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The Communication Dilemma

Does e-health improve doctor – patient communication? This is a question that health professionals, and patient advocates are grappling with. Let’s face it, we have the tools, including: digital health records, email, online resources, smartphones, and patient portals to engage in e-health and foster improved communication. We also know that clear instructions from physicians, pharmacists, nurses and nurse practitioners has proven to be a key factor in improving patient compliance, which positively impacts outcomes.


Science Daily in  2007,  reported that a systematic review of studies published over four decades  confirmed, without doubt, 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.


Furthermore, most patient complaints about doctors deal not with their technical competence or diagnostic skills, but with their communication skills and the fact that their doctors do not listen to them. Most patients want more and better information about their problems and outcomes, more openness about the side effects of treatment, relief of pain and emotional distress and advice about what they can do for themselves.


So why are there so many barriers to open communication between doctors and patients? There are many reasons including:


(1)There are  many doctors who still  believe that withholding information from patients does not undermine veracity or violate the truth principle but actually protects the patient from unnecessary anguish and stress. As a result these physicians  continue to practice 20th century  medicine, ignoring the fact that today’s more educated patient  has access to all sorts of  health information resources.


(2)There are many patients who ask their doctor not to provide full information as they simply do not want to know all of the  unpleasant details. The question here is whether physicians have an obligation to tell  patients the full story and how  they do that in  an appropriate way. Research indicates that the majority of patients (in one study over 55 percent of elderly frail patients) whose doctors did not discuss their prognosis, wanted to have that discussion so that they could make appropriate life choices, put financial affaris in order and know what to expect.


(3)In Pennsylvania there is legislation  that prohibits doctors from sharing information in certain circumstances.  This has to do with the requirement that companies disclose the indentity and amount of chemicals in fracking fluids to physicians who may be treating patients exposed to these chemically packed fluids. According to the law, the physicians must sign confidentiality agreements stating that they will not disclose that information to anyone else – not even the patient they are treating for a related illness.


There are also many patients who genuinely believe that they do not need to tell their physicians or other caretakers the whole story about their health issues because they consider this information to be private.


While the Communication dilemma does not  resolve  itself with a simple solution that will result in universal agreement, the answers are quite clear. Physicians need communication skills training, including mentoring in how to talk to patients, how to make eye contact and  how to  listen to patients so that their interactions are  more collaborative and less confrontational.  This training should be tied to their continuing education credits that they are required to fulfill.


Patients who typically want to be engaged with their providers, must provide full disclosure about their health issues and indicate their views. These patients need to seek appropriate information resources, filter that information  and become contributing members of their health care team. Given the e-health tools that are available all of this is achievable.





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