The first purpose of clinical medicine, Dr. William J. Donnelly quotes, is
to relieve human suffering.1 Why, then, does the education and practice of mainstream medicine say almost nothing about patient suffering, other than pain relief?
Continue Reading “Thursday Review: “Taking Suffering Seriously: A New Role for the Medical Case History””
What would a consultation look like if a patient were able to voice all of their concerns? Asked in a different way, how can we quantitatively demonstrate the benefits of a consultation where a patient is allowed to simply speak freely?
Writing in The Journal of the American Medical Association, Dr. M. Kim Marvel et al. give some rich detail and answers. They use a slightly different approach to “agenda” than Barry et al. did in their work on unexpressed patient agenda items. This paper, though, comes to the same general conclusion: that being intentional about hearing all that a patient has to say makes healthcare more effective, not less.
One of the most important concepts of my training in storytelling is one of the most overlooked.
The technical term is “The Space Between”. The idea is that one force alone is uninteresting, if not meaningless. It has to act with or against something else to be interesting and meaningful. This is a way of realizing that a story happens not because one person does something, but because a person does something to someone else. The Space Between, then, changes our thinking. Storytelling isn’t based on individuals, but is focused on the literal empty space between characters.
In the discussions about how to bring the humanities into medicine, one essential feature often gets lost. The attempts to make care more human and more humane aren’t being done for the sake of warm fuzzies. There are concrete ways medical outcomes suffer when healthcare practitioners and patients aren’t communicating well.
Writing in The BMJ, Christine A. Barry, et al. provide one of the clearest discussions on medical outcomes suffering from ineffective communication, and why both patients and doctors are hesitant to change communication for the better.
Continue Reading “Thursday Review: “Patients’ unvoiced agendas in general practice consultations: qualitative study””
In a section of the BMJ under the header How To Do It, Ian Christopher McManus, Charles A. Vincent, S. Thom, and Jane Kidd offer practical advice from their experiences teaching communications to students at St. Mary’s Hospital Medical School.
I’m certainly not running a medical school, but there are still some interesting, practical ideas to be gleaned from the authors’ experiences.
Continue Reading “Thursday Review: “Teaching communication skills to clinical students””
I read Dr. Michael E. Porter’s article in The New England Journal of Medicine a number of years ago. At the time, I was interested in concrete ways to talk about value and effectiveness in healthcare. Rereading it now, it strikes me that Porter provides a framework not only for those ideas, but also a template for having difficult conversations with patients.
The big idea in the paper is that value boils down to a simple equation:
Value = Outcomes / Costs
Dr. Moira A. Stewart, writing in the 1995 Canadian Medical Association Journal, writes that although there had been reviews of data exploring the
relation between communication and patient satisfaction,1 which
linked communication with quality of care,2 and others exploring the theory of physician-patient communication or how medical education could incorporate these ideas, none specifically looked at the relationship between communication and health outcomes.
Continue Reading “Thursday Review: “Effective Physician-Patient Communication and Health Outcomes””
The Quiet Burnout Bombshell
One of the major ideas behind medical storytelling is that better physician-patient communication yields better results.1 Writing in the Journal of General Internal Medicine, Dr. Neda Ratanawongsa, Dr. Debra Roter, Dr. Mary Catherine Beach, Shivonne L. Laird, Susan M. Larson, Kathryn A. Carson, and Dr. Lisa A. Cooper make a completely rational assumption:
[W]e hypothesized that professional burnout would diminish physicians’ inclination or ability to engage in rapport-building with their patients during routine medical visits. As secondary outcomes, we hypothesized that higher levels of burnout would be associated with less positive affect by physicians and patients, less patient-centeredness, shorter visit lengths, greater verbal dominance by physicians, and more negative patient ratings of satisfaction, trust, and confidence in their physicians.
It’s a kind of quiet bombshell, then, that after a survey of physician and patient interactions,
no differences were evident in the rapport-building behaviors of physicians relative to their burnout scores.
Continue Reading “Thursday Review: “Physician Burnout and Patient-Physician Communication During Primary Care Encounters””