Western medical care is facing a crisis. Doctors increasingly rely on diagnostic studies rather than the medical interview and physical examination. They are under pressure to complete administrative tasks, meet certification requirements, and manage electronic health records, which has strained the patient–doctor relationship. Compared to previous decades, clinicians now spend significantly less time communicating face-to-face during consultations – one-fifth of their time to be exact. This reduced interaction time hampers their ability to gather relevant information, understand the context of an illness, and address patient needs adequately. The result is frustration, a loss of fulfilment in their work, and potentially negative attitudes toward patients. Conversely, patients often feel dissatisfied due to unmet needs, diminished roles in the care relationship, and a lack of connection.
Improving patient–doctor communication, however, has been shown to enhance clinical outcomes and improve the experience for both patients and clinicians.
When clinicians prioritise patient understanding, they increase the likelihood that patients will follow their recommendations. Comprehension is key to enabling patients to make informed health decisions and is directly linked to better adherence to treatment plans and improved self-management.
Challenges in Patient-Doctor Communication
Although clinicians are often a patient’s primary source of medical information, patients also turn to friends, family, and the internet for health advice. This makes ensuring patient comprehension a complex task. Alongside listening respectfully, clinicians need to address three common barriers to understanding:
1. Misunderstanding of key words.
2. Difficulty envisioning tasks, processes, or anatomical structures.
3. Confusion around medical concepts.
Elucidating Explanations
Patients may misunderstand medical terms or phrases, especially when these words have different meanings in everyday language. Providing clear explanations, known as ‘elucidating explanations’, can help patients better understand these terms.
Here is an example:
• Patient scenario: A clinician suggests palliative care for a patient with congestive heart failure. The patient becomes distressed at hearing the term ‘palliative care’.
• Source of confusion: Patients often associate ‘palliative’ exclusively with end-of-life hospice care, equating it with giving up. They may not realise that palliative care aims to enhance quality of life for patients and families dealing with serious life-threatening illness.
• Elucidating explanation: ‘Palliative care is not hospice care or giving up. It’s a system designed to improve your quality of life while managing an illness that limits your abilities.’
Quasi-Scientific Explanations
Patients may find it difficult to understand how certain factors impact their health. To fully grasp their situation and make informed decisions, clear explanations are essential. Clinicians should use straightforward language and incorporate tools like diagrams or analogies to make complex concepts more accessible.
For instance, a patient experiencing difficulty breathing due to a pulmonary embolism might not immediately understand the connection between his/her symptoms and a blocked artery in the lung. Explaining this in simple terms is crucial. Additionally, clinicians can enhance understanding by using verbal or visual aids, such as figurative language, diagrams, or videos, to help patients visualise intricate structures, processes, or tasks.
Here is an example:
• Patient scenario: A patient logs consistently high blood pressure readings, even after being prescribed a new antihypertensive medication. He mentions taking readings during afternoon tea and while watching crime documentaries on television.
• Source of confusion: Patient may not understand that accurate blood pressure readings depend on factors such as posture, reduced caffeine intake, and a calm environment.
• Quasi-scientific explanation: ‘To get accurate blood pressure readings, follow these recommended steps. I’ll show you how.’ Here, the doctor could give a document (ex.: flyer) to remind the patient of the process.’
Transformative Explanations
Clinicians play a crucial role in clarifying medical concepts that patients may find confusing. People’s understanding of the world is shaped by their life experiences and observations, which lead to the development of knowledge schemas. These schemas help individuals interpret information and determine what they believe to be true. However, these frameworks can include folk theories or commonly held beliefs that may not align with medical realities. When patients encounter new or complex concepts that conflict with their existing knowledge schemas, they may struggle to act on the information.
For clinicians to address these gaps effectively, their explanations must first acknowledge the patient’s current understanding of the concept, including any merits it may have. They should then create a sense of dissatisfaction with the existing knowledge schema and offer an alternative explanation that makes sense within the context of the patient’s health. For instance, in a study involving 330 female smokers, researchers tested messages designed to promote smoking cessation for cervical cancer prevention. Women who received a message beginning with, “Most people find it hard to imagine how smoking can increase the risk of cervical cancer. If you smoke this is more likely to happen for two reasons…” were more likely to consider quitting smoking than those who did not receive a message acknowledging the unclear link between smoking and cervical cancer.
Here is an example:
• Patient scenario: A diabetic patient shares their pride in cutting out soda but mentions drinking apple and orange juice instead.
• Source of confusion: Patients may not realise that fruit juice, despite being made from fruit, contains concentrated sugars similar to soda.
• Transformative explanation: ‘Whole fruits and vegetables are beneficial as they provide important nutrients and fibre for your body. However, fruit juice condenses natural sugars so much that it’s closer to soda than eating a piece of fruit.’
Conclusion
Effective patient-doctor communication is arguably one of the most important “non-specific” effects in medicine. Understanding the processes underpinning communication is as crucial as understanding pharmacological processes. Shared understanding between clinicians and patients is vital for reaching agreement on both the nature of a problem and the most suitable treatment. The closer this alignment, the more likely patients are to follow recommendations and achieve better long-term outcomes.
Sources:
– Anderson L.N. & Ledford C.J.W. Improving Patient Comprehension Through Explanatory Communication. JAMA Published online November 20, 2024.
– Bishop A.J. et al. Increasing women’s intentions to stop smoking following an abnormal cervical smear test result. Prev Med. 2005;41(1):179-185.
– Drossman D.A. et al. A Review of the Evidence and Recommendations on Communication Skills and the Patient–Provider Relationship: A Rome Foundation Working Team Report. Gastroenterology 2021;161:1670–1688.
– McCabe R. & Healey P.G.T. Miscommunication in Doctor–Patient Communication. Topics in Cognitive Science 10 (2018) 409–424.