Just Listen: Teaching Doctors to Pay Attention

“There is a bias in medicine against talking to people,” a frustrated health care provider tells the Washington Post. Or, as a recent story in the Wall Street Journal put it, “Doctors are rude. Doctors don’t listen. Doctors have no time. Doctors don’t explain things in terms patients can understand.”

And then there’s the poignant explanation that a 78-year-old Medicare patient tells the Post: “In a doctor’s office, a lot of people, especially older people, feel pressure to get out because they know the doctor is busy and they’re a bit intimidated.”

Studies show that 40 to 80 percent of the medical information given to patients is forgotten almost immediately, and up to half is remembered incorrectly. So how can communication be improved? The two newspapers focused on very different strategies.

Laura Landro in the Wall Street Journal explains that this difficulty communicating is not only frustrating for patients; it hurts the bottom line: Health care costs go up, and so does the risk of lawsuits from misdiagnoses or preventable complications. Plus, under new Medicare rules, providers won’t get as much money if they rack up poor patient-satisfaction scores or too many preventable readmissions.

So medical schools, hospitals and malpractice insurers are setting up programs to improve doctors’ bedside manner, the Journal reports. This includes teaching them to explain things more clearly and “putting doctors through role-play sessions with actors to teach basics like always facing the patient, letting [patients] speak uninterrupted for two minutes and using key words to show compassion and empathy”  - like “I am so sorry you are in pain.”

Ezra Klein, in his Wonkblog for the Washington Post, writes about a very different solution: A small Pennsylvania program called Health Quality Partners has nurses pay regular home visits to Medicare patients who have a chronic disease or have been hospitalized.

These patients, including the 78-year-old man who felt intimidated in his doctor’s office, told Klein that the nurse helped them understand the physician’s orders and didn’t make them “feel like they were being a burden if they needed to ask one more thing, or have their medications explained to them again.”

This both helped patients stay healthier and paid off financially for Medicare. The program reduced hospitalizations by 33 percent and cut Medicare costs by 22 percent – although Klein writes that despite this success, Medicare is still planning on ending the pilot program’s funding in June.

Maybe doctors (and other health care providers) could try a simple technique to help their patients: the teach-back or show-me method. After hearing their physician’s instructions, patients are asked to repeat back what they’ve been told. If they can’t, the doctor then knows to further explain or simplify the instructions, or write them down for the patient.

When doctors at University of California San Francisco Medical Center tried this in 2011, hospital readmissions among heart patients over age 65 were reduced by 30 percent.

 

Photo: Alex E. Proimos /flickr