Learning From Both Ends of The Stethoscope

A systematic review of studies published over the past four decades has confirmed that good doctor-patient communication makes a difference not only in patient satisfaction but in patient outcomes including resolution of chronic headaches, changes in emotional states, lower blood sugar values in diabetics, improved blood pressure readings in hypertensives, and other important health indicators.

The review, published by researchers from the Indiana University School of Medicine and the Regenstrief Institute, Inc. and colleagues from the US Centers for Disease Control and Emory University, appears in the April 2007 issue of Medical Care, a journal of the American Public Health Association.

“In looking at these 36 studies we learned many things. For example, research on non-adherence to doctor’s instructions has focused on bad or poor behavior by patients rather than on the clarity of the physician’s instructions or whether the physician actually checked to see if his or her instructions were understood by the patient. The physician assumed that the patient understands and thus will comply. But is this a logical assumption? We don’t assume that when a pilot and an air traffic controller converse that they have understood each until there is an affirmation of understanding. That acknowledgement is lacking in most patient-physician encounters,” says Richard Frankel, IU School of Medicine professor of medicine and Regenstrief Institute research scientist, senior author of the study.

Frankel is a sociologist who studies ways to improve the doctor-patient relationship. He is currently investigating how behavioral changes by both doctors and patients impact medical care.

“From previous work, including a well regarded 1999 study from the University of Washington, we know that doctors ask patients whether they understand what was discussed during a medical appointment only about 1.5 percent of the time,” Frankel says. “It is extremely important that a patient be given the opportunity and probably even encouraged to ask questions. Doctors should be trained to routinely check for understanding to ensure that there is neither miscommunication nor mismatch between what the patient wants and what doctors assume the patient wants.”

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