Patient Communication Vs. Non-Verbal Communication
Table of Contents
1. Introduction 2
1.1. Doctor-Patient Interactions 2
1.2. Verbal Versus Non-verbal Communication 3
2. Background 4
3. Healthcare Communication Outcomes 5
3.1. Diagnostic Accuracy 5
3.2. Adherence 5
3.3. Patient Satisfaction 6
3.4. Patient Safety 6
3.5. Access 7
3.6. Prevention 7
3.7. Team Satisfaction 8
3.8. Consent 8
3.9. Malpractice Risk 9
4. Summary 10
5. References 12
1. Introduction
The quality of care (QoC) perceived by a patient during the medical encounter has implications for patient recovery and health maintenance. Patients who believe they have received poor QoC are less likely to adhere to doctor recommendations. A major influence on perceived QoC is the communication, both verbal and non-verbal, between the doctor and patient.
The …show more content…
medical interview is the portion of the interaction when the doctor assesses the patient 's symptoms and concerns. During the medical interview, a doctor must take note of the patient’s comments while continuing to listen and prompt the patient with more probing questions in order to elicit all potentially relevant health related information. Physicians have several options as to which note-taking medium to utilize. Traditionally, pen and paper have been used to jot down notes during the course of the examination. Alternatively, doctors may have chosen to make mental notes during the examination and to document these notes after exam completion
1.1. Doctor-Patient Interactions
Arguably, the interaction between doctor and patient during the medical consultation is the most critical point for transferring information and the delivery of excellent healthcare Bertakis, Roter, & Putnam, 1991; Ong, de HaeHoos, & Lammes, 1995; Russuvuori, 2001). The physician’s primary task is to become familiar with patient history while eliciting symptoms in a way that is meaningful. A secondary, but nearly as important, task is for the physician to connect with the patient. The doctor-patient interaction is the patient’s most salient feature on which to judge the QoC they receive. There are at least two aspects to healthcare quality: actual patient outcome (observable consequences due to a medical encounter); and perceived QoC (the patient’s personal judgment of the healthcare quality). Actual patient outcome can be measured in several ways including: adherence to doctor recommendations; recall of information given during consultation; and understanding of diagnosis (Ong et al.,1995). Perceived QoC is a good predictor of actual patient outcome (Ong et al.). Ong et al. report that patients evaluate their overall healthcare experience on their doctor’s interpersonal skills; skills which are interpreted through both verbal and (largely) non-verbal communication.
1.2. Verbal Versus Non-verbal Communication
Verbal communication consists not only of the spoken word, but also of verbal inflection, pauses in speech, and tone. Non-verbal communication has been operationalized as body positioning, posture, gaze, etc. These non-verbal components, or visual cues, make up approximately 80% of perceived interpersonal communication (Ong et al., 1995
Research evidence indicates that there are strong positive relationships between a healthcare team member’s communication skills and a patient’s capacity to follow through with medical recommendations, self-manage a chronic medical condition, and adopt preventive health behaviors. Studies conducted during the past three decades show that the clinician’s ability to explain, listen and empathize can have a profound effect on biological and functional health outcomes as well as patient satisfaction and experience of care.
2. Background
Patients’ perceptions of the quality of the healthcare they received are highly dependent on the quality of their interactions with their healthcare clinician and team. There is a wealth of research data that supports the benefits of effective communication and health outcomes for patients and healthcare teams. The connection that a patient feels with his or her clinician can ultimately improve their health mediated through participation in their care, adherence to treatment, and patient self-management.
Yet, it is estimated that less than half of hospitalized patients could identify their diagnoses or the names of their medication(s) at discharge, an indication of ineffective communication with their physicians.
The Institute of Medicine (IOM) Report on Health Professions and Training has identified that doctors and other health professionals lack adequate training in providing high quality healthcare to patients. The IOM called upon educators and licensing organizations to strengthen health professional training requirements in the delivery of patient-centered care. The patient-centered care model underscores the essential features of healthcare communication which relies heavily on core communication skills, such as open-ended inquiry, reflective listening and empathy, as a way to respond to the unique needs, values and preference of individual patients.
