Doctors should help patients to communicate better with them

Editor—When was the last time that you visited a doctor? Did you think that you were given all of the information you sought? Did you come away feeling there were still questions you wanted to ask but didn’t for whatever reason? Did you feel vulnerable?

If you felt somewhat disempowered on considering your answers to these questions you are not unusual. If you went into your consultation armed with medical knowledge and still came away feeling less than satisfied consider how much worse this would be for somebody without medical knowledge.

The concept of patients as partners is far from political correctness gone too far¹: it is essential for efficient doctor-patient consultations, in which mutual understanding leads to rapid diagnosis and negotiated treatment options that are thus more likely to be adhered to. A more fundamental issue, beyond providing information about diseases and therapeutics, is how we as doctors can enable patients to communicate more effectively with us. Often we are ignorant of the power we are perceived as having by some of our patients and about how this might inhibit them from communicating effectively with us. When patients are in the vulnerable position of feeling unwell our power is amplified.

I have explored some of these questions with patients who, importantly, are not my patients to see what makes patients feel inhibited in their communication with healthcare professionals and what ideas they have to improve matters. Some initial comments and suggestions were embarrassingly simple.

Patients commonly thought that doctors did not provide an environment in which they would feel free to ask questions because they could tell that the doctor’s time was obviously limited: the clinic was crowded, the doctor did not look them in the eye, or the doctor interrupted frequently when they were trying to speak. Patients also said that if they were confident that they could ask questions or seek clarification they would do so. Their suggestions for improvement included posters for waiting rooms that explicitly gave patients permission to ask questions, and checklists of credit card size that they could refer to during consultations as prompts.

It is wrong to assume that doctors letting go of some of their power and encouraging patients to be partners will be more time consuming. It should lead to much faster shared understanding, greater patient satisfaction, and improved health outcomes, as has been shown in diabetes.²