Eyeworld

July 2017 • Ophthalmology Business 17 'Medspeak,' health illiteracy, and language barriers I magine this scenario: A work- ers' comp patient enters the ER, complaining of back pain. He is given a prescription for physical therapy, a muscle relaxer, and oxycodone/acetaminophen, and told to see a doctor after 10 days. When Michael R. Marks, MD, MBA, saw this patient a week-and-a- half later, he found he hadn't gone to physical therapy and hadn't filled his prescriptions, seemingly ignor- ing and non-adherent with the ER physician's orders. But Dr. Marks dug deeper. Why hadn't he gone to physical therapy? Why weren't these prescriptions filled and the drugs taken as directed? Dr. Marks learned this patient didn't have time for physical therapy. He worked at night, and when he got home in the morning, he, as a single father, had to get his children off to school. Once they were gone, he had to sleep, and then be up to receive them home from school before heading back to work for the night shift. As for the prescriptions, the muscle relaxer, the patient said, was not affordable to him at $384, and as a recovering drug addict, clean and sober for the last 2 years, he wasn't about to start taking the oxycodone/ acetaminophen. Dr. Marks said a doctor who didn't ask these open-ended ques- tions might have completely mis- understood the patient's non-adher- ence. Dr. Marks, who owns Marks Healthcare Consulting, a healthcare communications firm in Westport, Connecticut, said the ER doctor in this case failed. "One of the things that you need to do when you talk with a patient is say, 'This is what I'd like to do for you … do you think you can do these things?' [The doctor] wouldn't have wasted time writing a physical ther- apy prescription if the [patient] had explained to him, 'It's not going to work for me.' He wouldn't have writ- ten him a narcotic if the [doctor] had inquired if [the patient] could take the medication. [The doctor] had a choice of different muscle relaxers, and he picked one that was $384 when he could have picked a generic for $16," Dr. Marks said. Situations like this and others, resulting from communication gaps, language barriers, misunderstand- ings, and more, happen all the time, he said. "I think to some extent [phy- sicians] recognize [the need for improved patient communication], and because of all the time pressures, everyone is afraid that if they ask open-ended questions, it's going to take more time, when these things actually save time," said Dr. Marks, who is a consultant for the Institute of Healthcare Communications, providing communication training to physicians around the country. He also continues to provide clinical care for the indigent in Norwalk, Con- necticut, after 23 years as a full-time orthopedic surgeon, followed by a role in hospital administration. Improving basic physician-patient communication A study published in 1984 found that less than a quarter of patients (23% of 74 patient encounters) were able to complete their opening statement to physicians. 1 Beckman et al. found the physician interrupted in 51 cases (69% of the time) to ask questions about a specific concern and in only one of these cases was the patient asked to finish the opening state- ment. On average, the physician interrupted the patient after 18 seconds. More than a decade later, a survey involving 264 patient-physi- cian interviews revealed 75% of the time physicians asked patients about their concerns, but patients were interrupted 72% of the time after an average of 23 seconds. 2 "We've not educated or trained as physicians to … let [patients] talk," Dr. Marks said, adding that physi- cians might be inclined to avoid asking patients open-ended questions or interrupting when they're under pressure to get to the next appoint- ment and don't know how long patients will talk. However, one study found that, on average, patients' spontaneous talking time was 92 seconds; 78% of patients finished their opening state- ment in 2 minutes. 3 What's more, asking open-ended questions can lead the physician to the root of the patient's problem fast- er than yes/no questions or interrup- tions, and it also can result in a more satisfying experience for the patient, Dr. Marks said. "You don't get the flavor of what's going on, what their goals are, what their desires are, what their long-term aims are, unless you ask open-ended questions," he added. "Another thing doctors rarely do is say, 'What do you think is going on?'" Dr. Marks said later. " Malpractice companies recognize it: Physicians [who] communicate well don't get sued. " —Michael Marks, MD continued on page 18

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