3. Healthcare Communication Outcomes
A clinician may conduct as many as 150,000 patient interviews during a typical career. If viewed as a healthcare procedure, the patient interview is the most commonly used procedure that the clinician will employ. Yet communication training for clinicians and other healthcare professionals historically has received far less attention throughout the training process than have other clinical tasks.
This is so even as evidence continues to mount that a structured approach to communication measurably improves healthcare delivery.
3.1. Diagnostic Accuracy
Most diagnostic decisions come from the history-taking component of the interview. Yet, studies of clinician-patient visits reveal that patients are often not provided the opportunity or time to tell their story / history, often due to interruptions, which compromise diagnostic accuracy. Incomplete stories /history leads to incomplete data upon which clinical decisions are made.
When interruptions occur, the patient may perceive that what they are saying is not important and leads to patients being reticent to offer additional information.
The bottom line is that when patients are interrupted, it is a deterrent to collecting essential information and it hinders the relationship.
3.2. Adherence
Adherence is defined as the extent to which a patient’s behavior corresponds with agreed upon recommendations from a healthcare provider. Certainly, we are all aware of the huge problem of non-adherence in health care. For instance, a Health Care Quality Survey conducted by the Commonwealth fund found that 25% of Americans report they did not follow their clinician’s advice and provides the reasons cited in this survey: 39% disagreed with what the clinician wanted to do (in terms of recommended treatment); 27% were concerned about cost; 25% found the instructions too difficult to follow; 20% felt it was against their personal beliefs; and 7% reported they did not understand what they were supposed to do
3.3. Patient Satisfaction
The core elements comprising patient satisfaction include: 1. Expectations (Providing an opportunity for the patient to tell their story), 2. Communication (patient satisfaction increased when members of the healthcare team took the problem seriously, explained information clearly, and tried to understand the patient’s experience, and provided viable options), 3. Control (Patient satisfaction is improved when patients are encouraged to express their ideas, concerns and expectations), 4. Decision-making (Patient satisfaction increased when the importance of their social and mental functioning as much as their physical functioning was acknowledged), 5.Time spent (Patient satisfaction rates improved as the length of the healthcare visit increases), 6.Clinical team (Although it is clear that the patient first concern is their clinician, they also value the team for which the clinician works), 7.Referrals ( Patient satisfaction increases when their healthcare team initiates referrals relieving the patient of this responsibility), 7.Continuity of care (Patient satisfaction increases when they receive continuing care from the same healthcare providers), 8. Dignity (As expected, patients who are treated with respect and who are invited to partner in their healthcare decisions report greater satisfaction).
3.4. Patient Safety
An estimated one-third of adverse events are attributed to human error and system errors. Research conducted during the 10 year period of 1995-2005 has demonstrated that ineffective team communication is the root cause for nearly 66 percent of all medical errors during that period. This means that when health care team members do not communicate effectively, patient care often suffers. Further, medical error vulnerability is increased when healthcare team members are under stress, are in high-task situations, and when they are not communicating clearly or effectively.
3.5. Access
There is compelling evidence that communication challenges have an adverse effect on initial access to health services. These challenges are not limited to encounters with physicians and hospital care. Patients face significant barriers to health promotion and disease prevention programs: there is also evidence that they face significant barriers to first contact with a variety of providers (Bowen, 2001). The research indicates that there is a general pattern of lower use of many preventive and screening programs by those facing language barriers (Woloshin et al., 1997). Higher use has been reported for some emergency department services, and for additional tests ordered to compensate for inadequate communication (Bowen, 2001).
