What did doctor actually say again?

Was it that you should be careful when taking two medicines at the same time, and should you be lifting heavy things? Health professionals should employ a definite strategy when giving patients information, researchers maintain.

Picture shows a woman sitting at a table discussing with two other women in white coats

Associate professor Hanne Cathrine Lie (to the right) says patients will take in more if the doctor gives both written and verbal information. Here she discusses this with medical student Maria Gullestad Binder (to the left) and research assistent Jannicke Kirkøen. (Photo: private)

Imagine that the doctor has just told you that you have heart disease. This makes you feel stressed and upset. The doctor carries on talking at speed, telling you about four different medicines that you must take in the correct way. How probable is it that you will remember everything the doctor has said when you get home?

– One study of patients sent home from an A&E unit showed that some patients recalled less than one tenth of the information they were given and patients varied greatly as to how much of the doctor’s information they had absorbed. Several studies reveal that patients often forget or misunderstand between 40 to 80 per cent of the information they receive, says associate professor Hanne Cathrine Lie.

Lie works at the Department of Behavioural Medicine at the Institute of Basic Medical Sciences, and together with postdoctoral fellow Julia Menichetti, she has published a new meta analysis in the Journal of General Internal Medicine.

Communication strategies are effective

In their analysis, the two researchers looked at studies where health professionals had employed different, specific strategies for giving information effectively in order to find out whether the strategies were beneficial. They discovered that in the majority of the studies, the strategies had a positive effect both when it came to how much information the patients remembered and to how far they followed the doctor’s advice afterwards.

– Strategies that work well involve adapting the communication to the individual patient and to the particular purpose of the information. For example, presenting information in a structured way is important if the objective is to ensure that the patient remembers well what has been said. It is important that health professionals are more aware of how they communicate and that they use specific strategies when giving information, says Lie.

Health professionals should also be aware of, and react to, the patient’s feelings during the consultation, because strong emotions affect the extent to which the patient absorbs the information given, she adds.

Lie and Menichetti have some further advice beyond that of the findings of their meta analysis: the patient will take in more if the doctor gives both written and verbal information and he/she uses visual effects, such as pointing to a picture of the body. Another technique is to record videos of health professionals in action in order to make them more aware of how they communicate. In this way, they can practise using different strategies.

What should the patient ask the doctor?

Lie also has some advice for the patient:

– If you are going to a planned consultation, think about what questions you need to ask the doctor before you go. Write them down on a piece of paper and take this with you. Let someone else accompany you who can help you to remember what the doctor says, or make notes during the consultation. Ask the doctor to put the key points down in writing. Ask if there is someone you can ring, if you have any questions later on.

Lie emphasises that it is important the patient dares to ask questions and is not put off by thinking that health professionals are always so busy. This is not the fault of the patient and it is better for all those involved that the patient has understood correctly.

Postdoctoral fellow Menichetti points out that doctors should prioritise the information provided and give it in small doses and in a simplified way. He or she should also pay attention to how the proposed treatment will fit into the patient’s life.

– During and at the end of the consultation, it is important to check that the patient has understood the most important points. This involves asking patients to repeat in their own words what they have comprehended – not just asking them whether they have understood everything. This method is called teach-back and should be used much more, she says.

Misunderstandings can lead to serious consequences

Some doctors may object that it takes more time to give information visually, orally and in writing. Others may feel uncomfortable about “cross-examining” the patient about their understanding of what has been said.

– But if the patient does not understand the messages, the doctor has wasted the time used during the verbal consultation and the consequences of misunderstandings can be serious. Patients can end up taking either too little or too much medicine, their health may deteriorate, they may have to be readmitted to hospital and in a worst case scenario, they can die, emphasises Lie.

Finding out if some strategies work better than others

In the new meta analysis, Lie and Menichetti investigated whether communication strategies have an effect.

– In studies where the goal was to get the patient to change behaviour, eight out of nine research projects showed that strategies had a positive effect. Examples of this were getting the patient to stop smoking, lose weight or control their blood sugar level. In these cases, several different communication strategies were often used simultaneously, reveals Menichetti.

In eight studies involving ten research projects, the researchers checked how much the patients had understood and recalled of the information given before and after the use of a communication strategy. Here, the patient remembered more in four of the cases and in most of the cases, only one strategy was used at a time.

Lie and Menichetti had to exclude many studies when conducting the meta analysis due to a lack of data on how the health professionals had been trained in communications or on how the information was given.

Going forward, both scientists at the Department of Behavioural Medicine will try to find out whether some strategies work better than others. However, Menichetti does not expect to find a “one size fits all” communication strategy because people differ.

Messages can be too vague

Lie would also like to point out that health professionals often communicate their messages in too vague and imprecise a manner. As, for instance, when they say “ring 113 if there are any changes”.

– What should the patient look for in particular and that would be considered “a change”? The same thing applies when health professionals say “you can ring if your condition worsens”. Which danger signs should the patient then react to? What did the doctor actually mean by “worsens”?

Lie and Menichetti stress that there is an increasing focus on communication skills both in medical school and in health care today. They hope that their findings on communication strategies can help to prevent serious consequences occurring as a result of patients having received inadequate information.

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