Communication skills, long absent from most physician training, are gaining emphasis as studies link good clinician-patient relations with better outcomes and higher patient satisfaction.
Recent research has bolstered the notion that patients who trust their doctors are more likely to comply with treatment programs and make return visits. Better communication also is believed to reduce unnecessary procedures and improve physicians' morale.
Those are desirable results, especially for medical groups in competitive markets.
"It is very clear that the quality of the doctor-patient relationship is extremely important to patients," said Rodney Dueck, M.D., medical director at HealthSystem Minnesota, an integrated system based in suburban Minneapolis. "It's the
No. 1 satisfier when things are going well and the No. 1 dissatisfier when things are not going well."
HealthSystem Minnesota is launching a comprehensive program to strengthen the communication skills of clinicians.
The main objective is better care, Dueck said, but financial survival is also a factor. In the Twin Cities, the Buyers Health Care Action Group is attempting to foster competition among providers by making available quality data on each of the major healthcare systems.
"When prices are similar, people will make their choices based upon the ability to have good relationships with our physicians," Dueck said.
Some HMOs have in-house training programs, and medical schools have started to add patient communications to the curriculum. Still, the vast majority of practicing physicians have had no communications training, Dueck said. He figures the average physician conducts 150,000 to 250,000 patient interviews in a career.
The workshop uses faculty and curriculum from the Woodstock, N.Y.-based American Academy on Physician and Patient, a not-for-profit group founded in the mid-1980s to foster physician-patient relations.
Clinicians are taught to avoid jargon, ask more questions and apologize if a patient is kept waiting. "We're operating under the assumption that all doctors want to have good relationships with their patients. It's a matter of having the skills to do it," Dueck said.
The academy recently began marketing its workshops to medical groups, health systems and HMOs. The surge in medical knowledge in the past 50 years created skepticism about the traditional art of hand-holding, said William D. Clark, M.D., the academy's director of courses. But recent medical and popular literature correlates patients' emotional states and physical health. "What we're talking about is delivering more traditional healing along with the science," Clark said.
Skepticism lingers that good communication can't be learned or takes too much time.
Clark said good communicators don't spend more time with patients. Rather, they listen more and focus on each patient's needs.
"It has been demonstrated that people will more reliably follow a complicated regimen if you do high-quality interviewing," Clark said. "That alone should save money because patients have fewer complications. They won't have to make phone calls to ask questions or go to one more doctor to see if they can get the right answer."
Since March, HealthSystem Minnesota has put 220 of its providers through the one-day workshops. The remaining 300 will participate in the first half of 1997. Most are physicians, but nurse practitioners, physician assistants and psychologists are also going through the program.
The system plans an ongoing commitment through training some of its clinicians as instructors, launching a clinician-patient communications newsletter and offering a consulting service where clinicians can go for advice. It's also considering conducting a six-day workshop that would be open to all physicians in the region.
The system has yet to determine whether patient satisfaction has increased since the training began, but Dueck said 93% of physicians who took part said they would recommend it to colleagues. Those invited to participate initially were identified as opinion leaders in their departments, he said.
The one-day workshops cost $200 per clinician, about the same rate as patient satisfaction surveys, Dueck said. In total, he said, the system has spent about $70,000 on development and training and $40,000 on measuring the results.
Few medical groups have established such elaborate programs, but Dueck believes more will make the investment.
"It's inevitable that this will become increasingly important because it's directly related to the quality and survival of care systems," he said.