Why is It Important for Patients to Communicate Well With Doctors?

by Peter Tate - Date: 2007-01-08 - Word Count: 670 Share This!

Put simply, the more the pair is in agreement about the diagnosis, the implications and the treatment of the perceived problem, then a plan suited to that individual becomes much more likely.

Think of this interchange as if you were the patient. By the end of the visit if you have reached a shared understanding, you will be more likely to follow the medical advice, because by implication in reaching such an understanding you are agreeing to the contract.

This is very important, not least because it is very unusual! Most medical encounters do not result in a shared understanding, this may be the main reason that the figures for the conscientious uptake of medical advice are so depressing.

When doctors talk about patients following advice they often use the word COMPLIANCE. This implies that the doctor knows best, tells the patient what to do or what to take, and the patient (you?) is expected to comply or in other words follow this advice slavishly. Our parents grew up with sort expectation from doctors and many of us still expect to be told by our doctors what to do: but there is a big problem with this common strategy. In the vast majority of cases it does not work.

Let me tell you about the rule of thirds again from the patient's perspective:

It is easy to remember and is very well authenticated:

One third of us patients take medical advice and act in accordance with it sufficient for the advice to be effective.

One third of us take heed of some of the advice but not enough for it to be effective. Imagine the way many of us take pills for a sore throat: a few one day when it is sore, forget for a day a day or so and then start again when the throat gets sore again.

One third of us just don't bother to take the prescribed medicine.

Let us take the common, life threatening, condition of maturity onset diabetes(otherwise known as Type 2). This is an illness that leads to blindness, terrible circulatory problems and considerable sickness and suffering. Many of us need at least two drugs to control the blood sugar adequately. So what are the facts? A careful and thorough study of 1000 type 2 diabetic patients from Tayside in Scotland reported in early 2000. The authors showed that compliance with a one drug regime did indeed fit with rule of thirds, 33% of patients taking the medication as prescribed. When two drugs were prescribed the compliance fell to 13%!

Let me say that again, only one person in 3 took one drug as prescribed, and very nearly only one person in ten took two drugs as prescribed. So the really strange people are those who take their tablets, not the ones who don't.

A review in 2005 of the literature revealed that long term compliance with drug treatment decreased over time and that 50% was an average figure after 3 years. So only half the people on medication takes it!

We should all think about this long and hard.

There is now a healthy debate about the very word compliance which implies a subservient relationship, many experts are now advocating the word concordance instead. Some prefer the word adherence. What is clear is that those of us who are slavishly following medical advice are not only unusual, we appear to be so uncommon now as to be considered abnormal.

Now think about this: you are living through a time of historic change in the role of doctors. Doctors are no longer the keeper of occult secrets, they are not the fount of all medical wisdom, many of us will know more about our individual disease than our doctors carry in their heads: the doctor's job is rapidly changing to that of our medical interpreter and provider. The internet has torn up the rules, old fashioned communication strategies are no longer viable, shared decision making is a must, concordance rules. So in order to improve our health we all must learn to understand our doctors better.

Related Tags: communicate, patients, patient, doctor, doctors

Peter Tate qualified as a doctor at Newcastle in 1968. After spells as a P&O Surgeon and as a trainee in Kentish Town he was a family doctor for 30 years. He was an MRCGP examiner from 1981; he retired as convenor of the panel of examiners in March 2006. He is the sole author of The Doctor's Communication Handbook now in its 5th edition. He is also the author of The Other Side of Medicine, a collection of essays and short stories. He has also recently published Seasickness, a novel based on his experiences as a young ship's surgeon. He was a co author of The Consultation and The New Consultation OUP. He has lectured widely on communication issues. His recent medical books are available from Amazon and http://www.radcliffe-oxford.com. Seasickness is also available from http://www.lulu.com/petertate Peter has just written 3 books for patients available at: http://thinkingaboutyourhealth.com

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