Good doctor-patient communication is key

Minority patients tend to feel the most unheard at doctor’s visits, but improved communication leads to improved outcomes.

On average, a patient gets to speak for about 18 seconds before their physician interrupts, but surveys indicate they would talk for 150 seconds if uninterrupted.

“This is the average. It’s worse if it’s a male doctor and a female patient, and it’s even worse if it’s a Caucasian doctor and an African-American patient,” Stephen Kopecky, MD, Mayo Clinic Rochester, said at the American College of Cardiology Scientific Session 2005.

However, research shows that good communication between a physician and a patient leads to improved compliance with therapy and improved outcomes. Kopecky offered several tips and techniques for improved communication.

“We often talk about how we can improve health care among minorities at a national or policy level, but the most basic level is the patient and physician interaction because that’s the one we can all affect,” Kopecky said.

Differences in care

Kopecky said there are 81 studies that have researched the differences in cardiac care by racial categories, and 68 of them found that blacks have less aggressive care. Another 11 studies showed no difference, and two showed that blacks received better care than the white population.

“African-Americans are less likely than whites to receive catheterization, angioplasty, surgery and thrombolytic therapy. These differences remain after you adjust for factors such as socioeconomic, clinical risk factors and heart disease severity,” Kopecky said.

Surveys have also shown that white doctors have less involvement with their black patients than with their white patients. “African-Americans feel that they would have better care if they were from a different race, which tugs at all our ethical standards,” Kopecky said.

Patient satisfaction

Physicians should pay more attention to patient satisfaction, which is a measurement much more complicated than what can be observed by curing a disease, Kopecky said.

“It’s essentially a question about whether the patient felt good coming away from their interaction. Things like ability to find a parking space, wait times and nursing care all affect this,” Kopecky said.

Patient satisfaction has a lot to do with expectations and is closely linked to trust, Kopecky said. Surveys show that the young tend to trust their physicians less than the elderly do, females tend to trust less than males, less educated patients are less likely to trust than highly educated patients, and patients are less likely to trust if they were assigned a doctor than if they were given the ability to select.

“Does this sound to you like the typical HMO patient? Our system actually sets things up to reduce the amount of trust our patients have in us,” Kopecky said.

Improved outcomes

In an environment where waiting lists can be months long, it is tempting to think patient satisfaction is not important, but Kopecky said studies show it improves outcomes. One such study, conducted in a primary care setting, showed that five of six health care measures were linked to patient satisfaction.

If a patient believes their physician has a comprehensive knowledge of their medical condition, they will comply with recommendations 44% of the time. “This isn’t just medicines. These are things like exercise, eating properly, etc. If they do not trust you, the adherence rate is much lower,” Kopecky said.

Other studies have shown that trust improves outcomes out to four years, Kopecky said, although these studies have been done in settings other than cardiology.

Simple things like using a stethoscope can improve trust levels. “Patients think a stethoscope can do amazing things. If you listen to a patient’s chest for 15 to 20 seconds, they think you now know everything about their condition,” Kopecky said.

But the most important aspect of patient-physician communication is to look unhurried. Ask if they have any questions. Do not answer a pager. “There’s evidence that if you spend 10 unhurried minutes with a patient, they feel like you have spent 20. It’s really amazing,” Kopecky said. – by Jeremy Moore

For more information:

• Kopecky SL. Patient physician communication: Can we talk? Presented at the American College of Cardiology Scientific Session 2005. March 6-9, 2005. Orlando.