The adage that says the more things change, the more they stay the same may apply—for better or for worse—to inpatient and physician communications. In a study at a Connecticut hospital, two physicians found that fellow providers who thought they were doing a good job talking and explaining facts to their patients actually found they were falling short of their medical goals.
While much has appeared in the medical literature about how to communicate better with patients, the job is still challenging, physicians say. "Compared to a decade ago patients are sicker, the time they are in the hospital is shorter, and having them involved in their care and getting them to understand their care is increasingly more important and increasingly more difficult," says one of the physicians, Douglas Olson, MD, a chief resident in the primary care program at the 367-bed Waterbury Hospital, private, not-for-profit community teaching facility.
The idea for the study came from the experiences at the hospital of Olson and Donna Windish, MD, MPH, associate program director of the primary care program at Waterbury. "Despite spending time with patients...and despite telling patients why they were in the hospital and telling them what medications they were receiving, we both had the idea that patients just weren't getting it on a daily basis," he says.
"We wondered if this was our own experience or something more of a systemic problem that all physicians are facing," Olson adds. So they decided to see what gaps in understanding existed and in particular how that differed from physician assessments. Their findings appear in the Aug.9 issue of the Archives of Internal Medicine.
They surveyed corresponding internal medicine residents and attending physicians—asking them to report on their care of hospitalized patients and their understanding of their patients' perspectives on the care received. For the study, 89 patients and 43 physicians participated.
What they found was an "impressive disconnect" in the communication and the perceptions of patients and physicians on the care that was provided: