Tue, Jun 16, 2009 - Page 16 News List

[ HEALTH ] Well-chosen words in the doctor’s office

Despite the importance of doctor-patient communication,it is an area sometimes overlooked in treatment plans

By Jane E. Brody  /  NY TIMES NEWS SERVICE , NEW YORK

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What do you want from your doctor, especially if you have a serious or life-threatening illness?

Researchers who conducted interviews a few years ago with 192 patients at the Mayo Clinics in Scottsdale, Arizona, and Rochester, Minnesota, identified seven “ideal physician behaviors.” Patients want their doctors to be “confident, empathetic, humane, personal, forthright, respectful and thorough,” the researchers wrote in Mayo Clinic Proceedings in 2006.

At the same time, of course, patients want their health problems properly diagnosed and competently treated. How, in the course of the 15 minutes that the typical patient gets to spend with a doctor, can all this happen?

With doctors increasingly pressed for time, how can they offer both the clinical expertise and the compassionate care that all patients deserve? And what can patients do to get what they most want from their doctors?

BUILDING TRUST

In her new book, Only 10 Seconds to Care: Help and Hope for Busy Clinicians (ACP Press), Wendy Schlessel Harpham combines her experience as an internist and her nearly 18 years of experience as a cancer patient to show how simple actions and well-chosen words on the part of medical professionals can make an enormous difference in a patient’s emotional and physical well-being.

Walter Baile, a psychiatrist at the MD Anderson Cancer Center in Houston, said in an interview that the book was replete with “clinical pearls — succinct ways that physicians can affect patients’ well-being and make them feel supported.”

Building a patient’s trust and confidence, he said,

is healing.

Many studies have shown that when doctors provide compassionate care, that increases the likelihood that patients will follow medical advice and practice self-care, which in turn reduces complications and their need for repeated treatments and costly hospitalizations.

Larry Mauksch, a specialist in doctor-patient communication in the department of family medicine at the University of Washington in Seattle, urges doctors to build rapport with their patients by greeting them warmly by name, asking briefly about important events in their lives, maintaining eye contact, focusing on the patient without interruptions, and displaying empathy through words and body language.

To make the most of each visit, Mauksch suggested that doctors first ask about patients’ concerns and then focus on just one or two of their most pressing medical problems, saving others for later visits.

KEEPING HOPE ALIVE

In her book, Harpham writes that dealing with patients’ emotions “is a vital task for healthcare professionals.” She applauds the response of an oncologist who said, after the first of many recurrences of her cancer, “I can only imagine what this feels like, but I’ll do all I can to help you.”

Baile cautions doctors against trying to “fix” the emotion when bad news upsets a patient. Rather, he said, “they should empathize and align with the patient and say something like: ‘I can see you weren’t expecting this news. I understand that you’re upset by it. I’m disappointed too that we didn’t get a better response to the treatment.’”

Harpham said there was a world of difference between “if” and “when” in discussing the chance that cancer will recur. The word “when” is a prediction of doom that can make it difficult or impossible for patients to find joy, she said.

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