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.
Using a search of MEDLINE, Stewart gathered data from a broad collection of studies published from 1983 to 1993 in order to determine whether communication had any actual bearing on health outcomes.
The studies which eventually qualified for the review were classified as investigating one of three categories:
- the communication of patients to doctors as a history was taken,
- the communication of doctors to patients as the “discussion of the management plan”, and
- other aspects of communication.
There were only four studies in the “other” category. The other two categories, though, had overwhelming results. Among the eight history-taking studies,
seven obtained significant positive findings and one a negative (nonsignificant) result. Of 15 studies of the discussion of treatment, 13
found significant correlations between communication interventions or variables and patient health outcomes.
No clear indication emerged from the four “other” studies.
Interestingly enough, studies looking at both history-taking and treatment discussions confirmed the same effects of the role of clear communication:
…both physician and patient education [on communication] were found to improve patient health outcomes. Physician education was demonstrated to affect the patient’s emotional status, whereas patient education was demonstrated to affect physical health…
This survey of communication studies is designed to track communication moving in one direction, which we know isn’t strictly how communication works. Although the results are separated according to the theoretical direction of communication, it’s easy to see how the results dovetail into one another and compliment each other. Stewart summarizes the effects of improved communication into several tables:
Table 3: Elements of effective history-taking Element Patient outcomes affected Physician Asks many questions about the patient’s understanding of the problem, concerns, and expectations, and about his or her perception of the impact of the problem on function Patient anxiety3 and symptom resolution4 … … Patient … … Perceives that a full discussion of the problem has taken place Symptom resolution5
Table 6: Elements of effective discussion of the management plan Element Patient outcomes affected … … Patient is successful at obtaining information Functional6, 7 and physiologic8, 9 status … … Physician gives clear information along with emotional support Psychologic distress,10 symptom resolution,11 blood pressure12 … …
Educating patients to communicate more effectively is a worthy goal. It’s also true that the physician can be a huge help to facilitating communication with the patient. The ways that patients affect their health outcomes are similar to the ways that physicians can positively affect their patients’ health outcomes.
This article is interesting because it points the way to what would become the Narrative Medicine movement in the early 21st century. Better communication is an end to better patient physical and psychological wellness. It is also a means to make the experience of being ill and seeking more human and less of a power struggle:
As well, agreement between physician and patient was found to be a key variable that influenced outcomes.13, 14 In my view, such agreement implies that decision making was a shared, egalitarian process. [The results of the studies] together debunk the myth that the only alternative to the physician’s total control of power in the therapeutic relationship is his or her total abdication of power. They indicate that patients do not benefit from the physician’s abdication of power but, rather, from engagement in a process that leads to an agreed management plan.
It’s undoubtedly true that patients can communicate better. The onus, though, is on the healthcare professional to seek out both the emotions of the patients and frank, open discussion of what the next steps are.
The article reviewed: Stewart, M. A. “Effective Physician-Patient Communication and Health Outcomes: A Review.” CMAJ: Canadian Medical Association Journal = Journal de l’Association Medicale Canadienne 152, no. 9 (1995): 1423–33.
1 Roter, Debra L., and Judith A. Hall. Doctors Talking with Patients/Patients Talking with Doctors: Improving Communication in Medical Visits. Westport, CT: Auburn House/Greenwood Publishing Group, 1992. ↑
2 Bensing, J. “Doctor-Patient Communication and the Quality of Care.” Social Science & Medicine 32, no. 11 (1991): 1301–10. ↑
3 Evans, B. J., F. D. Kiellerup, R. O. Stanley, G. D. Burrows, and B. Sweet. “A Communication Skills Programme for Increasing Patients’ Satisfaction with General Practice Consultations.” The British Journal of Medical Psychology 60 (Pt 4) (December 1987): 373–78. ↑
4 Heszen-Klemens, I., and E. Lapińska. “Doctor-Patient Interaction, Patients’ Health Behavior and Effects of Treatment.” Social Science & Medicine 19, no. 1 (1984): 9–18. ↑
5 Headache Study Group of The University of Western Ontario. “Predictors of Outcome in Headache Patients Presenting to Family Physicians—a One Year Prospective Study.” Headache: The Journal of Head and Face Pain 26, no. 6 (June 1, 1986): 285–94. https://doi.org/10.1111/j.1526-4610.1986.hed2606285.x. ↑
6 Greenfield, Sheldon, Sherrie Kaplan, and John E. Ware. “Expanding Patient Involvement in Care.” Annals of Internal Medicine 102, no. 4 (April 1, 1985): 520. https://doi.org/10.7326/0003-4819-102-4-520. ↑
7 Kaplan, S. H., S. Greenfield, and J. E. Ware. “Assessing the Effects of Physician-Patient Interactions on the Outcomes of Chronic Disease.” Medical Care 27, no. 3 Suppl (March 1989): S110–27. ↑
8 Kaplan, S. H. et al. Medical Care 27 ↑
9 Greenfield, S., S. H. Kaplan, J. E. Ware, E. M. Yano, and H. J. Frank. “Patients’ Participation in Medical Care: Effects on Blood Sugar Control and Quality of Life in Diabetes.” Journal of General Internal Medicine 3, no. 5: 448–57. ↑
10 Roter D. and J. Hall. “Improving psychosocial problem address in primary care: is it possible and what difference does it make?” Presentation at the International Consensus Conference on Doctor-Patient Communication, Toronto, Nov 14–16, 1991. ↑
11 Heszen-Klemens, I. et al Social Science & Medicine 19 ↑
12 Orth, J. E., W. B. Stiles, L. Scherwitz, D. Hennrikus, and C. Vallbona. “Patient Exposition and Provider Explanation in Routine Interviews and Hypertensive Patients’ Blood Pressure Control.” Health Psychology 6, no. 1 (1987): 29–42. ↑
13 Starfield, B., C. Wray, K. Hess, R. Gross, P. S. Birk, and B. C. D’Lugoff. “The Influence of Patient-Practitioner Agreement on Outcome of Care.” American Journal of Public Health 71, no. 2 (February 1981): 127–31. ↑
14 Bass, M. J., C. Buck, L. Turner, G. Dickie, G. Pratt, and H. C. Robinson. “The Physician’s Actions and the Outcome of Illness in Family Practice.” The Journal of Family Practice 23, no. 1 (July 1986): 43–47. ↑
Featured Image: “A physician talking to a patient about his illness, the patient is holding a basket containing a urine flask.” Engraving from the Wellcome Collection. Used under a CC BY 4.0 License.