A “Zeitgeist Moment” for Improving Physician-Patient Communication

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While the debate about drug costs rages on – whether we’re talking about innovative new ones or the more recent trend of turning decades-old, inexpensive drugs into high-priced “specialty drugs” – it is worth considering the value of lower-tech approaches to improving patient outcomes and controlling healthcare costs.

Like talking.

Recently, for example, a rigorous, landmark study funded by the National Institute of Mental Health (NIMH) concluded that schizophrenia patients who took part in a program that emphasized talk therapy and family support while keeping dosages of antipsychotic medication as low as possible (to minimize side effects) had better outcomes after two years of treatment than patients who got the usual drug-focused care.   

This isn’t a one-time finding. A huge amount of global evidence has built up over several decades demonstrating that better communication between physicians and patients improves health outcomes and reduce costs. The NIMH study was based on an approach called Open Dialogue, first developed in Finland in the 1980’s for people diagnosed with psychoses such as schizophrenia. It emphasizes early intervention that includes listening, collaboration and support for the individual’s network of family and friends, rather than relying solely on medication and hospitalization. “These are zeitgeist ideas,” said one of the experts quoted in the New York Times piece about the study. And indeed they are.

The Institute of Healthcare Communications (IHC) was an early initiative here in the U.S. that had its start nearly 30 years ago, as an initiative for Bayer (then Miles Pharma). Its aim was to spearhead a push for better physician-patient communication. The value of this work was validated early on in a very dollars-and-cents way, when clinicians who took part in IHC workshops were offered discounts on their malpractice insurance. Insurers saw first-hand that breakdowns in physician-patient communication were – and still are – at the root of many malpractice suits.

Today, not only insurers but many medical schools, health systems and hospitals are engaged in focused efforts to improve communication between patients and their healthcare providers. The impetus for this has come from many places over the last three decades. Recently, one of the more forceful kick-in-the-pants has come from Medicare, which in 2012 began reducing reimbursement to hospitals with poor performance on patient satisfaction scores, 30-day hospital readmission rates, and other metrics where it’s been shown that improving physician-patient communication can make a huge difference in outcomes and costs.

There have been and continue to be challenges. Lack of time (or the perceived lack of time) to attentively listen to patients is almost always blamed for the failure to communicate. A newer wrinkle has been introduced with electronic medical records, the maintenance of which requires a clinician to look at a computer screen rather than the patient for large chunks of the limited time they are in the same room together.

The bottom line, though, is that our healthcare system still rewards “doing” – prescriptions, procedures – over listening and talking. With drug prices unlikely to go anywhere but up for the foreseeable future, we have a social responsibility to make room for the low-tech, high-touch methods that we know can deliver more cost-effective and patient-centered care. It’s time to accelerate translating that knowledge into widespread practice.