Good communication, good care

February 23, 2004|by KATE COLEMAN

Pediatrician and internist Dr. Vincent A. Cantone practices medicine at the Smithsburg Family Medical Center.

He takes care of patients of all ages - "from birth to grave," he says.

He enjoys his work, and that helps him communicate with his patients.

Cantone, who's been in the practice since 1996, says he had some communication training in medical school. He interviewed patients in front of attending physicians and was graded on how he did.

When he gets a new patient, he looks at the information provided in the medical history. Then he sits down with the person to talk about it. He likes to assess the general situation - considering a person's body language and intonation along with their words.


Connecting with a patient - finding a commonality - can help break the ice with a shy person. He finds ways to draw people out. People sometimes have their guard up, he says. "I think you have to be disarming. Surprise them."

He encourages patients to ask questions.

Something to talk about

The relationship between a patient and doctor is a special one.

Dr. David Mallott, associate dean for medical education at the University of Maryland School of Medicine, describes it as intense and personal.

"We assume that health care is all about expertise," says Mallott, a psychiatrist. "For the patient, it's also about being able to connect."

In recent years, more attention has been paid to professionalism, he says. Medical schools are looking at ways to create the best product.

"What we're trying to do is teach the ideal," he adds, and good communication is an important part of being a good doctor.

University of Maryland School of Medicine is in the process of revising the structure of some of the classes for medical students. Attention - including videotaped interviews with "standardized" or "simulated" patients - has been paid to doctor-patient communication for years in classes, Mallott says.

Some of the curriculum changes will involve making the focus on communication one long thread through four years of study, rather than separate pieces, Mallott says.

Communicating care

Last year, the University of Pittsburgh School of Medicine started a new institute to teach and conduct research on ways to improve communication between doctor and patient.

So much of the focus in medicine has been on its high-tech features, says Dr. Robert Arnold, director of the institute.

Studies show that 70 percent of diagnoses are made from the medical history; 15 to 20 percent are made from the physical exam, Arnold says. In most cases, the lab tests just confirm what you think, he says.

Medical schools are telling students to pay as much attention to the relationship between a doctor and his patient, he says.

The doctor needs to have information about more than just signs and symptoms. He or she needs to know how the illness affects the person as a person, Mallott says.

Doctors have to know how to educate a patient in ways and language that are not too technical. Increasingly - in internet age - they also need to know how to re-educate a patient, Mallott says.

Doctors need to know how much information their patients want - and how much they can handle.

Arnold uses the example of car repair. He trusts his mechanic and wants him to take care of his vehicle without sharing every detail.

If patients need to mull over - or have their families help them understand - the doctor's advice, Arnold suggests requesting permission to record the meeting.

Asking the right questions

Good communication also is an important part of being a good patient. It's a two-way street, Mallott says.

People often are afraid of looking silly, but patients have to ask questions. Patients shouldn't be afraid to tell doctors how they feel - how their lives are affected.

One good question: "What effect will this medication have on my sex life?"

It's important for the doctor to know what matters. It's also important for patients to know that the doctor may not be able to answer every question during a single appointment. It's OK for the doctor to say we need to schedule another appointment to deal with the rest of these questions.

Patients also should feel free to decide that communication with a particular doctor is not good enough and to find a new one, he says.

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