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Continuing concerns, new challenges, and next steps in physician-patient communication.

For orthopaedic surgeons, effective communication with patients should be an area of concern. In a study on the office practices of orthopaedic surgeons, Levinson and Chaumeton determined that the mean duration of an office visit was thirteen minutes and that the surgeons talked more than the patients did. They also observed that, even though a substantial amount of patient education occurred during these visits, orthopaedic surgeons infrequently expressed empathy toward the patient and usually asked only closed-ended questions, allowing for only brief social conversation. According to Vaughn Keller, Associate Director of the Bayer Institute for Health Care Communication, the problem often starts within seconds of a consultation: the patient starts talking about a problem (usually not the important issue, which the patient is saving for toward the end of the visit) and the doctor interrupts within eighteen to twenty-four seconds and begins firing a series of questions at the patient. The big issue, therefore, never gets discussed. The role of effective physicianpatient communication in achieving the best medical outcomes and promoting patient satisfaction is well established in the literature and is confirmed by our personal experience as physicians. In a public opinion survey on what makes a good doctor, conducted by the American Association of Medical Colleges, the participants indicated that important attributes of the physician were a caring attitude and communication skills (85% of participants), the ability to explain complicated medical procedures (77%), good listening skills (76%), and an open mind about alternative therapies (29%). The importance of communication has received a great deal of attention among primary-care providers but little attention until recently among specialists, especially surgeons. Research in the primary-care setting has established that effective communication enhances patient recall of information, compliance with instructions, satisfaction, and psychological well-being and it improves outcomes. New knowledge about the impact of ethnicity, age, and gender on health-care utilization has further confirmed these observations. There is no doubt, according to Levinson and Chaumeton, that a trusting relationship between a physician and a patient is the bedrock of medical care. The purpose of communication is not to convince the patient to do what the physician desires but to understand the patient’s concerns and to make decisions acceptable to both the patient and the physician. As we move to a consumer-driven health-care system in which patients expect to understand their medical problems, their treatment options, and the relevant outcomes data as well as to participate in decisions about their care, we must be ready to answer their questions. We must be prepared to provide both information and judgment about new technologies, alternative treatments, interpretation of medical data, new pharmaceutical products, and the impact of genomics on their conditions and treatment options. We must communicate effectively. Managed care and information technology have altered our practice of medicine and the management of our offices. We must constantly reassess the impact of these changes on our ability to communicate with and to establish relationships with our patients and to carry out the duties of our profession. Adherence to the core elements of professionalism—that is, altruism, accountability, excellence, duty, honor, integrity, and respect for others—is not possible in the absence of effective communication between physicians and patients and between physicians and their colleagues.