3.6. Prevention
A number of studies focus on utilization of cancer screening programs. Fox and Stein (1991) found that the most important variable that predicted whether women of all racial groups had a mammogram was whether their doctors had discussed mammography with them. Hispanic women, compared to black or white women, were less likely to have physicians who discussed screening with them. Language preference (English versus Spanish) was strongly correlated with whether the physician discussed mammography with the woman or not. In a British study of participation in cervical screening programs by Naish et al. (1994), language and administration were seen to be barriers to participation by clients, not, as reported by physicians, lack of interest in prevention programs. Solis et al. (1990) found that language ability predicted the use of screening services. They suggested that the effect of language on screening practices was an access factor (i.e. proficiency in English increased access to service). In a study of health behaviour of older Hispanic women, Marks et al. (1987) found that the use of English language was associated most closely with increased use of screening programs.
In a Canadian study, Woloshin et al. (1997) analyzed self-reported utilization data on breast examination, mammography and Pap screening from the 1990 Ontario Health Survey. He found that French speakers were significantly less likely to receive breast examinations or mammography. These results persisted even when adjusted for social and economic factors, contact with the health care system, and measures of culture.
3.7. Team Satisfaction
Why is team satisfaction important? Communication among healthcare team members influences the quality of working relationships, job satisfaction and profound impacts patient safety. When communication about tasks and responsibilities are done well, research evidence has shown significant reduction in nurse turnover and improved job satisfaction because it facilitates a culture of mutual support. Larson and Yao found a direct relationship between clinicians’ level of satisfaction and their ability to build rapport and express care and warmth with patients. What are the elements that contribute to healthcare team satisfaction: Feeling supported, e.g., administratively and inter-personally, respected, valued, understood, listened to, and having a clear understanding of role, work equity and fair compensation.
3.8. Consent
Consent to treatment is a fundamental pillar of quality of care. Legislation protects patients from procedures for which they have not provided informed consent. Furthermore, the common law in Canada provides that where a patient does not speak an official language, the physician must ensure that the patient understands the information that is communicated before administering treatment. For example, in Anan vs. Davis, a refugee was sterilized after she consented to what she thought was a procedure to treat an infection that had occurred after birth. The ruling in this case concluded that the duty to ensure the patient understood the information included an obligation to be attentive to the language ability of the interpreter, and to ensure that the patient was returning reasonable and responsive replies. In Korollos vs. Olympic Airways, a physician obtained consent from a family member over the telephone for a patient’s surgery. The family member later stated that he gave consent only because he misunderstood the urgency of the situation. The court concluded that the duty of the doctor extended beyond communication of the facts, but also required a positive duty on the doctor to ensure that the patient actually understood the information (Bowen, 2001).
3.9. Malpractice Risk
According to Huntington and Kuhn, the “root cause” of malpractice claims is a breakdown in communication between physician and patient. Previous research that examined plaintiff depositions found that 71% of the malpractice claims were initiated as a result of a physician-patient relationship problem. Closer inspection found that most litigious patients perceived their physician as uncaring. The same researchers found that one out of four plaintiffs in malpractice cases reported poor delivery of medical information, with 13% citing poor listening on the part of the physician.
4. Summary
Communicating effectively with patients and families is a cornerstone of providing quality health care. The manner in which a health care provider communicates information to a patient can be equally as important as the information being conveyed. Patients who understand their providers are more likely to accept their health problems, understand their treatment options, modify their behavior and adhere to follow-up instructions. If the single most important criterion by which patients judge us is by the way we interact with them, it stands to reason that effective communication is at the core of providing patient-centered care.
Research evidence indicates that there are strong positive relationships between a healthcare team member’s communication skills and a patient’s capacity to follow through with medical recommendations, self-manage a chronic medical condition, and adopt preventive health behaviors. Studies show that the clinician’s ability to explain, listen and empathize can have a profound effect on biological and functional health outcomes as well as patient satisfaction and experience of care. Further, communication among healthcare team members influences the quality of working relationships, job satisfaction and has a profound impact on patient safety.
Clinicians and other members of the healthcare team conduct thousands of patient interactions during their career. The call to action from the Institute of Medicine (IOM) Report on Health Professions and Training underscores the importance of communication training for clinicians and members of the healthcare team. Similar to other healthcare procedures, communication skills can be learned and improved upon. Improvement in communication skills requires commitment and practice.
