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Doctor-patient communication in critical condition.

Much of the attention on health care reform has focused on providing everyone access to basic medical care. As patient caseloads increase, though, it will become critical for doctors and patients to communicate more efficiently and effectively, according to University of Wisconsin Medical School experts. "Health care reform is good in that everyone will have at least some form of coverage," notes Norman Jensen, professor of medicine and an expert on doctor/patient communication. "With more people in the system, however, doctors may be faced with the challenge of providing the same or better quality of care in a shorter amount of time. This will require doctors and patients to improve their rapport."

The main goal of national health care reform is to extend coverage to the 37,000,000. Americans who now lack insurance. Primary care physicians, in particular, will feel the impact of a universal system because they provide the front-line and preventive care most people use. "The efficient use of these doctors' time will become extraordinarily critical," Jensen points out. Already, their caseloads are extremely high because of a nationwide shortage of these specialists. As a result, it is essential that ways to attract more medical students into primary care also be addressed.

While health care reform further will stretch primary care resources, patient care won't necessarily have to be sacrificed if doctors do a better job of interviewing and listening to patients, and if patients take a more active role in their health care. Polls and research show that most people are dissatisfied with the way their doctors communicate with them. Patients say their physicians don't explain things thoroughly, don't empathize with the human dimensions of their illness, or use medical jargon that leaves them confused.

However, patients have responsibilities, too. For instance, it would be helpful if they arrive better prepared for their visit, so they will be able to maximize time with their physician, maintains Susan Skochelak, associate professor of family medicine and practice. One step they can take is do more background reading on their medical condition, rather than rely completely on the doctor for this information. She also encourages patients to make a list of concerns prior to seeing their doctor. "That way, the visit can be used effectively, and patients won't leave the office without having all of their questions addressed." To get the most out of your appointment. * Work with the appointments desk in scheduling an appropriate amount of time. Think about your reasons for seeing the doctor and schedule a time frame from that point. Understand that a 30-minute appointment may cost more than a 15-minute one. Ask for advice about how much time to schedule. * List your concerns in priority order and mention the most important ones early in the visit. Avoid what doctors call "door-knob concerns"--the ones patients mention incidentally as they're walking out the door: "Oh, by the way, I wanted to talk about the fainting spells I've been having." * Ask questions. As a patient, you have a right to understand your diagnosis, the treatment your doctor recommends, alternatives you might consider, and side effects that might occur. * Respect limits on your physician's time. If your doctor can't explain everything within the time you've scheduled, arrange to come in again or talk further by phone. * Be honest about the purpose of your visit. Don't schedule a physical exam when your real concern is that the red sore on your leg may be cancerous. It's naive to assume a doctor will discover anything that may be wrong if you don't mention it.
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Publication:USA Today (Magazine)
Date:Aug 1, 1993
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