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Seona Patel
Abstract:
In this paper, I investigated the relationship between the quality of patient care and the
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:
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
quality of the healthcare that they receive is highly dependent on the quality of their
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.
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.
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
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 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
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
General Communication
to healthcare, stating that “Without effective communication, there is no way to deliver effective
healthcare and that communication empowers the patient to be informed and become a partner in
THE IMPORTANCE OF DOCTOR-PATIENT COMMUNICATION IN HEALTHCARE 6
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
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
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
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
THE IMPORTANCE OF DOCTOR-PATIENT COMMUNICATION IN HEALTHCARE 7
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
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
THE IMPORTANCE OF DOCTOR-PATIENT COMMUNICATION IN HEALTHCARE 8
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
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.
THE IMPORTANCE OF DOCTOR-PATIENT COMMUNICATION IN HEALTHCARE 9
References
Betz, M., & O'Connell, L. (1983). Changing doctor-patient relationships and the rise in concern f
Bonvicini, K. A., Perlin, M. J., Bylund, C. L., Carroll, G., Rouse, R. A., & Goldstein, M. G.
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
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).
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
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
Appendix
1. How important is communication in the medical field? (At the hospital with patients,
coworkers, etc.)
4. When preparing to become a doctor, were you explicitly taught how to communicate
7. How is the empathy of doctors affected by the emotional demand of the training that
8. How do you think that this affects the communicational skills of doctors?
THE IMPORTANCE OF DOCTOR-PATIENT COMMUNICATION IN HEALTHCARE 11
9. How does the quality of health care depend on the effectiveness of communication
10. How do you ensure with your patients that you have effectively communicated with them