Given the wealth of evidence linking ineffective clinician-patient communication with increased malpractice risk, non-adherence, patient and clinician dissatisfaction, and poor patient health outcomes, the necessity of addressing communication skill deficits is of the utmost importance.
Since the products of healthcare systems are services, measuring healthcare quality must extend beyond clinical measures to also incorporate patient perceptions and experiences. In general, service quality is believed to be measured by five dimensions which are tangibles, reliability, responsiveness, assurance, and empathy. Previous studies have suggested adding usability which could be translated as ease of use as the sixth dimension. The definition of quality from a patient 's point of view is usually seen as the outcome of his/her treatment and communication with the healthcare system. As a result, we recommend adding communication between the healthcare system and patient as the seventh dimension of service quality.
5. References
1. Asnani MR. (2009). Patient-physician communication. WestIndian Med J, 58(4):357-61. pubmed
2. Clark, P. A. (2003). Medical practices’ sensitivity to patients’ needs: Opportunities and practices for improvement. Journal of Ambulatory Care Management, 26(2), 110-123. pubmed
3. Wanzer, M. B., Booth-Butterfield, M. & Gruber, K. (2004). Perceptions of health care providers’ communication: Relationships between patient-centered communication and satisfaction. Health Care Communication, 16(3), 363-384. pubmed
4. Duffy, F. D., Gordon, G. H., Whelan, G., Cole-Kelly, K., & Frankel, R. (2004). Assessing competence in communication and interpersonal skills: The Kalamazoo II report. Academic Medicine, 79, 495-507. pubmed
5. Heisler, M., Bouknight, R. R., Hayward, R. A., Smith, D. M., & Kerr, E. A. (2002). The relative importance of physician communication, participatory decision-making, and patient understanding in diabetes self-management. Journal of General Internal Medicine, 17, 243-252. pubmed
6. Renzi, C., Abeni, D., Picardi, A., Agostini, E., Melchi, C. F., Pasquini, P., Prudu, P., & Braga, M. (2001). Factors associated with patient satisfaction with care among dermatological outpatients. British Journal of Dermatology, 145, 617-623. pubmed
7. Safran, D. G., Taira, D., Rogers, W. H., Kosinski, M., Ware, J. E., & Tarlov, A. R. (1998). Linking primary care performance to outcomes of care. Journal of Family Practice, 47(3), 213-220. pubmed
8. Sullivan, L. M., Stein, M. D., Savetsky, J. B., & Samet, J. H. (2000). The doctor-patient relationship and HIV-infected patients’ satisfaction with primary care physicians. Journal of General Internal Medicine, 15, 462-469. pubmed
9. Zachariae, R., Pederson, C. G., Jensen, A. B., Ehrnrooth, E., Rossen, P. B., Von der Maase, H. (2003). Association of perceived physician communication style with patient satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease. British Journal of Cancer, 88, 658-665. pubmed
10. Piette, J. D., Heisler, M., & Wagner, T. H. (2004). Cost-related medication underuse among chronically ill adults: The treatments people forgo, how often, and who is at risk. American Journal of Public Health, 94(10), 1782-1787. pubmed
11. Makaryus, A. N., & Friedman, E. A. (2005). Patients’ understanding of their treatment plans and diagnosis at discharge. Mayo Clinic Proceedings, 80(8), 991-994. pubmed
12. Institute of Medicine. (2003). Health professions education: A bridge to quality. Washington, D.C.: National Academies Press
13. Stewart MA. (1995). Effective physician-patient communication and health outcomes: A review. Canadian Medical Association Journal. 152:1423-1433. pubmed
14. Stewart M, Brown J, Donner A, et al. (2000). The impact of patient-centered care on outcomes. J Fam Pract.;49:805-807. pubmed
15. Peterson, M. C., Holbrook, J., Von Hales, D., Smith, N. L., & Staker, L. V. (1992). Contributions of the history, physical examination and laboratory investigation in making medical diagnoses. Western Journal of Medicine, 156, 163-165. pubmed
16. World Health Organization. (2003) Adherence to long-term therapies: Evidence for action. Switzerland: WHO Library Cataloguing. World Health Organization
17. Davis, K., Schoenbaum, S. C., Collins, K. S., Tenney, K., Hughes, D. L., & Audet, A. M. (2002). Room for improvement: Patients report on the quality of their health care. New York: Commonwealth Fund
18.
