Mack Lipkin, MD, the founding president of the American Academy on Physician and Patient, a society dedicated to research, education, and professional standards in patient-physician communication, reported some interesting data in a PowerPoint presentation he gave in 2000 at the working conference on Diversity and Communication in Healthcare sponsored in part by the U.S. Office of Minority Health. Dr. Lipkin said that physicians’ lowest level of communication skills are reached during their medical residencies; even medical students’ skills were rated higher. Dr. Lipkin, who is also director of the Division of Primary Care in the Department of Medicine at New York University School of Medicine, New York City, went on to explain that, typically, physicians will recover some capacity with communication as they enter practice and years of experience ensue, but they never reach the level they possessed before they entered medical school.
While some hospitalists may consider this a startling claim, few are likely to find it shocking. Although hospitalists believe using good communication skills is an important part of their work, their skills may not necessarily match their beliefs or intentions. Research in progress by hospitalist Paul Mueller, MD, and his colleagues at the Mayo Clinic College of Medicine, Rochester, Minn., reveals that a majority of new internal medicine faculty—regardless of years in practice or background—believe they could benefit from and desire additional training in communication; yet these individuals teach communication skills to medical students (personal communication, 2005).
Medical education curriculum experts nationwide are pumping up their coverage of physician-patient communication to supply the demand stemming from a surge of interest in this topic in recent decades. Some reasons for this include reports and investigations into medical errors, an explosion of medical and health information easily accessible to patients and families, the rise of a vital consumer advocacy and empowerment movement, the reliance on outcomes assessments that include patient satisfaction ratings, a growing emphasis on patient- or relationship-centered care, and the reduced time for medical encounters caused at least in part by cost-containment initiatives.
The relationship between communication and medical outcomes is being increasingly explored, including the effects on physician satisfaction.1-5 But what are the further, personal effects to the individual hospitalist when he or she perpetuates poor communication skills?
—Robert Trowbridge, MD
Communication With Patients And Families
The work of hospitalists depends acutely on communication.
“It’s part of the role of the hospitalist to explain and help shepherd [patients] through the healthcare system,” says Robert Trowbridge, MD, a hospitalist and assistant professor of medicine, University of Vermont College of Medicine, Maine Medical Center, Portland.
Professionals whose medical practice is based on short clinical visits or performing procedures may or may not be good communicators, but it’s probably not as integral to the way they or the situations their patients are going through will be perceived. The conventional wisdom in professional and lay circles tends to be, “He may be a lousy communicator, but he’s a hellava surgeon,” says Dr. Trowbridge.
But most patients expect good communication from their primary care physician and because they are serving that function when a patient is hospitalized, hospitalists should understand that patients and families expect those skills of them. “And if the [hospitalists] don’t do well [in communicating], there can be much more stress on the patients and physicians,” explains Dr. Trowbridge.