Improving Medical Communication
About this Challenge:
Physicians are not typically trained in interpersonal communications and are not rewarded based on their communication skills.
Equally important, patients are often intimidated when talking to doctors and often feel they don’t have a receptive audience, especially when doctors are rushed. What can be done about this on both sides of the challenge (patients and doctors) — including possible initiatives in areas ranging from education to technology, to possible changes in the physical workspace? How do we make this issue a priority?
Meet the Challenge Team
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Robert M. Arnold, M.D., is a Professor in the Division of General Internal Medicine, Department of Medicine at the University of Pittsburgh and in the University of Pittsburgh Center for Bioethics and Health Law. He completed his medical school training at the University of Missouri-Kansas City and residency at Rhode Island Hospital. Subsequently he has been on the faculty at the University of Pittsburgh. In 2000, Dr. Arnold was named the first Leo H. Creip Chair of Patient Care. The chair emphasizes the importance of the doctor-patient relationship, particularly at the end of life. He is the Director of the Institute for Doctor-Patient communication and the Co-Director of the Institute to Enhance Palliative Care. He is clinically active in palliative care.
Dr. Arnold has published on end-of-life care, hospice and palliative care, doctor-patient communication and ethics education. His current research interests are focused on educational interventions to improve communication in life-limiting illnesses and better understanding of how ethical precepts are operationalized in clinical practice. He is the Past-President of the American Society of Bioethics and Humanities as well as the American Academy of Hospice and Palliative Medicine.
I have spent most of my life in medical education focusing on teaching physicians to communicate with seriously ill patients. Doing this has convinced me that most physicians want to develop good relationships with their patients. I think people often do not understand how hard physicians’ work or how much they care for their patients.
On the other hand, I also understand how complicated the medical system is and how frustrating it is for patients and their families. I also understand that doctors can forget how foreign the medical system is or make the experience worse by speaking in an unintelligible medicalized language.
Selma Caal, Ph.D. is an applied developmental psychologist and a Research Scientist at Child Trends. Her current research focuses on qualitative research methodology examining the reproductive health behaviors of young adults, particularly of racial/ethnic minorities. She is the lead researcher for a qualitative study looking at the decision-making process to prevent unintended pregnancies and STD contraction among African-American couples. She is also conducting two qualitative studies, one of which focuses on identifying barriers and facilitators to accessing family planning services among Hispanics. The second study examines the use of Natural Family Planning methods and fertility awareness among black and Hispanic women. Dr. Caal also has experience in program evaluation, examining impact and process data. As part of her work, she is an expert in translating study findings into recommendations for stakeholders for program implementation and service delivery improvement. In addition to her research experience, Dr. Caal has substantive experience working with diverse individuals, particularly Latino and African-American, in both research and practice.
Working with underrepresented populations in research and practice, I have witnessed that some individuals do not receive health care services because they often face many barriers. Some barriers are practical, such as lack of health insurance, lack of transportation, and lack of childcare. Other barriers might arise due to the cultural mismatch the patients encounter within the health care system. While providers may want to diminish the practical barriers patients face, health care organizations might have to commit to large financial investment to do this. However, efforts to minimize cultural barriers between provider and patient do not have to involve large financial investments.
In his role as President and CEO of Visible Health, John is primarily responsible for establishing vision, developing market and business development strategy, and managing marketing, business development, and sales functions. He is an enthusiastic healthcare product strategist, building on years of experience as a product manager and product strategist in healthcare, internet, and enterprise software markets.
Prior to the founding of Visible Health, John was the President and CEO of Escalation Point, a healthcare product strategy, design and development consultancy in Austin, Texas and led the effort for drawMD. At Escalation Point, John had built a team of dedicated marketing, design, and engineering professionals focused on providing user-centric mobile and web applications for individual and corporate entrepreneurs, including McKesson and The Advisory Board Company. Prior to Escalation Point, John served in a variety of managerial and operational roles with Between Markets, Coremetrics, and Trilogy Software.
John holds Masters and Bachelors degrees in Biomedical Engineering from the University of Texas and the University of Southern California, respectively, as well as an M.B.A. from the UCLA Anderson School. He resides in beautiful Austin, Texas, where he enjoys time with his family, running, poker, and someday hopes to take up golf.