Thiedke CC. (January 2007). What do we really know about patient satisfaction? Family Practice Management, 33-36. pubmed
19. Team strategies and tools to enhance performance and patient safety (TeamSTEPPS), Department of Defense and Agency for Healthcare Research and Quality http://www.ahrq.gov/qual/teamstepps/
20. Lein C., & Wills CE. (2007). Using patient-centered interviewing skills to manage complex patient encounters in primary care. American Academy of Nurse Practitioners, 19:215-220. pubmed
21. DiMeglio K, Lucas, S. Lucas, & Padula, C. (2005). Group Cohesion and Nurse Satisfaction. Journal of Nursing Administration. 35:3 , 110-120. pubmed
22. Larson, E. B., & Yao, X. (2005). Clinical empathy as emotional labor in the patient-physician relationship. Journal of American Medical Association, 293(9), 100-1106. pubmed
23. Huntington, B., & Kuhn, N. (2003). Communication gaffes: A root cause of malpractice claims. Baylor University Medical Center Proceedings, 16, 157-161. pubmed
24. Beckman, H. B., Markakis, K. M., Suchman, A. L., & Frankel, R. M. (1994). The doctor-patient relationship and malpractice. Lessons from plaintiff depositions. Archives of Internal Medicine, 154(12) 1365-1370.
pubmed
1. Introduction 2
1.1. Doctor-Patient Interactions 2
1.2. Verbal Versus Non-verbal Communication 3
2. Background 4
3. Healthcare Communication Outcomes 5
3.1. Diagnostic Accuracy 5
3.2. Adherence 5
3.3. Patient Satisfaction 6
3.4. Patient Safety 6
3.5. Access 7
3.6. Prevention 7
3.7. Team Satisfaction 8
3.8. Consent 8
3.9. Malpractice Risk 9
4. Summary 10
5. References 12
1. Introduction
The quality of care (QoC) perceived by a patient during the medical encounter has implications for patient recovery and health maintenance. Patients who believe they have received poor QoC are less likely to adhere to doctor recommendations. A major influence on perceived QoC is the communication, both verbal and non-verbal, between the doctor and patient.
The …show more content…
medical interview is the portion of the interaction when the doctor assesses the patient 's symptoms and concerns. During the medical interview, a doctor must take note of the patient’s comments while continuing to listen and prompt the patient with more probing questions in order to elicit all potentially relevant health related information. Physicians have several options as to which note-taking medium to utilize. Traditionally, pen and paper have been used to jot down notes during the course of the examination. Alternatively, doctors may have chosen to make mental notes during the examination and to document these notes after exam completion
1.1. Doctor-Patient Interactions
Arguably, the interaction between doctor and patient during the medical consultation is the most critical point for transferring information and the delivery of excellent healthcare Bertakis, Roter, & Putnam, 1991; Ong, de HaeHoos, & Lammes, 1995; Russuvuori, 2001). The physician’s primary task is to become familiar with patient history while eliciting symptoms in a way that is meaningful. A secondary, but nearly as important, task is for the physician to connect with the patient. The doctor-patient interaction is the patient’s most salient feature on which to judge the QoC they receive. There are at least two aspects to healthcare quality: actual patient outcome (observable consequences due to a medical encounter); and perceived QoC (the patient’s personal judgment of the healthcare quality). Actual patient outcome can be measured in several ways including: adherence to doctor recommendations; recall of information given during consultation; and understanding of diagnosis (Ong et al.,1995). Perceived QoC is a good predictor of actual patient outcome (Ong et al.). Ong et al. report that patients evaluate their overall healthcare experience on their doctor’s interpersonal skills; skills which are interpreted through both verbal and (largely) non-verbal communication.
