As health goes awry, doctor-patient relationship more than a nicety

Jul 07, 2009

The cornerstone of a good doctor-patient relationship begins with the doctor's ability to clarify a patient's preferences and values, especially during a difficult diagnosis, a commentary in the Journal of the American Medical Association said.

Lead author Ronald M. Epstein, M.D., of the University of Rochester Medical Center, also suggests there are certain things physicians can do or say to define each situation, including being mindful their own biases.

Before having a high-stakes discussion, he suggests doctors ask themselves questions such as: "Has the patient shown understanding of the relevant options?" "Do I understand the patient's values?" And, "In what ways are feelings and intuitions informing or biasing preferences?"

"It is essential for physicians to find ways to be appropriately engaged with patients as they guide them through difficult decisions," said Epstein, professor of Family Medicine, Psychiatry and Oncology at URMC and director of the Rochester Center to Improve Communication in Health Care. "Without adequate communication skills and the willingness to know their patients as people, doctors cannot deliver patient-centered care, which is the hallmark of quality."

The JAMA article, published July 8, 2009, offers a common scenario as an illustration of things to consider during a shared deliberation between doctor and patient. Two men are diagnosed with localized . Each man is considering three options: surgery, or watchful waiting, in the absence of compelling data favoring one approach.

Even if each patient is well-informed, however, he might have very different personal beliefs, Epstein noted. One man might fear surgery because of the belief that it could spread the cancer, whereas the other man might believe surgery is the best way to remove all of the cancer.

In these types of situations, the article said, doctors should guide patients to use their emotions and logical thinking skills in concert, and should frame information with more than one perspective. An example of a way to present complex information is: "For some people, a 10 percent risk seems like a lot -- but for others it's small compared to the benefit."

Patients share the responsibility to articulate their gut feelings, knowledge and values, especially in the face of uncertainty. "Patients need to go beyond comprehension to a greater depth of knowledge and the ability to apply information meaningfully to a particular situation," the commentary noted.

Physicians can address a patient's conflicts by probing whether the gut feelings make sense, and to untangle emotions from long-term utility. If a patient is making a decision about a colostomy, for example, the doctor might point out that although colostomy carries a negative image, surprising data shows that most who live with one report a high quality of life.

If both sides work hard through complex situations, Epstein said, the result can correct misconceptions, increase options, generate new ideas, and promote respect and learning.

Source: University of Rochester Medical Center (news : web)

Explore further: Informal child care significantly impacts rural economies, study finds

add to favorites email to friend print save as pdf

Related Stories

Patients wonder, 'Could this be something serious?'

Dec 04, 2007

Nearly 4,800 patient surveys and 100 covertly recorded visits by actors posing as patients revealed that empathy is lacking in many exam rooms around the Rochester, N.Y., area – however, doctors who do convey empathy are ...

Rx for time-crunched physicians

Jul 14, 2008

With their waiting rooms crowded and exam rooms full, many physicians say they are too busy to be good communicators. Those who study physician time-management think otherwise. Certain communication skills can foster efficiency ...

Hurried doctor visits may leave patients feeling forgetful

Jun 25, 2008

Have you ever been whisked through a doctor's visit, and afterward were unable to remember what the doctor said? A University of Rochester Medical Center study disclosed that doctors don't often take the steps necessary to ...

Physicians often miss opportunities to show empathy

Sep 22, 2008

In consultations with patients with lung cancer, physicians rarely responded empathically to the concerns of the patients about mortality, symptoms or treatment options, according to a study led by a University of Rochester ...

When the patient can't decide

Aug 18, 2008

Family members are often called upon to make medical choices for patients who are unable to do so themselves. Researchers led by Alexia Torke, M.D., of the Indiana University School of Medicine and the Regenstrief Institute, ...

Recommended for you

Preterm children's brains can catch up years later

11 hours ago

There's some good news for parents of preterm babies – latest research from the University of Adelaide shows that by the time they become teenagers, the brains of many preterm children can perform almost as well as those ...

Mortality rates increase due to extreme heat and cold

12 hours ago

Epidemiological studies have repeatedly shown that death rates rise in association with extremely hot weather. The heat wave in Western Europe in the summer of 2003, for example, resulted in about 22,000 extra deaths. A team ...

User comments : 1

Adjust slider to filter visible comments by rank

Display comments: newest first

HouseDoc
not rated yet Aug 12, 2009
Effective communication can go along way to help develop a healthy doctrelationship. This doesn't stop at the office. There are online services such as www.housedoc.us, that also enable email communications, which are more convenient than using the phone.