In my roles at Visible Health and Escalation Point, I am fortunate to work closely with physicians and other clinical entrepreneurs who believe that technology can help cultivate collaborative relationships between clinicians and patients. There are a number of challenges in my day-to-day experiences with clinical entrepreneurs – bridging knowledge gaps, learning each other’s languages, being clear about expectations – that parallel the challenges that clinicians and patients face in their efforts to work more as a team. We believe that technology – by supporting the creation, capture, and communication of clinical context before, during and after interactions between providers and patients – will make this collaboration possible to the benefit of the individuals involved as well as the healthcare system as a whole.
Barbara Ficarra, RN, BSN, MPA is founder of Healthin30.com, award-winning broadcast journalist, featured writer for The Huffington Post, health educator and health advisor. She is on the front lines of health care as a registered nurse and a leading nurse voice in health focusing on patient engagement and empowerment, healthy living, health care social media, digital technology (mobile health, gamification, telemedicine), and the doctor-nurse team.
Ficarra began her broadcasting career in radio as creator, host and executive producer of the award-winning Health in 30® radio show. She is a member of the editorial advisory board and is a consumer health expert at Sharecare.com, and is the former senior director of clinical affairs for a telehealth company. She is a contributor to other health sites, medical blogger, freelance writer, and has been quoted as an expert in health care for multiple journals and magazines and has appeared on FOX News Live.
Ficarra speaks internationally on issues surrounding health care focusing on patient engagement and empowerment, health care social media networking, digital technology and professional development. She served as faculty for the American Medical Association’s Medical Communications Conferences. She served on the board of the National Association of Medical Communicators, and served on the Academy of Judges for the International Health and Medical Media Awards. She is President of Barbara Ficarra Productions, LLC and is she is consultant, moderator, and media trainer. Healthin30 was voted Best Health Blog 2011 by Healthline.
[@BarbaraFicarra |Healthin30.com | http://healthin30.com/ | http://www.facebook.com/Healthin30 ]
As a registered nurse, writer, broadcast journalist, and health educator, I’m dedicated to deliver accurate, reliable and trustworthy health and medical information. I’m committed to encourage patients and consumers to be proactive, engaged and in charge of their health. I share a nurses inside perspective on healthy living and personal health, and I sort through the latest research and provide consumers with relevant information without any of the confusing medical jargon. I’m also recognized in the professional arena and I speak internationally on the topics of digital technology (telemedicine, gamification and mobile health), health care social media networking, and patient engagement and empowerment.
He graduated magna cum laude and Phi Beta Kappa from Columbia College, went on to the Albert Einstein College of Medicine and the Memorial Sloan Kettering Cancer Center. Board certified in Internal Medicine and Gastroenterology he was an assistant professor of clinical medicine at Columbia and Einstein. During his teaching years, he published scholarly articles in a number of medical journals. His work was referenced by two major textbooks of Internal Medicine and Epidemiology.
He founded and managed one of New York’s largest GI practices until he left clinical care to write his book, Doctor, Your Patient Will See You Now (Rowman & Littlefield, 2011) His book was reviewed by The New York Times and was cited as one to the top ten health and wellness titles of 2011.
Dr. Kussin’s web site, MedicalAdvocate.com has an international following.
His proudest accomplishment is being the father of Zachary and Efrem and the life partner of his sweetheart, Annie McGuirl. They have homes in central New York and Manhattan.
Forty years in medicine is a long time. But it took two life threatening personal experiences to end my clinical years. The time I spent both as a physician and a patient inspired me to write my book and to open a Shared Decision Center. What was my goal? To help correct the communication blackout that exists today between providers and health care consumers.
Joseph C. Kvedar, M.D., Founder and Director of the Center for Connected Health, Partners HealthCare, is creating a new model of healthcare delivery, developing innovative strategies to move care from the hospital or doctor’s office into the day-to-day lives of patients.
Dr. Kvedar is leveraging information technology – cell phones, computers, networked devices and remote health monitoring tools – to improve care delivery. Based on the technology platform developed at the Center, Healthrageous, a personalized health technology company, was launched in 2010, creating a range of health and wellness self-management programs. He is a Co-Founder and Chair of the company’s Scientific Advisory Board. Dr. Kvedar established the first physician-to-physician online consultation service in an academic setting, linking patients from around the world with specialists at Harvard-affiliated teaching hospitals.