1.2. Verbal Versus Non-verbal Communication
Verbal communication consists not only of the spoken word, but also of verbal inflection, pauses in speech, and tone. Non-verbal communication has been operationalized as body positioning, posture, gaze, etc. These non-verbal components, or visual cues, make up approximately 80% of perceived interpersonal communication (Ong et al., 1995
Research evidence indicates that there are strong positive relationships between a healthcare team member’s communication skills and a patient’s capacity to follow through with medical recommendations, self-manage a chronic medical condition, and adopt preventive health behaviors. Studies conducted during the past three decades show that the clinician’s ability to explain, listen and empathize can have a profound effect on biological and functional health outcomes as well as patient satisfaction and experience of care.
2. Background
Patients’ perceptions of the quality of the healthcare they received are highly dependent on the quality of their interactions with their healthcare clinician and team. There is a wealth of research data that supports the benefits of effective communication and health outcomes for patients and healthcare teams. The connection that a patient feels with his or her clinician can ultimately improve their health mediated through participation in their care, adherence to treatment, and patient self-management.
Yet, it is estimated that less than half of hospitalized patients could identify their diagnoses or the names of their medication(s) at discharge, an indication of ineffective communication with their physicians.
The Institute of Medicine (IOM) Report on Health Professions and Training has identified that doctors and other health professionals lack adequate training in providing high quality healthcare to patients. The IOM called upon educators and licensing organizations to strengthen health professional training requirements in the delivery of patient-centered care. The patient-centered care model underscores the essential features of healthcare communication which relies heavily on core communication skills, such as open-ended inquiry, reflective listening and empathy, as a way to respond to the unique needs, values and preference of individual patients.
3. Healthcare Communication Outcomes
A clinician may conduct as many as 150,000 patient interviews during a typical career. If viewed as a healthcare procedure, the patient interview is the most commonly used procedure that the clinician will employ. Yet communication training for clinicians and other healthcare professionals historically has received far less attention throughout the training process than have other clinical tasks.
This is so even as evidence continues to mount that a structured approach to communication measurably improves healthcare delivery.
3.1. Diagnostic Accuracy
Most diagnostic decisions come from the history-taking component of the interview. Yet, studies of clinician-patient visits reveal that patients are often not provided the opportunity or time to tell their story / history, often due to interruptions, which compromise diagnostic accuracy. Incomplete stories /history leads to incomplete data upon which clinical decisions are made.
When interruptions occur, the patient may perceive that what they are saying is not important and leads to patients being reticent to offer additional information.
The bottom line is that when patients are interrupted, it is a deterrent to collecting essential information and it hinders the relationship.
3.2. Adherence
Adherence is defined as the extent to which a patient’s behavior corresponds with agreed upon recommendations from a healthcare provider. Certainly, we are all aware of the huge problem of non-adherence in health care. For instance, a Health Care Quality Survey conducted by the Commonwealth fund found that 25% of Americans report they did not follow their clinician’s advice and provides the reasons cited in this survey: 39% disagreed with what the clinician wanted to do (in terms of recommended treatment); 27% were concerned about cost; 25% found the instructions too difficult to follow; 20% felt it was against their personal beliefs; and 7% reported they did not understand what they were supposed to do
3.3. Patient Satisfaction
The core elements comprising patient satisfaction include: 1. Expectations (Providing an opportunity for the patient to tell their story), 2. Communication (patient satisfaction increased when members of the healthcare team took the problem seriously, explained information clearly, and tried to understand the patient’s experience, and provided viable options), 3. Control (Patient satisfaction is improved when patients are encouraged to express their ideas, concerns and expectations), 4. Decision-making (Patient satisfaction increased when the importance of their social and mental functioning as much as their physical functioning was acknowledged), 5.Time spent (Patient satisfaction rates improved as the length of the healthcare visit increases), 6.Clinical team (Although it is clear that the patient first concern is their clinician, they also value the team for which the clinician works), 7.Referrals ( Patient satisfaction increases when their healthcare team initiates referrals relieving the patient of this responsibility), 7.Continuity of care (Patient satisfaction increases when they receive continuing care from the same healthcare providers), 8. Dignity (As expected, patients who are treated with respect and who are invited to partner in their healthcare decisions report greater satisfaction).
