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THE IMPORTANCE OF DOCTOR-PATIENT COMMUNICATION IN HEALTHCARE 1

The Importance of Doctor-Patient Communication in Healthcare

Seona Patel

University of California, Davis


THE IMPORTANCE OF DOCTOR-PATIENT COMMUNICATION IN HEALTHCARE 2

Abstract:

The Discourse Community of healthcare professionals frequently communicates in various ways.

In this paper, I investigated the relationship between the quality of patient care and the

communication skills of specialized physicians. I utilized a primary source, through an interview

with an ophthalmologist, to analyze the importance of verbal doctor-patient communication in

the health field and determine how the medical training process affects doctors’ communication

skills. I found that although communication is crucial for doctors to effectively treat their

patients, medical training both builds and compromises these skills in doctors.

Introduction:

The healthcare community involves many different types of communication. In a typical

physical appointment, the doctor begins by asking the patient general questions about their

health. Then, they will perform a few tests on the patient such as taking their weight and height,

testing their reflexes, and checking the alignment of their spine. Finally, the doctor will

summarize the results of the physical and address any health concerns. It is apparent that

throughout this appointment, communication is essential because patients’ perceptions of the

quality of the healthcare that they receive is highly dependent on the quality of their

communication and interaction with their clinician (Impact of Communication in Healthcare,

2011). While doctors engage in many other types of communication, I focused on doctor- patient

interactions to examine the role that communication plays in quality patient care.

A Health Care Quality Survey conducted by the Commonwealth Fund found that 39% of

Americans disagreed with what their clinician wanted to do in terms of recommended treatment,
THE IMPORTANCE OF DOCTOR-PATIENT COMMUNICATION IN HEALTHCARE 3

27% were concerned about the cost, 25% found the instructions to be too difficult for them to

follow, 20% felt the treatment was against their personal beliefs, and 7% reported that they did

not understand what they were supposed to do (Impact of Communication in Healthcare, 2011).

These issues can be avoided if physicians take more time to address the concerns of their patient.

If patients actively voice their health concerns and physicians communicate with them

effectively, a significant percentage of the people who were affected by the lack of proper

communication with their physician would not have felt that way. Improper communication can

lead to misunderstandings, which can negatively impact the doctor-patient relationship. One

possible reason for a lack of proper communication may stem from a difference in belief about

control in the doctor-patient relationship. Although some patients prefer shared control (both the

patient and doctor have equal control in the relationship and make decisions together), others

prefer doctor control, where the physician has total control of patient treatment (Street, Krupat,

Bell, Kravitz, & Haidet, 2003). Research shows that a physician’s and patient’s beliefs about

control in their relationship and one another’s behavior influences communication in medical

encounters (Street, et al., 2003). This indicates that in order to improve a patient’s quality of

care, they must be able to build a relationship with their doctor in which bidirectional

communication is encouraged.

Another major cause of miscommunication is a physician’s lack of empathy. Often times,

the high stress of medical school causes students to lose empathy as they see the awful truths that

patients face in hospitals and terrible prognoses that they must understand (Neumann et al.,

2011). Through the many exams and understanding what it means to fail, students lose some

empathy (Neumann et al., 2011). Despite evidence demonstrating the high value placed on

physician empathy by patients, studies show that this element is often lacking in medical
THE IMPORTANCE OF DOCTOR-PATIENT COMMUNICATION IN HEALTHCARE 4

encounters (Bonvicini et al., 2009). A study done at the St. Augustine Campus in the University

of West Indies examined empathy scores of medical student scores before and after one year of

training. Results showed that a decline in self-reported empathy scores of medical students began

during the first year of training (Nunes, Williams, Sa, & Stevenson, 2011). Apathy can cause

doctors to discount patient and/or family concerns and fail to take into account the patient’s

perspective (Ong, Haes, Hoos, Lammes, 1995). This leads to miscommunication because the

doctor does not include the patient in the conversation of their healthcare.

Failure to understand a patient’s perspective leads to an undesirable doctor-patient

relationship which can increase a patient’s likelihood to take legal action against the physician in

the form of a malpractice claim. Regardless of the quality of care that the physician renders,

research suggests that patient dissatisfaction due to miscommunication can lead to malpractice

claims (Hojat,et al., 2003). In addition, malpractice attorneys have indicated that more than 80%

of malpractice suits are based on unsatisfactory doctor-patient relationships (Hojat, et al., 2003).