He is internationally recognized for his leadership and vision in the field of connected health, and has authored over 90 publications on the subject. Dr. Kvedar serves as a Board member for a number of organizations, including Care Continuum Alliance. He serves as a strategic advisor at Physic Ventures and West Health Institute, and is a mentor at Blueprint Health and Rock Health, providing guidance and insight to developing companies.
I have launched dozens of research studies and clinical programs using information technologies to help providers and patients manage chronic conditions, maintain health and wellness, and improve adherence, engagement and clinical outcomes. From a virtual relay race to get inner city kids more active, to remote monitoring for our sickest patients with heart failure, I focus on integrating these tools into clinical workflow and into the day-to-day lives of patients.
As a practicing physician, I conduct virtual visits with my patients and have seen, first hand, how personalized connected health strategies can change behavior, enhance patient self-care and improve outcomes.
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26 Comments
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Timothy Landers: One of the problems is that there are so many providers involved in the care of patients -- especially those with complex needs. Primary nurses, attending physicians, facility staff, consulting physicians, therapists, residents, nurse practitioners, technicians can all interact with a patient over the course of treatment.
I thought that the TED MED app and its ability to track a "network" of contacts -- including photos, name, and title -- would be an innovative way to capture contacts for patients as well. A patient-directed system could also show a "social network" of health care providers seen by a patient including contact information for the professionals. -
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Tina Munjal: Really appreciate Dr. Robert Arnold's honest response to question 1 on the complexity of medical communication. Each patient is unique and each clinician is unique. Teaching the next generation of physicians how to build rapport with their patients over time is essential to remediating this problem. As a first-year medical student, I've had the opportunity to experience a curriculum that emphasizes the patient-doctor relationship and patient-centered care from the beginning, and I've noticed that this approach, coupled with lots and lots of early patient contact, has given me the confidence and flexibility by which to communicate effectively with diverse patients to facilitate shared decision-making (a concept that Dr. Joseph Kvedar discusses in his response to question 3). Enforcing this paradigm early in the medical education pipeline and allowing students to interact with patients from the beginning--while the students are still fresh and open-minded--is a huge first step.
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Daniel Penn: Are there tools out there that give automatic feedback to physicians on how to deal with certain diagnosis. From my experience health care professionals are starting to worry about the amount of data they are collecting and if they are liable when that data is collected. Almost going as far as a don't ask policy.
I would be really curious what feedback/resources to both physicians and patient are available and how easily they could be created. -
Daniel Penn: Our product, TickiT, helps solve many of these issues by using an interactive interface that is friendly and easy for patients while being clear and simple for physicians.
Our biggest issue is integrating into EMR systems which are not built to utilize the innovative communication tools that are currently available. Sadly I don't believe this data will ever reach the physician without the integration.
I would love to know if others are having the same realization.
Daniel
www.tickitforhealth.com
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Steven Aronoff: It has been said that the patient-doctor relationship has evolved from one that is top down to one in which the doctor and the patient are partners in treating the patient's illness. This results in a system that resembles one that blames the victim. The patient cannot know all that the doctor does. He or she may not be the best at formulating the most pertinent questions. During a patient's treatment, physician input is not the only input generated. The patient hears from technicians, nurses, physician assistants, friends, and family. Then what is one to do?
A physician should never expect that the patient will be able to come up with the most erudite and perceptive questions. In any event, it's much like reinventing the wheel. Thousands and millions of patients have already "invented" much of this. It is up to the physician to provide the patient with a baseline understanding of his or her ailment and what the important questions (and answers) are. Long ago these ought to have been summarized and made available to the patient from the start. -
Steven Aronoff: It has been said that the patient-doctor relationship has evolved from one that is top down to one in which the doctor and the patient are partners in treating the patient's illness. This results in a system that resembles one that blames the victim. The patient cannot know all that the doctor does. He or she may not be the best at formulating the most pertinent questions. During a patient's treatment, physician input is not the only input generated. The patient hears from technicians, nurses, physician assistants, friends, and family. Then what is one to do?
A physician should never expect that the patient will be able to come up with the most erudite and perceptive questions. In any event, it's much like reinventing the wheel. Thousands and millions of patients have already "invented" much of this. It is up to the physician to provide the patient with a baseline understanding of his or her ailment and what the important questions (and answers) are. -
Steven Aronoff: It has been said that the patient-doctor relationship has evolved from one that is top down to one in which the doctor and the patient are partners in treating the patient's illness. This results in a system that resembles one that blames the victim. The patient cannot know all that the doctor does. He or she may not be the best at formulating the most pertinent questions. During a patient's treatment, physician input is not the only input generated. The patient hears from nurses, physician assistants, friends, and family. Then what is one to do?
