooner principles. The message to patients is that it's up to them to sit down with their doctors and open up these conversations.
But physicians, often in grand rounds style, are being oriented to the SpeakSooner principles. The Toolkit video, showing cancer patients talking about their conditions, is used as a trigger, where physicians are then asked, “How would you approach this topic with your patients?”
“Although they use the word all the time, it’s much more uncomfortable for physicians, especially when you’re talking about illnesses that are life-threatening,” Bandman says. “I think it’s helping physicians get more comfortable with uncomfortable subjects.”
Bandman says the result of SpeakSooner principles is a much more efficient and effective use of the time physicians and patients spend together.
“When patients better understand what their treatment options are, the system is not spending a great deal of money on very aggressive treatments, and people are not ending up in emergency rooms and intensive care units,” Bandman says. “It’s being shown more and more in the literature that with effective communication, healthcare costs are lowered.”
That shows up in office visits with greater efficiencies.
“When patients are much more prepared to open these conversations and build relationships with their physician, they end up having conversations that, more often than not, lead to choices that are not aggressive in terms of treatment,” Bandman says. “And aggressive means costly.”