ALBANY, N.Y., June 15 (UPI) -- Not a day goes by that we are not encouraged in the media or advertisements to discuss new medications or treatments with our doctors, but that can be difficult within a 15-minute appointment.
And time is not the only constraint limiting communication with healthcare providers. Numerous studies show barriers to communication due to gender, age, manner and conversational style, not to mention a string of taboo subjects including mental health, alternative treatments, medical costs and dying that neither doctor nor patient feels conformable discussing.
In the old days, the doctor/patient/caregiver communications wasn't a big issue because the usual model was the doctor gave orders and the patients did as instructed.
"Things have changed -- today we tell people to ask the healthcare provider what kind of medication is being prescribed and for what purpose. A nurse told me that when she started, if a patient in the hospital asked what the medication was for, she was instructed to say, 'doctor's orders,'" Dr. Vicki Rackner of Mercer Island, Wash., co-author of "Chicken Soup for the Soul Healthy Living Series: Heart Disease" and author of "The Biggest Skeleton in Your Doctor's Closet," told UPI's Caregiving.
"In the 'Leave it to Beaver' era doctors told patients what to do and patients rarely countered doctors."
Many studies say that communication and trust are key for patients seeking medical care. For example, researchers at Baylor College of Medicine in Houston found doctors skilled in communicating with patients do much better when it comes to treating the rheumatic diseases.
Patient-centered communication helps build trust between doctor and patient -- a key factor in promoting improved quality of life, compliance with treatment and better health outcomes, according to the study published in the June issue of Arthritis Care & Research.
Doctor/patient/caregiver communications can be stymied by a series of issues. For example, gender: A U.S. study found teenage boys say they feel uncomfortable talking to a female doctor, while a study in Britain found teen pregnancy rates were significantly lower in areas with clinics staffed by young female physicians.
Another study found female primary-care physicians spend more time with their patients and engage in more positive, social and emotionally focused talk than their male colleagues, according to researchers at the Johns Hopkins Bloomberg School of Public Health and Northeastern University.
"Our review found that female physicians more often engage in communication that we would consider more patient-centered and broadly relates to the larger life context of the patient's conditions," said lead author Debra L. Roter.
Time is another barrier. Researchers at the universities of Wisconsin at Madison and North Carolina at Chapel Hill questioned 6,100 U.S. doctors; while both sexes reported feeling strong time pressure, women doctors said they were allotted about five minutes less per new patient than men doctors.
"Our most important finding is the extent to which not having enough time corresponds with physician frustration in their jobs," said Dr. Thomas R. Konrad of the University North Carolina. "Women physicians especially are under a lot of pressure because they tend to attract patients with more complex psychosocial problems who need a sympathetic ear and also because they often are mothers of young children themselves."
Increasingly, we are asking physicians to do preventive health care, but these services take time that doctors often don't feel they have, according to Konrad.
Then there are the taboo topics.
For example, a British study found doctors have trouble talking to patients about psychotic symptoms and doctors tended to hesitate and avoid answering the patients' questions.
A five-year University of California at San Francisco study found only a third of women with breast cancer disclosed using alternative treatment to their doctors. The most frequently cited reason for lack of disclosure was the feeling that the physician was not interested in the patient's use of alternative medicine; unresponsiveness was taken as a sign that the physician did not want to hear more about the patient's practices.
And yet, because alternative or complementary medicine can affect the patient's treatment, patients are advised to tell their doctor.
Although patients and physicians agree that discussion of out-of-pocket costs is important, researchers from the University of Chicago have found that these discussions rarely occur. Sixty-three percent of patients felt the need for such talks, but only 15 percent reported that they discussed costs with their doctors.
Issues of quality of life and dying are also often taboo.
"Doctors want to cure and many take how the patient is doing as a reflection on them -- if the patient is doing well than the doctor is doing well. And I think patients know this and often they give the doctor information to make them and the doctor look good," said Rackner.
"I believe we like to think that health-related decisions are made out of logic -- but fear of death, pain and loss of independence can result in visceral responses in patient and doctor. And some doctors don't like being around people they can't cure."
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Next: How to enhance doctor/patient/caregiver communication
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Alex Cukan is an award-winning journalist, but she always has considered caregiving her primary job. UPI welcomes comments and questions about this column. E-mail: [email protected]
