How hard is it for doctors to listen and to care?

Oct. 19, 2011 — Last month, the Pritzker School of Medicine at the University of Chicago received a substantial gift — $42 million — to establish the Bucksbaum Institute, intended to “improve doctor-patient communication and clinical decision-making.” The Institute is the latest of a series of initiatives that have been started by medical schools in recent years in response to widespread complaints that doctors often fail to communicate effectively with their patients and, perhaps even more fundamentally, fail to empathize with them.

Remapping Debate’s examination of the issues of doctors failing to communicate and empathize reveals that, despite innovative efforts at a number of medical schools, the medical community as a whole still has far to go to remedy these problems.

Indeed, some of those most closely involved in trying to reshape medical education to bring communication and compassion to the forefront candidly admit that there are currently profound structural barriers in the organization of medical care that limit the effectiveness of the most well-intentioned training interventions.

Furthermore, a longstanding culture within medicine resistant to taking issues of communication and compassion as seriously as other aspects of medical practice has meant that the change that is occurring generally has begun only in the last several years.

A status quo not centered on the patient

According to a 2006 Commonwealth Fund report based on a survey of patients from Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States, “on most measures of quality of care,” particularly regarding “measures of equity, patient perceptions of safety…[and] patient-centeredness,” the United States “ranked last or second-to-last.”

The same report noted “nearly one in four U.S. respondents” reported “leaving the doctor’s office without having all of their important questions answered,” and “50 percent of sicker adults in the U.S. reported that their regular doctor sometimes, rarely or never tells them about care options or asks for their opinions.” The report concluded that seen through the lens of the patient, “the U.S. health care system is not the ‘fairest of them all,’ at least from the viewpoint of those who use it to stay healthy, get better, or manage their chronic illnesses.”

Dr. Robert Arnold, director of the University of Pittsburgh’s Institute on Doctor-Patient Communication, said that patient communication suffered because of an excessive focus on the technologies of medicine.

“We need really good science and really good communication, because good communication is crucial in terms of patient adherence to treatment plans, patient satisfaction with their care experience, and whether they come back.” Arnold believes that many doctors still see effective communication as a “soft topic,” one not on par with the scientific knowledge required to be a successful physician.

Navigating increasingly complex systems

Dr. Matthew Sorrentino, a faculty member at the Pritzker School of Medicine at the University of Chicago, identified the increasing reliance on technology within the medical community as having a tendency to erode good doctor-patient communication.

“As medicine has become more technology-based, as procedures and medical therapies have become more sophisticated, as times in the hospital have become more fast-paced and confusing, doctor-patient communication is more important than ever but is also one of the first things to go.”

Dr. Jeffrey Gold, a member of the American Medical Association’s Council on Medical Education, said, “A typical hospitalization may involve as many as 200 different professionals interacting with a patient. Between changes in nursing shifts, physicians rotating call, and the other social services and occupational therapists that may be involved, there are many different opportunities for patients to get lost in the shuffle.”

Do doctors have an obligation to help patients navigate this bureaucracy? Arnold said they do.

“Doctors should play an important role. There need to be more systems where all of a given patient’s doctors see that patient together, and then they all talk, so the patient doesn’t have to run from place to place.”