I was lying on a gurney, trying to prepare myself for a six-hour breast-reconstruction surgery. A few months earlier, I’d had a mastectomy for breast cancer. Because I am small boned, my doctor told me I needed to have a muscle sliced from my back and moved to my chest to create a proper foundation for an implant. I knew the operation would slow me down bad news for someone who swims, runs and chases three young kids. But as the surgeon diagrammed incision points on my chest with a felt-tip pen, my husband asked a question: “Is it really necessary to transfer this back muscle?”
The surgeon’s answer shocked the patient No, it was not necessary and if she didn’t have the procedure, her recovery time would be cut in half. The surgeon had simply assumed, without asking the patient, that she would prefer the more complicated procedure because cosmetically it would be preferable. But after a hurried consultation with her husband, the patient opted for the less invasive procedure.
Lack of communication between medical care providers and patients can be a major obstacle to good medical care. Such communications failures occur for several reasons. One is that Physicians make an assumption about what patients prefer, or they push a particular treatment that they prefer without consulting patients.
Furthermore, the relatively high prestige of physicians may intimidate patients. Patients may also be reluctant, to volunteer information that might cast them in a bad light, and physicians may have difficulties encouraging their patients to provide information. In many cases, Physicians dominate an interview with questions of a technical nature, whereas patients attempt to communicate a personal sense of their illness and the impact it is having on their lives.
Furthermore, the view held by many patients that physicians are “all-knowing” can result in serious communication problems. Many patients do not understand their treatments yet fail to ask their physicians for a clearer explanation of a prescribed course of action. About half of all patients are unable to report accurately how long to they continue taking a medication prescribed for them, and about a quarter do not even know the purpose of the drug. In fact, some patients are not even sure, are they are about to be rolled into the operating room, why they are having surgery.
Sometimes patients-physicians communication difficulties occur because the material that must be communicated is too technical for patients, who may lack fundamentals knowledge about the body and basic medical practices, In response to this problem, some health-care providers routinely use baby talk (calling patients “honey” or telling them to go “night-night”) and assume that patients are unable to understand even simple information.
The amount of physicians-patients communication also is related to the sex of physicians. Overall female primary care physicians provide more patient centered communications than do male primary care physicians.
Cultural values and expectations also contribute to communication barriers between patients and their physicians. Providing medical advice to a patient whose native language is not English may be problematic. Furthermore, medical practices differ between cultures, and medical practitioners used to be familiar with a patient’s culture to produce compliance with medical recommendations.
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