By Edie Grossfield for Next Avenue
Part of the Transforming Life as We Age Special Report
Next Avenue recently asked readers to tell us the questions they’d like answered about how to most effectively communicate with their doctors. We’re now back with two experts’ views on the top three questions we received. They are:
- How can I make sure my physician understands my concerns when all I get is a nod from him or her while typing away on a laptop computer?
- Does a surgeon have an obligation to fully explain a serious mistake he or she made during my surgery?
- How do you talk confidentially with your doctor with so-called “scribes” taking notes in the room during your visit?
Talking with your physician during a visit is an important part of your health care, and for many people who have watched this digital age come into being, the way communication is happening with health care providers can be a little unsettling.
Before computers started showing up in exam rooms, physicians and nurses jotted notes on paper. Today, they are often staring at a screen and typing on a keyboard. That can feel impersonal to some people.
Also, health care organizations encourage patients to receive and send information electronically. They push the use of online patient portals, where you can request a prescription refill, see the results of medical tests and make appointments. There are even “e-visits,” where you can communicate your minor health problem to a health care provider online and receive a diagnosis, care plan and even a prescription.
All of this can lead some to believe they’re not really being heard.
But take heart, says Dr. Albert Wu, director of the Johns Hopkins Center for Health Services and Outcome Research, a part of the Johns Hopkins Bloomberg School of Public Health in Baltimore. “The good news is that, in general, the physician who is typing into the computer is transcribing what you are saying, so that’s the reason that as you are speaking, they are typing, in the large majority of cases,” says Wu, who also is a general internist at The Johns Hopkins Hospital. He added that patients shouldn’t necessarily assume a doctor isn’t listening carefully because of a lack of eye contact.
“I am a pretty good typist, but not a 100 percent touch typist, so when my patients are talking, I may need to look at the screen or even my keyboard to make sure that I’m capturing what they’re saying. I think I probably make less eye contact in the post-computer era than before,” he says.
Also, Wu reminds that even before computers, when physicians took notes with a pen, they had to break eye contact to write. The computer is just a different tool for doing the same thing.
Hey, Doc, Are You Really Listening?
Wu has some suggestions for ensuring your doctor is hearing you and understanding your concerns.
One is to interpose questions during the conversation. “Ask things like ‘What do you think? Does that make sense? Have you ever heard of this before? Should I be concerned about this?’ which would inspire the physician to respond,” Wu says.
Also, because physicians these days are under pressure to see more patients per day and spend more time working with electronic medical records, they generally have less time to spend with each patient. A good strategy is to organize your thoughts ahead of the visit and prioritize them.
“Focus on a couple or three things that are of greatest importance to you first,” Wu says. “And discuss each of them in turn. If there’s a story, you should tell the story, but it is difficult for the physician to think about 10 problems, listed one after the other, and to hold all of those things in his or her mind. You know what you are there for, so doing your best to organize and manage the presentation would really be a good thing.”
When Your Physician Makes a Mistake
If your surgeon or other health care provider makes a mistake during your surgery or some other procedure, you have the right to know what happened during your care. “The surgeon (or other type of provider) does have an obligation to explain,” Wu says.
The Joint Commission — from which hospitals seek accreditation so they can receive payments from Medicare and Medicaid — requires physicians and hospitals to communicate with patients about mistakes made in their care or a deviation from a decided-upon plan of care.
“The Joint Commission has a standard in its patients’ rights chapter that requires providers to discuss with patients unanticipated outcomes from care, treatment and services that are classified as [serious, unanticipated] events by the Joint Commission,” says Robert Campbell, the commission’s clinical director for Standards Interpretation-Hospital and Ambulatory Programs.
The Joint Commission also requires hospitals to comply with state law, which could have further mandates related to patient-provider communication about medical errors or unanticipated events.
If the provider or health care organization refuses to tell a patient what happened in their care, patients can file a formal complaint with the organization, which must then issue a written response. That “may or may not give them the information they request,” Campbell says. “Beyond that, they would need to consult with their state’s department of health or work with the risk manager of the (health care) organization.”
Medical Scribes and Confidentiality
An increasing number of physicians and health care organizations now employ medical scribes to transcribe patient-doctor conversations during visits. Some people might be uncomfortable with having another person in the exam room while they’re talking about their sensitive health issues.
Wu says this is another innovation to take the documentation task off the doctor’s hands so he or she can have better interactions with patients. “And these are trained professionals whose training includes a lot of emphasis on the confidentiality of patient information,” he says.
If there is an issue that you really only want your physician to hear, however, Wu advises asking if the scribe can step out of the room for just that portion of the visit.
“But you should consider the scribe as an extension of the physician,” he says. “The physician and, for that matter, scribe hear all sorts of embarrassing things all day long. You don’t need to apologize for talking about your bathroom habits — it’s part of the job.”