Asking the right questions just might save your life. It's a message that can’t be repeated often enough. Study after study has shown that good communication and patient safety are inexorably linked. When communication with health care providers fails, patients are less likely to follow medication instructions, are subjected to more diagnostic tests and are more likely to have to return to the doctor's office, the hospital or the emergency room. And billions of dollars are added every year to the nation's health care costs.
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.