He/She Said | Doctor Said

by Clive Riddle, November 9, 2018

The AAFP (American Academy of Family Physicians) has highlighted a new Harris Poll survey - commissioned by the Samueli Integrative Health Programs  - that shows "there are considerable gaps between what primary care physicians (PCPs) discuss with their patients and what patients would like to discuss with their physician." In particular, the concern raised from the survey seems to be that this communication gap is an impediment to SDOH (social determinants of health) goals.

AAFP reports that "although 74 percent of adults said they typically had discussions about physical health with their physician -- and more than 50 percent had discussions about test results, medications and exercise -- discussions about other key factors, including issues related to social determinants of health, were reported by less than half of respondents."

AAFP elaborates that "Fifty-two percent of adults said they and their physician didn't discuss much more than medical needs, such as physical symptoms, test results, medications and surgical history. Conversely, 53 percent of adults wished their physician would talk to them about nonmedical therapies such as nutrition, acupuncture, massage therapy and meditation, and 45 percent of adults said they wished they and their physician talked more about why they want to be healthy."

Here's some more details:

• 42% had discussions about the patient's diet
• 40% had discussions on sleep
• 36% had discussions about the patient's mental health
• 20% discussed why it is personally important to the patient to be healthy
• 13% discussed the patient's personal environment
• 11% discussed what brings the patient joy and happiness
• 10% had discussions about the patient's spiritual health

Wayne Jonas, M.D., the executive director of Samueli Integrative Health Programs, comments on the communication gap, stating "Part of the disconnect stems from how doctors are trained. Medical training sharply limits the ability of physicians to make healing their primary mission, and the current model of care does not allow for much time to capture the personal, social, behavioral and environmental factors that contribute to most chronic diseases. Unfortunately, patients will often defer to their doctor about what is discussed during their appointment, so if it's not brought up by their doctor, they may not be likely to mention it."

Another study published this month in JMIR mHealth and uHealth might offer hope for improvement in patient-physician communication in the form of mHealth.  The study: Simulated Clinical Encounters Using Patient-Operated mHealth: Experimental Study to Investigate Patient-Provider Communication was designed to examine “how personal mobile technology, under patient control, can be used to improve patient-provider communication about the patient’s health care during their first visit to a provider.”

The study found that “Overall, encounter and task times averaged slightly faster in almost every instance for the treatment group than that in the control group. Common ground clearly was better in the treatment group, indicating that the idea of designing for the secondary UX to improve provider outcomes has merit.”

But the age of technology advancing mHealth also has brought the avalanche of available medical information to patients. Combined with increased availability of direct-to-consumer medical products and services that empower patients to have greater autonomy in their healthcare, resulting challenges emerge in patient-physician communication.

The challenges are addressed in a JAMA article published last month: The New Age of Patient Autonomy - Implications for the Patient-Physician Relationship. The authors state that “expanded access to information and to a variety of health-related products and services will bring new opportunities for patients to direct their own health care. It will also bring new challenges for physicians who must manage the downstream consequences of tests and screens they did not order. Most important, the new age of patient autonomy will necessitate that physicians reconceptualize their role in the patient-physician relationship.

The authors conclude that in this new age of autonomy, physicians may need to act in the following three capacities: 

1. "Physicians will serve as consultants or advisors to patients who will increasingly direct their own care."
2. "Physicians will continue to perform diagnostic and therapeutic procedures that patients are not able to carry out."
3. "Although physicians will still be the gatekeepers of many medical resources, the function of gatekeeping will change. The availability of DTC products and services has pushed physicians gatekeeping back a level."