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Communication Key to Good Health Care
- August 21, 2003
by Eileen Beal

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According to recent studies, including one that appeared this June in the on-line ethics journal of the American Medical Association, patient-physician communication during an office visit is crucial to getting good health care.

Good communication"or lack of said"affects adherence to treatment plans, patient satisfaction, and health outcomes. Good communication helps everyone get good health care, but it"s especially important for the elderly.

"They have a lot more going on medically [because] they are usually managing multiple chronic diseases and taking multiple medications," explained Dr. James Campbell, Chair of Family Practice and Geriatric Medicine for the MetroHeath System, "so they are getting a lot of content when they are talking to their doctor."

Despite the fact that doctors are giving "a lot of content," their elderly patients may not be getting a lot of information, however. This is usually due to one or more of the following: Poor hearing, inability to understand the medical terms the physician uses in his/her explanations, high anxiety due to the emotional strain of coping with a disease, diminished mental function, and/or depression.

"In a lot of cases"especially when anxiety levels are high"patients aren't hearing anything the physician is saying," said Karen Murray, Assistant Director of Nursing at the Cuyahoga County Department of Senior and Adult Services. One way seniors can address the information disconnect and the anxiety overload is to bring someone else along"a family member, a friend, a home health aide"to a doctor"s appointment.

Because there are usually many things that need to be discussed; because the patient"s medical and medication histories need to be reviewed and updated; because more than just the "medical perspective" needs to be addressed in the doctor"s office; and because it's more likely that two sets of ears will remember what was said during an office visit, "two heads are definitely better than one during an office visit," said Alberta Chokshi, Intake Administrator at Benjamin Rose.

"It"s always appropriate to bring another person to an office visit," said Dr. Campbell. "And they often want to come, too. All they are waiting for is to be asked."

Don"t assume that just because two people are present during an office visit that you"ll be guaranteed good patient-physician communication, however. "You have to be assertive," said Dr. Campbell.

To do that:

  • come to the appointment prepared with not only a health history and medication list, but also with a list of questions that have been jotted down "as you think of them at home" and "prioritized for discussion during the office visit"
  • communicate wants, wishes, and needs effectively by "giving information, not waiting to be asked" and "by being thorough and truthful"
  • request explanations and repeat information back to the physician "to make sure things are understood"
  • take notes or audio tape explanations during the visit to help you, and a second set of ears, remember what was said after the visit
  • have the doctor or nurse draw diagrams or write out difficult or complex information and/or instructions
  • request sources for additional information"specialists, disease-specific organizations, books and home medical guides, internet sites, support groups, etc."on issues discussed in the office
  • recognize when the patient-physician partnership isn"t working

"Personality differences and differences in communication styles can definitely lead to problems," said Chokshi. If the situation continues, "you may need to change doctors," she added.

Being assertive doesn"t end when you walk out of the doctor"s office. After the visit, review prescriptions for new medications with a pharmacist"to make sure there are no adverse drug interactions"and review notes, audio tape, and/or office handouts. If new medications or treatments were prescribed, pay attention to how you feel when using them and notify the doctor of any problems. And if the doctor recommended additional tests, seeing a specialist, or a follow-up visit, make appointments for them.

Sources and Resources:
Booklets:
America"s Senior Health Guide, University Hospitals UH Health Smart Senior Program
216-844-4700

Talking With Your Doctor: A guide for older people, National Institute on Aging
800-222-2225

Talking With Your Doctor, American Cancer Society
216-241-1177

Your Guide to Choosing Quality Health Care and The Pocket Guide to Good Health for Adults, both published by the Agency for Healthcare Research and Quality
800-358-9295

Web sites:
Communicating With Your Healthcare Provider
http://www.nlm.nih.gov/medlineplus/communicatingwithyourhealthcareprovider.html

How To Talk To Your Doctor (and get your doctor to talk to you)
http://www.houstonexceed.org/downloads/how_to_manual.pdf