The American Association of Orthopaedic Surgeons stated that good communication has a

favorable impact on patient behavior, patient care outcomes, and patient satisfaction, and in

effect reduces the incidence of malpractice lawsuits (Huntington & Kuhn, 2003). This shows the

importance of proper communication in the medical field. Through my research, I investigated

the emphasis placed on communication in the medical field to further explore how doctors

ensure that their patients receive quality care and are communicated to properly.

Methodology

In my research, I interviewed Chirag Patel, an experienced ophthalmologist that specializes

in the diagnosis and treatment of diseases of the cornea, anterior segment, and lens. He is a part
THE IMPORTANCE OF DOCTOR-PATIENT COMMUNICATION IN HEALTHCARE 5

of many medical associations such as the American Academy of Ophthalmology and Association

for Research in Vision and Ophthalmology. I utilized the interview process to ask Dr. Patel a

series of questions regarding the importance of communication in the medical field and how

communication in his workplace differs from that of general practitioner’s or pediatrician’s. I

chose to interview Dr. Patel because I am interested in becoming an ophthalmologist and want to

learn more about the type of communication that he engages in every day compared to other

physicians. I used an open-ended question format in my interview so that I could receive answers

to my questions that went in-depth regarding the impact of communication in the medical field

(Appendix). An interview was a better way to gather data for my research than a survey because

it allowed me to receive more meaningful and unrestricted answers than a survey would.

From the interview, I gained insight into the different methods of communication doctors

utilize in various situations, while also learning about the training process that medical students

must go through to improve their communication skills before becoming physicians. After

interviewing Dr. Patel, I compared and contrasted his experiences to that of what other scholars

and doctors have experienced to analyze the importance of communication in healthcare.

Results & Discussion:

General Communication

In the first part of my interview, I investigated the importance of doctor-patient

communication in general. Dr. Patel expanded on how doctor-patient communication is essential

to healthcare, stating that “Without effective communication, there is no way to deliver effective

healthcare.” Furthermore, he said that communication is paramount to increasing the quality of

healthcare and that communication empowers the patient to be informed and become a partner in
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their care. In order for patients to receive quality care, they must feel included by physicians

when discussing their diagnosis and treatments. This shows the importance of the doctor-patient

relationship and the consequences (patient dissatisfaction) of ignoring the patient’s perspective

(Hojat, et al., 2003). Dr. Patel’s input also agrees with “Impact of Communication in Healthcare

(2011),” in which they state that communication with a doctor is crucial to the patient’s

perception of the quality of the care that they received.

Specialization

In the next part of the interview, I asked Dr. Patel about how specialization affects

doctor-patient communication. Dr. Patel explained that patients are less likely to trust their

specialists because they have not built a strong, long-term relationship with them like they have

with their general physician. Specialization breaks down the structure of generalized care by

replacing a long-term relationship with a general practitioner with several short-term

relationships with specialists, increasing the likelihood of miscommunication (Betz, O’Connell,

1983). Strong doctor-patient relationships are key to improving communication because

communication in medical encounters is influenced by the physician’s and patient’s belief about

control in the relationship as well as by one another’s behavior (Street, Krupat, Bell, Kravitz, &

Haidet, 2003). This shows that specialization causes miscommunication because the patient’s

short-term relationship with their specialist may not be strong enough such that the patient feels

as if they are an active partner in their healthcare.

Dr. Patel continued, saying that if a patient's problem is very specific, they may have

difficulty understanding the medical information and terminology presented by the specialist.

Patients are less likely to ask questions and communicate their concerns if they have not built
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long-term trust with their doctor (Ong, et al., 1995). Dr. Patel finds that he encounters this since

he is a specialist for ophthalmology and that this may affect whether a patient believes they were

properly communicated to.

Medical School Preparation and Empathy

In the last segment of my interview, I investigated how medical school prepares future

doctors for daily patient communication while also negatively affecting the long-term

communicational skills of physicians. Dr. Patel said that there are specific courses and

curriculum elements that focus on communication with patients. For example, there are lectures,

small group sessions, simulated patient encounters with actors, and direct patient care in the

clinical setting that all aid in teaching students to communicate with patients properly. In

addition to the curriculum in medical school, Dr. Patel states that “a physician’s ability to

communicate is most dependent on individual character traits and personality.” Contrary to what

I initially believed from my preliminary research, I learned from Dr. Patel that doctors are well

prepared through courses to communicate with patients once they enter the medical field.

Despite this, empathy can be eroded by the rigors of training in medical school. Dr. Patel said, “it

is easy to become jaded to the training process due to long hours, high stress, and significant

burdens.” This, in turn, can lead to burnout which can cause a physician to become numb to the

concerns of the patient, which ultimately affects the quality of their care (Neumann et al., 2011).

