For patients with critical illnesses, interactions between doctors and patients need to be more value-adding to both the doctor and the patient. A more effective doctor-patient communication template can make a big difference to people like amma.
Do I have a template for such effective communications?
In the last two months while I was fine tuning this work, I read through hundreds of reports, articles and research papers on improving doctor-patient communications. Reading these only made me realize the intricacies involved in the vast world of healthcare.
Perhaps there’s no one doctor-patient communication template that will work for all scenarios, given the complex nature of health care systems, diverse diseases and vast differences in the types of healthcare beneficiaries.
But there will surely be a few fundamentals that will need to be a part of any template.
Some of the excellent literature and research I reviewed on this topic ranged from historical perspectives (way back starting with Hippocrates) to relatively recent insights from workshops, 194 to research focussing specifically on communications for old patients, 195 to a specific focus on communications for elderly patients with chronic diseases, 196 and many more. If I were to distil all the inputs I received from these research and studies into just a few takeaways for doctor-patient communications, it would be the following, especially for people like amma:
- Time commitment – Doctors should spend real quality time with patients or caretakers to understand both their symptoms as well as concerns.
- Science vs. art – Rather than depending almost solely on a biomedical approach (science), doctors should also give enough time and commitment to a human-centric (art) approach.
- Patient involvement and awareness creation – Doctors should involve and engage the patients and caretakers in key decisions – be they on surgery or medications – and ensure that the patients are well informed about the risks and benefits.
That was what the research said. If I were to independently put down my thoughts, based on my own experience, for patients such as amma with multiple critical ailments some of which are complex, any such template needs to be anchored around the following simple questions:
- Listening – Is the patient given enough opportunity to explain her symptoms, concerns and problems either during treatment or during follow up visits?
- Problems and symptoms post discharge – Does the patient/caretaker know what are the real problems he/she could face post discharge, and what could be the key symptoms to look out for?
- Medication benefits and side effects – Does the patient/caretaker have a good understanding of the benefits and side effects of each medication prescribed? There needs to be a significant emphasis on explaining the side effects to watch out for those medications with highly harmful side effects.
All the above need to be communicated orally and interactively. Having these inputs printed at a corner of a hospital discharge sheet or at the bottom of the prescription will not be effective enough.
If you thought the above three aspects would be currently fully taken care of in good hospitals, get ready to be surprised.
Only in a minority of our interactions had the doctors spent enough time listening to amma or me to understand the key symptoms and concerns we had. Most times, they arrive at a fairly quick inference on what the real problem is. Of course, in most cases they have amma’s medical history as well the extensive medical test results to support their inferences and diagnosis. This combination of very short interviews with the history and test results providing the rest of inputs actually works fine for most of the common or well understood ailments. But in cases where the patient is like amma, suffering from multiple ailments with some of them quite complex, and taking multiple medications, it can make a significant difference if the doctor spent enough time to listen to all the symptoms and complaints, and make it a detailed question-answer session.
I wish the doctors clearly spelled out the symptoms that are real red flags. In most cases, I had to specifically ask the doctor to spell out all the important symptoms I should look out for before rushing her to the hospital. This was especially important for her because I cannot rush her to the hospital every time she complains of a minor chest pain – which was pretty much every day in the last three years. It’s true that amma’s case was complex, but that’s why I need expert opinions. Even a Google search will tell me what symptoms to look out for if all she had was migraine.
Today, millions of patients with critical health conditions use multiple medications, each with its own benefit and risk profile. In my ten year experience with a dozen hospitals and over 25 doctors, only a few doctors actually even bothered to tell us the role or benefit of each prescribed medicine for amma. And no one had ever spelt out any critical side effects of any of the medications they prescribed. In amma’s case, I should have been specifically warned about the side effects of anticoagulants, especially their role in internal bleeding. This was actually mentioned in the hospital discharge summary, but I think something like this deserves to be communicated orally with a good emphasis. 197
What does it take to develop a doctor-patient communication system that does justice to all the three questions?
Doctors and hospitals can do far better than what they are doing right now, even with the existing infrastructure and resources.
When I think about this with my management consultant hat on, an additional time commitment required from doctors for each patient seems to be an optimal starting point for a significantly improved performance in doctor-patient communications.
197. For instance, a short note about the risks from anticoagulants was provided in the discharge summary from the cardiac hospital