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| 50th Annual Meeting of the American Headache Society |
Boston, Massachusetts June 26-29, 2008 |
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Physician Perspective on Patient Communication |
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BY MAURY M. BREECHER
Contributing Writer |
BOSTON — Good communication with patients is
critical to headache care and can be achieved by
developing a working alliance with patients, said Dr.
Sutapa Ford at the 50th Annual Scientific Meeting of the
American Headache Society on June 29.
“A working alliance is a collaborative partnership
distinguished by its interactive nature in which both
physician and patient reach an agreement on treatment
expectations and goals,” said Dr. Ford of the University
of North Carolina School of Medicine in Chapel Hill,
N.C.
The key, she said, to forming such a collaborative
partnership is the establishment of an emotional bond of
liking, trust, empathy, and respect between physician
and patient (Pat. Educ. and Counseling. 2007;66:29-36).
“Physicians have a strong and active role in
establishing that type of partnership,” said Dr. Ford.
“When emotional bonds are present, patients are more
forthcoming with sensitive information.”
“Pain is a subjective experience and we rely heavily on
patient’s self reports,” she continued. “Communication
is the primary tool headache providers use throughout
the assessment, diagnostic, and treatment process.”
According to Dr. Ford, historically, however, the
doctor-patient relationship has been a hierarchal one in
which physicians had the control. Communication was
one-sided as physicians gathered information and decided
what was best for the patient.
But there is now a movement toward patient-centered care
that includes the establishment of a working alliance
between physician and patient. The primary goal is an
agreement between treatment expectation and goals.
Hundreds of studies over the past 40 years have
confirmed the “working alliance is the most consistent
and reliable predictor of clinical treatment outcomes,”
said Dr. Ford.
She told of a study in which 118 chronically ill
patients provided ratings of their “working alliance”
with their physicians. The patients were then tracked
for three months and surveyed again. Researchers found
that “working alliance” was linked to the patients’
confidence and ability in being able to adhere to the
treatment plan (Health Commun. 1994;4:234-265).
“The biggest predictor of treatment adherence in this
study was emotional bonds and connectivity, the extent
to which they liked and trusted their physician,” said
Dr. Ford.
A key to the working alliance is “Shared Decision
Making” (SDM), noted Dr. Ford. “This is a process of
collaboration between patients and healthcare providers
that integrates patients’ preferences and joint decision
making into the process,” she explained.
The popularity of shared decision making has increased
over the years and some argue that patients have a right
to be involved in decisions about their own health and
well being.
No longer are physicians the exclusive storehouse of
medical information, continued Dr. Ford. Patients are
getting their information from the media and the
Internet. With this in mind, it is not uncommon for
patients to come into the physicians’ offices already
having expectations and agendas. It is important that
physicians elicit and discuss these, offering education
if necessary.
The literature shows that SDM is linked to improved
diagnostic and treatment outcomes (JAMA
2003;290;1157-1165).
Female physicians are more likely to employ SDM than
males Dr. Ford said. She pointed out that the literature
reveals that all physicians are less likely to employ
SDM with minority patients and those from low social
economic strata.
“That’s because physicians are disinclined to engage
patients who appear to lack comprehension of medical
information,” she explained. “Physicians are also less
likely to engage in SDM with patients who seek
alternative treatment approaches.”
Dr. Ford advised physicians to develop a non-judgmental
attitude, and have respect and empathy for patient
concerns. Cultivate a relaxed, approachable demeanor and
create an environment that welcomes patient questions
and discourse (JAMA. 1994;271:79-83). |
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