3.4. Patient Safety
An estimated one-third of adverse events are attributed to human error and system errors. Research conducted during the 10 year period of 1995-2005 has demonstrated that ineffective team communication is the root cause for nearly 66 percent of all medical errors during that period. This means that when health care team members do not communicate effectively, patient care often suffers. Further, medical error vulnerability is increased when healthcare team members are under stress, are in high-task situations, and when they are not communicating clearly or effectively.
3.5. Access
There is compelling evidence that communication challenges have an adverse effect on initial access to health services. These challenges are not limited to encounters with physicians and hospital care. Patients face significant barriers to health promotion and disease prevention programs: there is also evidence that they face significant barriers to first contact with a variety of providers (Bowen, 2001). The research indicates that there is a general pattern of lower use of many preventive and screening programs by those facing language barriers (Woloshin et al., 1997). Higher use has been reported for some emergency department services, and for additional tests ordered to compensate for inadequate communication (Bowen, 2001).
3.6. Prevention
A number of studies focus on utilization of cancer screening programs. Fox and Stein (1991) found that the most important variable that predicted whether women of all racial groups had a mammogram was whether their doctors had discussed mammography with them. Hispanic women, compared to black or white women, were less likely to have physicians who discussed screening with them. Language preference (English versus Spanish) was strongly correlated with whether the physician discussed mammography with the woman or not. In a British study of participation in cervical screening programs by Naish et al. (1994), language and administration were seen to be barriers to participation by clients, not, as reported by physicians, lack of interest in prevention programs. Solis et al. (1990) found that language ability predicted the use of screening services. They suggested that the effect of language on screening practices was an access factor (i.e. proficiency in English increased access to service). In a study of health behaviour of older Hispanic women, Marks et al. (1987) found that the use of English language was associated most closely with increased use of screening programs.
In a Canadian study, Woloshin et al. (1997) analyzed self-reported utilization data on breast examination, mammography and Pap screening from the 1990 Ontario Health Survey. He found that French speakers were significantly less likely to receive breast examinations or mammography. These results persisted even when adjusted for social and economic factors, contact with the health care system, and measures of culture.
3.7. Team Satisfaction
Why is team satisfaction important? Communication among healthcare team members influences the quality of working relationships, job satisfaction and profound impacts patient safety. When communication about tasks and responsibilities are done well, research evidence has shown significant reduction in nurse turnover and improved job satisfaction because it facilitates a culture of mutual support. Larson and Yao found a direct relationship between clinicians’ level of satisfaction and their ability to build rapport and express care and warmth with patients. What are the elements that contribute to healthcare team satisfaction: Feeling supported, e.g., administratively and inter-personally, respected, valued, understood, listened to, and having a clear understanding of role, work equity and fair compensation.
3.8. Consent
Consent to treatment is a fundamental pillar of quality of care. Legislation protects patients from procedures for which they have not provided informed consent. Furthermore, the common law in Canada provides that where a patient does not speak an official language, the physician must ensure that the patient understands the information that is communicated before administering treatment. For example, in Anan vs. Davis, a refugee was sterilized after she consented to what she thought was a procedure to treat an infection that had occurred after birth. The ruling in this case concluded that the duty to ensure the patient understood the information included an obligation to be attentive to the language ability of the interpreter, and to ensure that the patient was returning reasonable and responsive replies. In Korollos vs. Olympic Airways, a physician obtained consent from a family member over the telephone for a patient’s surgery. The family member later stated that he gave consent only because he misunderstood the urgency of the situation. The court concluded that the duty of the doctor extended beyond communication of the facts, but also required a positive duty on the doctor to ensure that the patient actually understood the information (Bowen, 2001).
