Shared Understanding with Patients
by Neal Maskrey, FRCGP and Andrea Gordon, MD
Published on Aug 07, 2017
Most physicians would agree that communication is the foundation of the doctor-patient relationship and is integral to the clinical practice of medicine. Studies validate, good communication has a therapeutic effect for patients, even reducing pain, improving blood pressure readings and increasing function. Patients who understand their doctors are also more likely to acknowledge health problems, understand treatment options, modify their behaviors and comply with medication schedules.
When asked if they would like to be involved in decisions about their health care, approximately 9 of 10 US patients say they want to know all of their options. But far fewer people said they were offered options than wanted to discuss them, and, by offering a range of options, health professionals are only beginning a process of shared understanding. At its simplest, shared understanding may involve a one-off binary choice (eg, take an antibiotic or have a surgical procedure), but often it involves a dialogue that must be maintained through the complexities of chronic or comorbid illnesses.
Technically excellent care is an important goal, but quality is represented by something more than this. The top factors influencing whether people believe they have experienced quality care are good interpersonal skills from clinicians and associated staff, including communication and empathy; easy access to care, including convenient appointments with a familiar clinician; and involvement in care processes, including participation in decisions and self-care support. The art of the office visit (consultation) lies in creating a collaboration in which both the clinician and the patient are aware of the limitations and uncertainties of the clinical evidence but seek to make the most of the opportunity to align their goals and values.
Shared understanding is more than information. How can we move from the science of a technically focused exchange of information to the art of mutual understanding?