Communication is a two-way street
While patients need to express concerns and ask questions, doctors need to practice what Moira Stewart, M.D., director of the Center for Studies in Family Medicine at the University of Western Ontario, refers to as "patient-centered communication" — that is, pay attention not only to the condition but also to the patient's experience of the condition. Her research shows that when this type of exchange takes place, the patient has fewer diagnostic tests and referrals, and improved health.
A "cascade of consequences" occurs when communication breaks down, Stewart says. For one thing, recovery is slower. "Patients with an acute condition should get better in six weeks — but they don't," she says. They are less likely to follow their medication instructions and are more likely to undergo unnecessary tests and to be readmitted to the hospital.
Readmissions are hard on the patient, but they also inflate the financial burden on the health care system. A study in the New England Journal of Medicine found that one in five Medicare patients is readmitted to the hospital within a month of discharge. The reason: They are not told clearly how to take care of themselves at home. Researchers estimated that the cost of these unplanned return visits was $17.4 billion in 2004.
In another study published last July in the Annals of Emergency Medicine, Kirsten Engel, M.D., an emergency medicine physician at Northwestern University's Feinberg School of Medicine, and her colleagues looked at patients' understanding in four areas: diagnosis, treatment in the ER, instructions for at-home care, and hospital discharge instructions. "We found that 78 percent of the 140 patients questioned did not understand instructions for their care after leaving the emergency room," Engel says.
Further, Engel says, "Only 20 percent recognized that they had difficulties understanding information given to them." So if a patient doesn't know what he or she doesn't know, where do we go from here?
"Having a meaningful conversation with a health care provider is a skill that needs to be developed," says Nancy Whitelaw, director of the Center for Healthy Aging at the National Council on Aging. "There are accessible, convenient community-based programs that give people the confidence to have conversations with their providers."
Developing that skill may mean the difference between life and death. "We learn it's not polite to argue," says retired ship captain Carpenter. "But you have to take charge of your own health. You pay a price for passivity."
How to Ask Good Questions
At the doctor’s office:
Experts suggest that patients go to an appointment with a set of questions or perhaps even an e-mail, or fax the doctor ahead of time. "If you have a lot of questions, call the office to say that you may need a little more time," says Gloria Lopez-Cordle, author of The Personal Medical Journal.
- Ask whether your doctor has washed his or her hands before starting to examine you.
- Ask your doctor to draw pictures if it might help you understand.
- Ask for written instructions.
- Ask for permission to bring a tape recorder to help you remember instructions.
Questions to ask about meds:
- How will this new medicine help me?
- What is the prescription? Does it have a brand or generic name?
- What is the dosage?
- What are the side effects? If I have a bad reaction or worrisome side effects, whom should I call, and when?
- Are there any foods or drinks I should avoid while taking it?
- Can I take this medicine with any allergies I may have?
- Is it safe to take the medicine with other vitamins, herbs or supplements I take?