3.9. Malpractice Risk
According to Huntington and Kuhn, the “root cause” of malpractice claims is a breakdown in communication between physician and patient. Previous research that examined plaintiff depositions found that 71% of the malpractice claims were initiated as a result of a physician-patient relationship problem. Closer inspection found that most litigious patients perceived their physician as uncaring. The same researchers found that one out of four plaintiffs in malpractice cases reported poor delivery of medical information, with 13% citing poor listening on the part of the physician.
4. Summary
Communicating effectively with patients and families is a cornerstone of providing quality health care. The manner in which a health care provider communicates information to a patient can be equally as important as the information being conveyed. Patients who understand their providers are more likely to accept their health problems, understand their treatment options, modify their behavior and adhere to follow-up instructions. If the single most important criterion by which patients judge us is by the way we interact with them, it stands to reason that effective communication is at the core of providing patient-centered care.
Research evidence indicates that there are strong positive relationships between a healthcare team member’s communication skills and a patient’s capacity to follow through with medical recommendations, self-manage a chronic medical condition, and adopt preventive health behaviors. Studies show that the clinician’s ability to explain, listen and empathize can have a profound effect on biological and functional health outcomes as well as patient satisfaction and experience of care. Further, communication among healthcare team members influences the quality of working relationships, job satisfaction and has a profound impact on patient safety.
Clinicians and other members of the healthcare team conduct thousands of patient interactions during their career. The call to action from the Institute of Medicine (IOM) Report on Health Professions and Training underscores the importance of communication training for clinicians and members of the healthcare team. Similar to other healthcare procedures, communication skills can be learned and improved upon. Improvement in communication skills requires commitment and practice.
Given the wealth of evidence linking ineffective clinician-patient communication with increased malpractice risk, non-adherence, patient and clinician dissatisfaction, and poor patient health outcomes, the necessity of addressing communication skill deficits is of the utmost importance.
Since the products of healthcare systems are services, measuring healthcare quality must extend beyond clinical measures to also incorporate patient perceptions and experiences. In general, service quality is believed to be measured by five dimensions which are tangibles, reliability, responsiveness, assurance, and empathy. Previous studies have suggested adding usability which could be translated as ease of use as the sixth dimension. The definition of quality from a patient 's point of view is usually seen as the outcome of his/her treatment and communication with the healthcare system. As a result, we recommend adding communication between the healthcare system and patient as the seventh dimension of service quality.
5. References
1. Asnani MR. (2009). Patient-physician communication. WestIndian Med J, 58(4):357-61. pubmed
2. Clark, P. A. (2003). Medical practices’ sensitivity to patients’ needs: Opportunities and practices for improvement. Journal of Ambulatory Care Management, 26(2), 110-123. pubmed
3. Wanzer, M. B., Booth-Butterfield, M. & Gruber, K. (2004). Perceptions of health care providers’ communication: Relationships between patient-centered communication and satisfaction. Health Care Communication, 16(3), 363-384. pubmed
4. Duffy, F. D., Gordon, G. H., Whelan, G., Cole-Kelly, K., & Frankel, R. (2004). Assessing competence in communication and interpersonal skills: The Kalamazoo II report. Academic Medicine, 79, 495-507. pubmed
5. Heisler, M., Bouknight, R. R., Hayward, R. A., Smith, D. M., & Kerr, E. A. (2002). The relative importance of physician communication, participatory decision-making, and patient understanding in diabetes self-management. Journal of General Internal Medicine, 17, 243-252. pubmed
6. Renzi, C., Abeni, D., Picardi, A., Agostini, E., Melchi, C. F., Pasquini, P., Prudu, P., & Braga, M. (2001). Factors associated with patient satisfaction with care among dermatological outpatients. British Journal of Dermatology, 145, 617-623. pubmed
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