A physician should never expect that the patient will be able to come up with the most erudite and perceptive questions. In any event, it's much like reinventing the wheel. Thousands and millions of patients have already "invented" much of this. It is up to the physician to provide the patient with a baseline understanding of his or her ailment and what the important questions (and answers) are. -
Sally James: I don't see any mention here of reimbursement (and ICD9 code) for communication. I believe we have evidence-based outcome measurement that suggests talking to patients can improve their health. Why can't we put the money where that mouth is and reimburse for the time that providers spend with patients?
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Question 1
What are the top 10 contributing factors that result in medical communication being a complex and difficult problem for patients, doctors, the medical establishment and society in general…and how do these factors interact?Discussion Policy
Discussion Policy
- The TEDMED Community is offered as a free public service to promote discussion on the future of Health and Medicine.
- Any “Submission” made is of the opinion of the community member who posted it and does not, in any way, reflect the views or opinion of TEDMED.
- In making a Submission, you agree that you will not violate any trademark or copyright laws. You agree and acknowledge that TEDMED does not represent any rights to the Submissions.
- As a member of the TEDMED community, we encourage you to share your knowledge, information and opinion. In making a Submission, you agree that such submission is made in a professional manner with the purpose of furthering or expanding discussion on TEDMED.com.
- As a member and participant of TEDMED.com, you also agree to respect the Submissions of your fellow TEDMED community members and allow for equal opportunity and participation.
- In making a Submission you consent to the right of TEDMED to expand or edit any Submission and we may contact you to discuss further.
- TEDMED has the right to remove, in its sole discretion, any Submission made that does not represent or encourage a professional and communal environment.
- TEDMED has the right to indefinitely suspend, in its sole discretion, any account for members registered at TEDMED.com.
6 Comments
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Daniel Penn: Our product, TickiT, helps solve many of these issues by using an interactive interface that is friendly and easy for patients while being clear and simple for physicians.
Our biggest issue is integrating into EMR systems which are not built to utilize the innovative communication tools that are currently available. Sadly I don't believe this data will ever reach the physician without the integration.
I would love to know if others are having the same realization.
Daniel
www.tickitforhealth.com
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Sally James: I don't see any mention here of reimbursement (and ICD9 code) for communication. I believe we have evidence-based outcome measurement that suggests talking to patients can improve their health. Why can't we put the money where that mouth is and reimburse for the time that providers spend with patients?
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Sally James: I don't see any mention here of reimbursement (and ICD9 code) for communication. I believe we have evidence-based outcome measurement that suggests talking to patients can improve their health. Why can't we put the money where that mouth is and reimburse for the time that providers spend with patients?
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Hayman Buwaneswaran Buwan: In addition, for effective medical communication and care management one needs to know the 'goals' of patients. That way clinicians are more focused in their care and there is no misunderstanding or unfulfilled wants and needs from a patient's perspective. Some of the miscommunication seems to stem from this mismatch.
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Amy Lynn Smith: I write frequently about physician-patient communication (mostly for consumer audiences), but often find the advice from experts is boilerplate -- which only underscores the problem. Patients can tell when they're not getting personalized advice, which either diminishes trust or discourages further questions. How can patients encourage their physicians to communicate more clearly? What kinds of questions/approaches will motivate physicians the most?
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John Cox: Hi Amy. I couldn't agree more about the importance of personalization. That's one of the key factors for the success of our drawMD apps - helping physicians personalize the information and experience for their patients.
I would say that patients could best encourage physicians to communicate by being prepared to ask intelligent questions and express interest in their care. It's a positive feedback cycle - understanding creates interest, interest creates more questions, questions result in answers, and answers lead to more understanding!
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Responses By Team Member:
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 | MODERATOR: Emily Paulsen is a DC-based writer and editor specializing in health and healthcare topics. Her special interests including patient education, healthcare communications, health information technology, and improving the healthcare experience for patients and professionals alike. Learn more about Emily here. Follow him on Twitter @: eapwriter. |
Participants:
Robert Arnold, MD, Selma Caal, MD, John Cox, Barbara Ficarra, RN, BSN, MPA, Steven Kussin, MD, Joseph Kvedar, MD
Meet the Team