Dr. Patel also stated, “any loss of empathy leads to the degradation of communication skills.”

This also agrees with the study done at the St Augustine Campus in the University of West

Indies that showed that the empathy of the students decreased by the end of their first year in
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medical school (Nunes, et al. 2011). When a physician cannot place themselves in the patient's

shoes, all sense of partnership in the healthcare process is lost, and thus the patient will not

receive quality care.

Conclusion

I researched the impact of communication on the quality of patient care in the healthcare

Discourse Community. Through primary and secondary research, I found that proper

communication is essential for making patients feel included in their healthcare process and for

understanding their doctor’s instructions. I learned from Dr. Patel that although medical school

helps future doctors learn patient etiquette and communication skills, it also causes them to lose

empathy and concern for patient’s needs. Miscommunication is the root cause of malpractice

claims and is why patients don’t follow their doctor’s diagnoses and prescriptions.

In addition, when doctors are specialized, this can also diminish the quality of the care

that the patient receives because of the specificity of the problems that their patients have.

If specialists do not properly communicate with their patients, then they will not understand

what their treatment is for and thus not believe that they are receiving proper care. From this,

more studies can be conducted investigating whether in-person interactions or information read

through textbooks and pamphlets are more useful for disseminating information to patients. Due

to the limitations of having one primary source, few concrete conclusions could be drawn about

the healthcare Discourse Community. However, through this research, I have expanded on many

important factors influencing communication in healthcare and its importance to the community.
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References

Betz, M., & O'Connell, L. (1983). Changing doctor-patient relationships and the rise in concern f

or accountability. Social Problems, 31(1), 84-95.

Bonvicini, K. A., Perlin, M. J., Bylund, C. L., Carroll, G., Rouse, R. A., & Goldstein, M. G.

(2009). Impact of communication training on physician expression of empathy in patient

encounters. Patient education and counseling, 75(1), 3-10.

Hojat, M., Gonnella, J. S., Mangione, S., Nasca, T. J., & Magee, M. (2003, March). Physician

empathy in medical education and practice: experience with the Jefferson Scale of

Physician Empathy. In Seminars in Integrative Medicine(Vol. 1, No. 1, pp. 25-41). WB

Saunders.

Huntington, B., & Kuhn, N. (2003, April). Communication gaffes: a root cause of malpractice

claims. In Baylor University Medical Center Proceedings (Vol. 16, No. 2, pp. 157-161).

Taylor & Francis.

Impact of Communication in Healthcare. (2011, July). Retrieved from

https://healthcarecomm.org/about-us/impact-of-communication-in-healthcare/

Neumann, M., Edelhäuser, F., Tauschel, D., Fischer, M. R., Wirtz, M., Woopen, C., ... &
THE IMPORTANCE OF DOCTOR-PATIENT COMMUNICATION IN HEALTHCARE 10

Scheffer, C. (2011). Empathy decline and its reasons: a systematic review of studies with

medical students and residents. Academic medicine, 86(8), 996-1009.

Nunes, P., Williams, S., Sa, B., & Stevenson, K. (2011). A study of empathy decline in students

from five health disciplines during their first year of training. Int J Med Educ, 2, 12-17.

Ong, L. M., De Haes, J. C., Hoos, A. M., & Lammes, F. B. (1995). Doctor-patient

communication: a review of the literature. Social science & medicine, 40(7), 903-918.

Street, R. L., Krupat, E., Bell, R. A., Kravitz, R. L., & Haidet, P. (2003). Beliefs about control in

the physician-patient relationship. Journal of general internal medicine, 18(8), 609-616.

Appendix

1. How important is communication in the medical field? (At the hospital with patients,

coworkers, etc.)

2. How does a doctor's specialization impact their communication with patients?

3. How do doctors effectively communicate bad news to patients?

4. When preparing to become a doctor, were you explicitly taught how to communicate

effectively with patients?

5. Did medical school prepare you to communicate better with patients?

6. Do you think that an emphasis needs to be placed on effective communication with

patients when students are in medical school?

7. How is the empathy of doctors affected by the emotional demand of the training that

students must undergo in order to become a doctor?

8. How do you think that this affects the communicational skills of doctors?
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9. How does the quality of health care depend on the effectiveness of communication

between doctors and patients?

10. How do you ensure with your patients that you have effectively communicated with them

all that needed to be said regarding their health or concerns in an appointment?