You’re at the doctor’s office and the nurse or medical assistant is assessing your vital signs. Weight, height, temperature, blood pressure, pulse – each is measured and silently written down.
What’s missing from this picture? The sharing of information, that’s what. Are the patient’s vital signs a matter for the clinician’s eyes only, or are they something that also should be shared with the patient? Because all too often, whether it’s in the exam room or at the hospital bedside, the information goes straight into the medical record while the patient is bypassed.
I’m not trying to single out the people who take vital signs or suggest that they’re deliberately withholding information from the patient. This just happens to be an example I’ve noticed of a pattern that seems ingrained in health care culture: the assumption that the information doesn’t really need to be shared unless the patient specifically asks for it.
Late last week I was drawn into an online debate at Mind the Gap, a doctor-patient communication blog hosted by Steve Wilkins.
Wilkins opened with a basic premise: that the fastest way to disempower, de-activate and disengage patients is a trip to the doctor’s office. He writes:
If you were to believe the admonitions of the NIH, AHRQ, hospitals, pharma and every WebMD lookalike, you would think that patients these days would be more involved in their visit… asking questions, sharing information and making decisions. But as most physicians will attest… most patients don’t have much to say in the exam room anyway. And the longer they have to wait before being seen, the less patients are likely to bring up the few questions they wanted to ask.
Predictably, the responses were divided into doctors-are-incredibly-pressured-and-doing-the-best-they-can vs. patients-feel-shut-out-and-are-sick-of-fighting-for-every-scrap-of-knowledge-about-their-health.
While there are numerous factors contributing to this less than optimal state of affairs, at least some of it seems to stem from a playing field that simply isn’t level when it comes to sharing information.
One of the commenters said she asks questions in the doctor’s office and asks for copies of her medical record. “I ACT LIKE an empowered patient,” she wrote.”But it’s only possible to BE an empowered patient when the doctor is an active part of the process. An empowered patient can ask questions. That doesn’t mean that the doctor will provide an answer. An empowered patient can request notes and test results. No guarantee that those will be provided either.”
There’s in fact a new commodity in health care these days: information. Clinicians have it; patients want it. And therein lies a constant source of misunderstanding, frustration and defensiveness on both sides.
Patients chafe at the hoops they’re often required to jump through in order to obtain their medical information. This isn’t just their perception. Among complaints alleging violation of the federal HIPAA law governing the privacy of patient health information, problems with access to the medical record consistently rank No. 3 on the list of the top five violations requiring investigation and corrective action.
For their part, clinicians are under intense pressure and often can’t spend the time they’d like to share information more fully with patients. A physician commenter at Mind the Gap wrote:
This is the reality of today’s primary care office visit. 15 minutes: 4 minutes used for data entry into the EMR (has to be completed by the time the patient leaves); 3 minutes for entering lab orders and referrals; 90 seconds for reviewing health maintenance needs that have no relation to the visit at hand; 60 seconds for prescription reconciliation; THEN the six active problems can be addressed. There is no time for communication for any type, much less patient-centered communication!
Yet if you look at the research, it suggests many patients leave the doctor’s office with an incomplete understanding of key information such as what their diagnosis is or why they need a particular medication.
It’s true that for some patients, this simply might be more information than they’re able to absorb. This can’t be assumed for all patients, though. And it’s hard to see how patients can help make the most of limited time with their doctor when the default strategy is to give them minimal information in the belief that they don’t need more or won’t know how to use it.
What to do? Ironically, there’s more health information available than ever before. Consumers can go online and research their diagnosis. They can connect with other patients. They can check out the quality of their local hospital. They can rate their doctor. But none of this means very much when patients still often struggle for access to some of the most important data of all – information about their own health.