“90 percent of my job is education, and I have no training for that. What I learned in medical school only counts for a fraction of what I’m actually doing every day.” Talking to patients, encouraging patients, getting them on board with the task of improving their health is all about cajoling, persuasion, and lots and lots of education. And that’s a daunting thing.
Thomas Goetz highlights an ongoing issue in health care: patients and their doctors are not always on the same page and the resulting miscommunication is frustrating for all.
The quality of communication has significant impact on important outcomes. For the most part people really do want to live long and prosper and very very few simply don't care that a medical condition or lack of appropriate prevention reduces the likelihood of achieving that desire.
Diabetic patients with depression are much less likely to manage their diabetes well when compared to diabetic patients with no depression. Diabetic patients with pain are much less likely to achieve exercise targets than diabetic patients without pain.
This is true for any person regardless of the diagnosis: People who suffer from signifcant pain or emotional problems (scoring 4-5 on a 5 point pain or emotion scale) don't do as well as people who don't have problems with pain or emotions.
In the reality of primary care we are not given the resources we need to fully address patient needs: we are not afforded the time we need to respectfully delve into the complex issues that block people from following through on good intentions or to use 'teach-back' skills that enhance communication.
There are tools a busy clinician and care team can use to quickly and reliably unmask behaviorally sophisticated issues. I have used Dartmouth's HowsYourHealth.org on-line patient checkup tool. Most of the time I correctly anticipated the responses from patients I knew, but maybe one patient out of ten provided an answer that unmasked hidden issues with major impact on their health. Rather than floundering in the old 'non-compliance' paradigm of miscommunication and wasted time we honed right in on the crux of the issue.
My point is that this work seems daunting until you know that there are good tools and processes a busy clinician can use to address matters reliably and with ease. Because we had a high functioning team, the patient came in prepped and ready, the information was available and we could address issues the patient had identified as their major impediments.
We successfully transferred this knowledge to volunteer practices in the Ideal Medical Practices project (grant funding from the Physicians' Foundation) and watched as many more physicians and their patients got on the same page and quality results improved.
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