MEDICAL MATTERS:Do patients know enough to have conversations with their GPs?, writes MUIRIS HOUSTON
HOW COMFORTABLE do you feel when talking to your doctor? Do you have enough “medical” knowledge to allow you to participate in shared decision- making with a health professional? Or is the experience a one-sided blur of jargon and assumption on the doctor’s part?
Even the most diligent medical communicator may struggle, according to the results of a survey published earlier this month. Some 700 people in Britain were asked to look at outlines of both a male and female body and to identify particular organs.
Less than 50 per cent of those surveyed could correctly place the heart; the intestines did best, with more than eight in 10 correctly identifying their location.
The kidneys proved more challenging, with less than 30 per cent of the population able to identify them. And when people with renal disease were asked about the kidneys – organs especially relevant to their health – more than half were unable to correctly locate them.
The survey was a repeat of one carried out 40 years ago; remarkably the results were almost the same in 1970.
One of the authors said he had expected that improvements in education, coupled with an increased media focus on health as well as greater internet access would have led to an increase in patients’ anatomical knowledge. The findings certainly raise concerns about doctor-patient communication. For people to use the health service effectively they need to be able to understand what is being said to them. And how can we expect patients to participate fully in decisions involving their health with significant knowledge deficits?
This very issue was the subject of a blog last week by the primary care editor of the British Medical Journal(BMJ).
Dr Domhnall McAuley, reporting from the International Shared Decision Makingconference in Boston, noted some difficulties in assessing the actual health benefits of patient involvement.
One speaker had reflected on research about the heart rhythm disturbance, atrial fibrillation, that was successful in involving patients in the decision-making process. As a result, fewer patients opted for treatment with the blood-thinning drug warfarin.
However, this may lead to an increase in strokes for these patients. So while there was a good involvement by patients, it “runs counter to evidence- based guidance and creates a dissonance between personal and population health gain”.
McAuley noted that shared decision-making may lead to healthier patients but more illness.
The onus of good doctor-patient communication must fall more heavily on the physician; they are the professionals in the equation – it’s their job – and so they need to train for the role. So I was fascinated to read the story of “Amanda Jones”, a mixed reality human developed by scientists at the University of Florida.
Ms Jones is a life-sized computer avatar combined with a mannequin with a prosthetic breast. She is the culmination of efforts to help teach intimate procedures, such as breast examinations, to medical students.
The hybrid computer/ mannequin doesn’t just help train students to correctly perform a breast examination, but also how to talk to the patient during the procedure.
The lead researcher, Benjamin Lok, said of the virtual patient, “all of a sudden students have to not only practise their [examination] technique, but they also have to work on their empathy. Studies have shown that communication skills are actually a better predictor of outcome than medical skills.”
The virtual representation of Ms Jones moves and speaks on a flat screen above the mannequin. Medical students have to tease out her medical history, listen to her concerns and respond to her questions. This interview occurs simultaneously with the physical examination, just as it would in real life. The evidence so far is that students do not hesitate to express empathy to Ms Jones.
Meanwhile, back in the real world, and against the background of controversial cutbacks at Our Lady’s Hospital for Sick Children, we have to find ways to involve lay people in health service decision- making. With recession comes rationing of healthcare resources, and a democratic approach to that must include user involvement.