How To Create Better Medical Communications

June 6, 2018

By Beverly Beaudoin

We live in a world that often misunderstands medicine. Even the loftiest media aren’t immune; I recently read an article in the New York Times that, among other errors, referred to a glucose monitoring lancet incorrectly as a “drug applicator”.¹ In an era when consumers are increasingly asked to make better health choices, the statistics about their medical awareness are disturbing. Surveys show that nearly 9 in 10 patients lack a clear understanding what the doctor told them during their most recent appointment. More than 50% of patients leave the office confused as to what they are supposed to do.²

As a result, patients often aren’t taking the medicines they should, or taking them the way they should. That leads to ineffective treatment and side effects, both of which inflate health care costs.

Why is medicine full of such disconnects? Here are several reasons—and, with them, potential solutions.

1.  Many Americans are poor readers. Many, if not most patient education materials are written at the 10th grade level, yet 1 in 5 US adults reads at the 5th grade level (age 10/11) or below. One solution: picture-rich infographics that deliver needed information in a cartoon-like form even low-literacy audiences can take in.
2. Medical jargon is off-putting. Many patients find medical language confusing, but they’re too intimidated by health professionals to ask for clarification. Doctors and nurses who make the effort to choose simpler language get better results. A key strategy: Asking the patient to repeat back the doctor’s instructions in his or her own words.
3. English is a second language for more than 61 million Americans. Consider that the language spoken at home is Spanish for 38.4 million, Chinese for 3 million, Tagalog for 1.6 million, Vietnamese for 1.4 million, French for 1.3 million, and Korean and Arabic for 1.1 million each.³ Children often end up being the translators. If you’re preparing education materials, ensure they’re available in a variety of languages.
4. Doctors aren’t listening. On average, the physician interrupts the patient 18 seconds into the office visit.⁴ Only 9% of patient care decisions are made with patient involvement. We’ve got to replace a condescending “doctor-knows-best” approach with a genuine appreciation for the patient’s experience, even as clinical teams experience relentless time pressure.

When medical communication falters, patient adherence drops. Adherence is the extent to which a patient’s behavior follows medical advice in terms of taking medication and adopting new health behaviors. The most frequent reasons cited by patients for poor adherence are:

• Forgetting to use or renew a prescription (24%)
• Avoiding side effects (20%)
• Drug costs (17%)
• The patient believes he or she no longer needs the drug (11%)⁶

Technological aids such pillbox organizers, smartphone-based reminders, and pharmacy driven refill automation can help patients remember and renew. Answers to the other issues listed above depend, however, on changing patient understanding of what’s involved. Patient education and better patient-physician dialogue are needed.

To communicate better in medicine, one size doesn’t fit all and individualization pays off in better outcomes. Clinical teams can and should look beyond the symptoms and assess the context of the individual patient’s attitudes and behaviors. Patient-centered encounters can then be individually adjusted so as to increase comprehension, adherence, and patient satisfaction.

Importantly, the focus of the visit can change from diagnosing the problem to implementing a realistic care plan. This includes involving patients in assessing how successful their therapy is in relation to predetermined and agreed goals. When reasonable expectations are articulated well, understood, and agreed, it is far more likely that the desired result will be achieved. These expectations must include discussion of potential benefits and risks of treatment (in language relevant and understandable to the patient), as well as costs of both treatment and poor adherence.

As part of patient communications and education programs, key performance indicators should be assessed at various points along the patient’s journey; it’s not just that the symptoms improve, but that they do so in a sustainable and self-reinforcing way. When patients believe the action to be taken is attainable and they see tangible progress, they’re more likely to stay on course.

We’re not going to see overnight changes in how medical consumers understand their bodies and the interventions that can help them. With some of these insights, however, we can substantially improve the status quo—with health and economic benefits for us all.

References:
1. Danny Hakim. Ask your doctor; until then, here’s a word from our sitcom. https:// www.nytimes. com/2018/03/09/business/drug-commercials-product-placementblackish. html. Accessed March 12, 2018.
2. Kaplan SH, Greenfield S, Ware Jr JE. Assessing the effects of physician patient interactions on the outcomes of chronic disease. Med Care, 1989, 27 (supplement 3), S110-S127. 3. Data are derived from the 2013 American Community Survey of the Census Bureau. Cited in Camarota SA, Ziegler K. One in Five U.S. Residents Speaks Foreign Language at Home. Center for Immigration Studies. https://cis.org/One-Five-US-Residents-Speaks-Foreign-Language-Home-Record-618-million. Accessed March 12, 2018.
4. Beckman HB, Frankel RM. The Effect of Physician Behavior on the Collection of Data. Ann Intern Med. 1984;101(5):692-696. DOI: 10.7326/0003-4819-101-5-692.
5. Boston Consulting Group. The Hidden Epidemic: Finding a cure for unfilled prescriptions and missed doses. http://www.bcg.com/publications/files/TheHiddenEpidemic_Rpt_HCDec03.pdf.
6. Marcum ZA, Sevick MA, Handler SM. Medication Nonadherence: A Diagnosable and Treatable Medical Condition. JAMA. 2013;309(20):2105-2106. doi:10.1001/ jama.2013.4638