ROCKPORT, Maine — The importance of doctors and patients understanding one another was the focus of Friday’s opening of the Maine Medical Association’s three-day symposium at the Samoset Resort.
“Communication skills are important in the patient-physician relationship for both understanding and trust,” said J. Gregory Carroll during his keynote address at the association’s 155th annual session.
Communication improves diagnostic accuracy and adherence to treatment, said Carroll, who holds a doctorate and is an educational psychologist at the Institute for Healthcare Communication in New Haven, Conn. It also improves patient and doctor satisfaction and reduces malpractice risk, said Carroll, who has taught interpersonal communication skills in the health professions.
His topic Friday — “Communicating to Improve Performance” — focused on the need for doctor-patient communication to ensure successful medical care.
He cited one survey in which 25 percent of the patients said they did not follow their doctor’s advice. Of the reasons given, 39 percent disagreed with their doctor, 27 percent were concerned about cost, 25 percent said the instructions were too difficult, 20 percent said the advice was against personal beliefs, and 7 percent said they did not understand the advice.
Carroll cited two models of clinical care for physicians to try — one with the biomedical tasks to “find it and fix it,” and the other with the communication tasks to “engage, empathize, educate and enlist.”
Dr. William Strassberg, outgoing Maine Medical Association president and an orthopedic surgeon at Mount Desert Island Orthopedics in Bar Harbor, believes strongly that communication is an important tool for physicians and patients in what has become an industrial health care system.
“One of the tools is to make sure we understand the patient’s concerns with the immediate problem and the underlying concerns behind the problem, and to make sure the patient understands our thoughts and how to best proceed.”
To the complaint that a doctor starts talking 17 seconds after a session with a patient begins, Strassberg quipped that “it’s gone up to 22 seconds.”
“It’s not that the doctor isn’t listening to the patient,” Strassberg said, “it’s that he or she is trying to think of answers to make a diagnosis and treat the patient.”
“The patients are there to tell a story of their problem, and we’ve learned that there is more to the problem than we immediately asked,” he said. “We need to allow the patients time to tell their story.”
On the subject of managed care and its focus on efficiency, Strassberg said, “There’s a constant battle and tension between the time we want to devote to each patient, and constraints put upon us from the outside.
“We are losing some of our independence, and we are losing some of our own ability to run our offices the way we want to,” he said.
“Part of what we’re doing as a medical association is trying to regain some of that autonomy and ability,” Strassberg said.
One of the keys to understanding any health care system is understanding the cost of health care delivery, he noted. One of the improvements would be in having not-for-profit insurance providers as opposed to for-private insurance companies handling health insurance.
Physicians are in danger of losing their central place in medicine with insurance and pharmaceutical companies trying to control decisions about care.
“Physicians have lost their voice,” he said. “MMA is reasserting the voice of the physician in medicine.
“We need to communicate to our patients what is happening to health care in this country,” he added.
“Our patients have to be able to trust us,” he said.