TARRANT COUNTY PHYSICIAN (29)
January/February 2021
• Patient Communication (in general)
– What can we all do that will engage
patients and foster relationships in
which information can be shared in a
meaningful way?
The event includes a breakout session to
allow participants to explore the topic more
deeply in small groups.
Effective patient communication has
come a long way in recent years, but
we have a long way still to go. All are
welcome to join us for this informative and
interactive session. If you are interested
in attending, go to page 20 for additional
information.
References
1The exponential growth of medical knowledge can be
illustrated by tracking the number of authors for the
definitive textbooks. As noted, by 1951 Harrison’s
Principle of Internal Medicine had 53 authors. By the
time I was in medical school it had 273 authors. Today it
has over 600. Plot it on a curve. It’s exponential.
2From René Laennec’s De l’Auscultation Médiate,
quoted in Laënnec and the Stethoscope. JAMA.
2019;322(5):472. doi:10.1001/jama.2018.15451
Stewart MA. Effective Physician-patient Communication
and Health Outcomes: A Review. Canadian Medical
Association Journal. 1995; 152(9):1423-1433.
3Effective patient–physician communication. Committee
Opinion No. 587. American College of Obstetricians
and Gynecologists. Obstet Gynecol 2014;123:389–93.
4Virshup BB, Oppenberg AA, Coleman MM. Strategic
Risk Management: Reducing Malpractice Claims
Through More Effective Patient-Doctor Communication.
American Journal of Medical Quality. 1999;14(4):153-
159.
of action to a patient. The patient then
largely deferred to the physician’s
judgment and expertise, reinforcing the
benevolent paternalism that had been
implicit in patient-physician encounters for
generations, only now it had a name.
Popular culture was replete with examples
of benevolent paternalism, perhaps best
embodied by actor Robert Young who played
the lead role in both Father Knows Best
(1954-1960) and Marcus Welby, MD (1969-
1976). His character was similar in both
series. He was the trusted expert, and those
in his charge did what he told them to do.
Or did they? Patients actually doing what
they are advised to do is every bit as important
as the advice itself. We came to realize what
the priests, shamans, witch doctors, and
medicine men knew millennia ago: personal
relationships built on a foundation of trust and
effective communication are important. If the
primary endpoint is healing the patient, we
must be able to communicate the pathway
that gets them there, which means we must
understand and help them navigate around
the roadblocks they will encounter along the
way. These could be social, cultural, linguistic,
ethnic, racial, intellectual, and/or economic,
to name a few. Dr. Welby may have arrived
at the correct diagnosis and recommended
an appropriate evidence-based course of
treatment, but what good is that if the patient
won’t—or can’t—follow through with it?
Twenty-five years ago, the correlation
between effective physician-patient
communication and improved health
outcomes was already obvious.3 The body
of evidence has only grown, demonstrating
that providers who are good communicators
obtain more complete information, arrive at
more accurate diagnoses, and facilitate more
appropriate counseling, all of which increase
the likelihood that patients will adhere to the
plan.4 And if that doesn’t get our attention,
good communication has also been shown to
reduce the likelihood of a lawsuit.5
Locally, the importance of effective
communication has been underscored
by the creation of a dean level position at
the UNTHSC-TCU School of Medicine,
the highest position ever dedicated to this
important aspect of patient health at an
American medical school. We should be
proud that this occurred in our county,
but it’s just a beginning. There are many
layers to this onion, and it will take more
than an emphasis at a medical school to
peel it. For those of us who are already
in practice—many for decades—we are
learning to communicate in new ways. A
year ago, telemedicine consults were not
on my radar at all. Now I have several every
day. These newer forms of communication
and patient interaction, coupled with a
better understanding of what effective
communication actually is, introduce
additional challenges to the patient-provider
relationship.
Recognizing the timeliness and rapid
evolution of this topic, Healthcare in a
Civil Society, the annual CME hosted by
TCMS’s Ethics Consortium, will dedicate
its 2021 symposium to effective patient
communication. As the era of shared
decision-making has moved forward,
so has our need to communicate with
our patients in meaningful and relevant
ways. This program will explore how
communication between providers and
their patients has changed, and the ethical
implications this change has had in a variety
of areas.
AMA President, Dr. Sue Bailey, will keynote
this Zoom event which has been generously
supported by UNTHSC and the Cook
Children’s Medical Center Foundation. The
Hon. Pete Geren will moderate an expert
panel who will address topics such as:
• Shared Decision-Making – How can
we know that a medical decision is truly
“shared” and the consent obtained truly
“informed”?
• Truth-Telling and Apology – How
do we communicate with patients
about difficult topics, especially when
something goes wrong, or we make a
mistake that results in patient harm?
• High-Stress Conversations – How
does our communication with patients
change when providers are in a highstress
situation, and how can providers
self-regulate and/or de-escalate a
contentious conversation?
Sir William Osler (1849-1919)