UDM Solutions

Open and thorough patient-clinician communication is important both for efficacy of treatment and efficiency of office visits. Certain barriers can impede this. For patients, these barriers may be psychosocial factors such as personality, beliefs, socio-economic status and/or conceptions about their treatment. Additionally, patients can underestimate their own importance in the outcome of their pharmacotherapy. While certain psychosocial dynamics can also be a factor for clinicians, a commonly cited communication barrier is a lack of time. Studies and research have sought to address these issues in communication by developing methods to improve the clinician-patient relationship. By incorporating these methods with the use of laboratory diagnostics, medical history and pharmacogenetic data, clinicians are able to enhance the quality and efficiency of health care through more accurate diagnostics, improved patient adherence, increased patient satisfaction and decreased malpractice litigations.

Some patients may refrain from openly communicating with their clinicians out of fear that they will be perceived negatively. As demonstrated my blog entitled “Real-Life Opportunities to Improve Pharmacotherapy,” patients may endure needless pain because they do not want to “upset” anyone or be viewed as “a difficult patient.” Patients should understand that by telling us how they are responding to treatment they are contributing in a proactive manner that is important to individualize and improve their pharmacotherapy. The following ideas may help us to portray this to patients:

1. Build Trust and Encourage Open Communication: According to a comprehensive review of studies on patient-clinician communication and relationships, “A warm greeting, eye contact, a brief non-medical interaction, or checking on an important life event can build rapport in less than 1 minute.”¹ These gestures improve the course of treatment for both clinician and patient by developing a mutually beneficial relationship; and, they require virtually no additional time the office visit.
2. Understand Patients as Individuals: Empathizing with our patients’ concerns about their treatments and understanding them as individuals allows us to take into account what psychosocial factors may be affecting their pharmacotherapy. This in turn improves our ability to create a pharmacotherapy that is specific to them, enhancing its efficacy and reducing the need for future adjustments.
3. Ensure that Patients Understand Their Treatment: Clinicians can take a preventative approach to improving adherence by eliminating confusion (e.g., complex regimens) and helping patients understand all aspects of their treatment. Opening up this dialogue also aides in creating an environment where patients can candidly discuss any other factors affecting adherence.
4. Offer Suggestions to Improve Communication: As clinicians, we can also offer patients suggestions to improve communication, such as writing down their questions before they come to their office visit. This helps assure that all of their concerns are addressed, reiterates the importance of their active role in their treatment, and ensures that the office visit is utilized most effectively.

Better communication leads to better treatment, and neither requires any extra time. In effect, establishing an open and communicative patient-clinician relationship can save future time spent adjusting and making changes from miscommunication or factors affecting adherence that could have been addressed if communicated initially. Psychosocial factors or concerns about how their clinician perceives them may inhibit some patients from openly communicating with their clinician. Alleviating these concerns can help to create an environment where patients feel comfortable disclosing all information pertinent to their pharmacotherapy and can help patients to understand the importance of doing so. Employing empathy and education strengthens the patient-clinician relationship and results in better treatment and more satisfied patients. Patient satisfaction has been shown to decrease malpractice litigations. Information provided by patients regarding the effects of their treatment can be used with laboratory diagnostics, medical history and pharmacogenetic data to further individualize pharmacotherapy and improve the quality of health care.

1. Roxanne Nelson and Charles Vega MD, Improving Communication Skills Enhances Efficiency and Patient-Clinician Relationship. Medscape Medical News 2008.