by Dianna M. Burns-Banks, MD
“Perhaps when our patients do not comply with a medical regimen,
we may share some responsibility. Both the difficulty in adhering to a plan and the
health expectations must be clearly
defined and understood by both parties.”
Most physicians define their communication skills as above average if not excellent.
The phrase “good bedside manner” probably is more of an evaluation of communication skills than of clinical ability. I recall a discussion I had several years ago with an elderly man I met at a health fair. We had taken his blood pressure and noted it was significantly above normal. I began to talk to him about hypertension, its causes, the potential complications, and his need for follow-up. He quickly informed me that he was seeing a physician for his blood pressure and that he was taking medicine. However, he had only four pills left and he was saving them. I still am not sure what would be the determinant factor to precipitate his taking those pills. However, I am certain that neither the instructions on the bottle nor the physician’s instruction implied that the pills should be saved and taken at the first signs of heart attack or stroke.
I am sure that part of this gentleman’s dilemma was the cost of drugs and his financial limitations but I am not sure whether my communication skills that day were adequate to convince this elderly man of the importance of compliance. Our success and the success of our patients both depend on the provider’s ability to communicate and the patient’s ability to understand and translate that understanding into action.
A significant part of each physician’s day is spent educating patients. Each patient must understand his or her disease process and management in order to prevent complications and to improve his health and the overall health status of the community. Healthcare providers must be consistent in the messages they give their patients in order to prevent confusion and limit problems with compliance.
As we move toward a more consumer-focused healthcare system in our effort to provide cost-effective, quality medical care, patients will need to take a more active role in healthcare decision-making. To accomplish this, the consumer – the patient – must have health information skills.
This can be as simple as being able to understand the instructions on the prescription drug bottle. If a medicine is prescribed to be taken three times a day, does that mean approximately every eight hours, with a day defined as 24 hours, or does it mean every three to four hours with a day defined as daylight hours?
Patients must be able to understand the healthcare provider’s instructions and the importance of follow-up. It is often frustrating to review changes in a management plan addressing acute exacerbations for a chronic asthma patient only to discover, at the scheduled follow-up two to three weeks later, that he or she has failed to initiate any of the discussed changes – and now questions why there was no improvement in symptoms. Perhaps when our patients do not comply with a medical regimen, we may share some responsibility. Both the difficulty in adhering to a plan and the health expectations must be clearly defined and understood by both parties.
Involving the consumer in healthcare decisions is more crucial as medicine and business move into increasingly complex delivery systems designed to curtail cost and equate provider performance with quality of medical care. The patient’s ability to negotiate this very complex system probably creates a greater healthcare challenge than ensuring that he understands the physician’s instructions and how to take the medicines that the physician prescribes – but it is equally as important.
The patient is no longer selecting merely an insurance plan based on a primary care physician and the listing of specialists available on that plan. He now is afforded the opportunity to review provider performance, evaluate the quality of his work, and compare one physician’s cost for a designated procedure to that of his peers.
Healthcare literacy is more than just the ability to read. It requires that the healthcare consumer have not only the ability to listen, to analyze, and to make decisions, but also the ability to utilize and apply these skills to maximize his or her own health.
Communicating effectively with the patient at each encounter is essential for us as physicians. However, to really affect the negative impact of poor or limited health literacy, we must require that health knowledge be among the skill sets taught to our children beginning in kindergarten. Health education and health promotion must become a real part of our daily lives and of the lives of those in our communities.
