Challenge #1 For Health Care Providers – Way Too Much Information And Way Too Little Communication With Patients

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One of the biggest problems with health care today is that there is way too much information and way too little communications going on between providers and patients.

Here’s a great quote that explains what I mean:

The two words information and communication are often used interchangeably, but they signify quite different things. Information is giving out; communication is getting through.

Sydney Harris,  Journalist

FailuretoCommunicateI was reminded of this and the quote from “Cool Hand Luke” quote in an exchange I had with a primary care physician on LinkedIn recently.   In that exchange, which dealt with long-term physician-patient relationships, I hypothesized that intentional non-adherence may be the by-product of situations in which physicians and patients in long-term relationships simply grow to distrust each other.

The good doctor commented as follows:

In the end, it is the patient’s decision to be compliant or not, yet many physicians continue to care for these patients because someone must. Would the patient comply better with a new doctor? I doubt it.

I replied to the good doctor’s comment as follows:

True…the decision to comply or not is up to patients.  But the evidence shows that compliance is not a product simply of bad patient behavior. Non-compliance is an outcome for which both physician and patient have shared responsibility.

I suggest that most people would be a lot more likely to comply if they: 1) understood and agreed with the need for the prescription and 2) believed that the benefits of taking the medication outweighed the risks and concerns. But these issues are seldom brought up by the physician or the patient, due to limited time, provider attitudes and beliefs about patient, and so on.”

Then he dropped the A-bomb – a move intended to silence anyone who would dare challenge physician authority and learnedness:

A professional who deals with this on a daily basis can explain meds, conditions, etc. very quickly and to the satisfaction of the patient.

That’s when it occurred to me…too much information and not enough communication

No doubt most providers today are proficient at quickly giving information to patients (including telling them what to do).  What most providers (and people in general) are not good at is effectively communicating, e.g.,  getting through, with patients (or each other).   Anyone who has ever been married knows the difference between information giving and communicating.

And how would the good doctor know that his patients understood the information he gave them…not to mention their being satisfied with it?   Surely he’s not banking his revenue going forward under P4P on his patient satisfaction surveys alone.

If anything, the weight of evidence suggests that his patients probably do not understand the information he quick doles out and probably are not particularly  satisfied with it.   Like many of us, his patients probably do not want to confront the good doctor choosing instead to ignore his recommendations or seek advice elsewhere, e.g., no-adherence.

But as with any good relationship, effective spouse-centered (I mean patient-centered) communications is key.   To truly engage the other party, you have to know where they are coming from, what’s important to them and never, never ask them to do more than they are willing and able to do.  I had to say that since my wife “proof reads” my blog posts…lol).

That’s what I think…what’s your opinion?

7 Comments

  1. Kathy Torpie says:

    I am often surprised, when I read about “patient engagement”, that it almost always refers to methods of providing information and almost never refers to actually “engaging” with the patient – which requires establishing a relationship with the patient.

    • Kathy,

      Thanks for sharing your thoughts. You are absolutely right about a strong physician-patient relationship being a prerequisite to patient engagement. Physicians nor any other provider can initiate engagement absent a patient that 1) is already engaged or involved in their health and 2) trusts and respects the provider and what they have to say. The provider’s real job is to facilitate and increase the level of engagement which brought the patient to the physician in the first place. Too often…the provider inadvertently throws cold water on the patient’s motivations (by the way they interact with the patient) which can result in disengagement.

      Steve Wilkins

  2. Karen S says:

    Physicians cannot expect patients to comply with medical advice if they don’t provide a reason why it is necessary. We learned as children to ask why, and our need to understand medical issues doesn’t diminish as we grow older. We simply become embarrassed to ask “why” and may walk away from a visit with the question unspoken. Even so, physicians should provide a rationale each and every time if patients are to take actions that (1) cost them money (they often can’t afford), (2) are outside their normal routine, (3) may make them feel worse before they feel better, (4) are counter-intuitive because they have no immediate consequences, and (5) may not address the reason they made the visit in the first place. Just as physicians are detectives when determining the cause of the patient’s complaints, they must also be detectives when considering a patient’s motivation. Good rapport in the physician-patient relationship can go a long way in allowing this to happen in a short period of time.

  3. What is compliance? Can we imagine being ‘ compliant’ with the patient’s goals for their life and health care? We are asking them to be ‘ compliant’ with us.
    By ” compliance” we are really asking patients to make a CHANGE in their routine, in their understanding of their health ( now I have to take pills – if we are talking about meds ). Change does not happen in one step. We know the data on behavior change.. it happens in steps – including thinking about something.. even visualizing it, .
    We can apply this science by expecting a process of change – or compliance – and asking questions appropriate to the stage of change a patient might be in. First is why they are ready to make a change in the first place: We want their BP down.. What do they want? To live long enough to see their grandkid graduate? . Not to have a stroke? To keep playing golf? If we know that, maybe relating the reduced BP to that goal would help them understand their choices.
    Start with their goal.. give them specific data on how likely the reduced BP is to help them reach that goal.. and then start with readiness.
    ” Given your goals and the improvement in your risks with lower BP, are you OK enough with the idea of another pill for your BP to try it.? You are unlikely to get the side effects that you have heard about.”
    It may take several visits to get on the same page with a patient.

    • si says:

      I think you are spot-on about change and compliance. On the other hand, I know people who do not understand, really, what their physician is talking about, and thus take one of two tacks: one, dismiss the MDs recommendations or instructions as “just more from those pill-pushers” or two, “I don’t know why, the doctor said so…”

  4. [...] Too much Information; too little communications. A corollary cousin to the item above, Mind the Gap blogger Stephen Wilkins brought the “too much/too little” idea home to us recently in his post: Challenge #1 For Health Care Providers. [Recommended reading here.] [...]

  5. Nancy Riffle says:

    I was struck by your admonition to “never ask the patient to do more than they are willing and able to do”. As a nurse practitioner I firmly believe that. However, it is not always clear to me how much a patient is willing to do. They may nod or acquiesce but later return not having filled a prescription or followed up.

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