Addressing overmedicalisation: Effective Doctor-patient Commun.,Talking About What’s Truly Needed

​

Listening is just the beginning: Perhaps the key to stopping overdiagnoses and unnecessary treatments is good doctor-patient communication.

A likely scenario: A patient walks into the clinic complaining of a back pain and leaves with a prescription for certain medication and sometimes, a referral for MRI imaging.

Chances are, the back pain could have been a result of poor sleeping position, prolonged bad posture at work, or other lifestyle issues that might not have been properly communicated or addressed during consultation—which an MRI imaging also would not have benefitted.

Truth is, back pain is not the only condition that is often “overmedicalised”.

A research letter published in the Journal of American Medical Association (JAMA) highlighted that neuroimaging due to headaches, which contributes to approximately USD1 billion in annual costs—is increasing over time. This is despite published guidelines discouraging neuroimaging for simple headaches.

In the accompanying Editor’s Note, Mitchell H. Katz MD echoed, “As the authors demonstrate, the financial costs of neuroimaging for headaches are substantial. But, the costs we should care most about as physicians are the unnecessary radiation (in the case of computed tomographic scans) and incidental findings that lead to unnecessary medical procedures and great anxiety on the part of our patients.”

“I still see a lot of patients with two days of back pain and an MRI their primary-care physician ordered,” said F. Todd Wetzel, president of the North American Spine Society (NASS).

Listening is just the beginning – why communication matters
When a patient imparts a concern or complaint to the doctor, the underlying cause of that patient’s concern may often be overlooked. Doctors are trained to have a medical perspective and may overestimate ordinary ailments and very mild symptoms as signs of much more serious medical problems or diseases. This would consequently lead to overdiagnosis and prescriptions for unnecessary tests and treatment.



Cold feet may just be a case of the body’s normal reactions to colder temperatures instead of being seen as a sign of more severe diagnoses such as diabetes or nerve disorders.

Take cold feet, for instance, which can be associated with various causes, ranging from diabetes to nerve disorders. Cold feet in fact can also be caused by a state of high stress or anxiety. In such cases, the patient’s condition may be appropriately addressed by getting to the root of the underlying problem, which is reducing stress and tension.

However, when a patient has “cold feet”, the level of anxiety may or may not have been mentioned to the doctor, therefore it is possible that this particular factor is not taken into account in the patient’s diagnosis.

The same could be said when patients describe experiencing numbness, tingling sensation, or other mild symptoms. If doctors are unable to interpret patients’ descriptions and concerns accurately, it would ultimately result in poor treatment decisions – thus, compromising quality care.

Realigning the focus of doctor-patient communication
In this regard, communication is at the core of the matter. How well do doctors understand the reality behind the words and terms relayed by their patients? Are appropriate questions being asked during the consultation? Are patients given ample opportunity to share about their condition?

Danielle Ofri, MD, physician at Bellevue Hospital and Associate Professor of Medicine at New York University School of Medicine, discussed in her book, “What Patients Say, What Doctors Hear”, the state and common barriers of doctor-patient communication.

She told Medical Economics, “We all know the data that physicians interrupt patients in eight to 10 seconds and how awful that is. So, I tried an experiment where I let patients talk without interrupting them. We all worry that patients will talk forever; but, I learned quickly that they don’t do this. Most patients, within a minute, get out what they need to say and then they are done, and ready for questions from the physician.”



Dr Danielle Ofri, an associate professor of medicine at the New York University School of Medicine believes that good patient-physician communication can resolve the “overmedicalisation epidemic”. Photo credit: Medical Economics

Nevertheless, the precious time during consultation should also be used in focusing on what really matters. “Patients often come with a list of questions—which is generally a good thing—but, I caution them to be realistic. If you make a list, I tell them, prioritise the top two or three things. Don’t expect that we’ll get to them all. Otherwise, we’ll end up doing a superficial job, which can even make things worse,” added Dr Ofri.

Poor communication leads to poor understanding, and this leads to increased possibility of errors as well as patient dissatisfaction.

The commitment to provide patients with the best care possible means to realise that communication is intrinsic to the goal of providing quality health care. This requires doctors to have the skills to approach patients’ concerns from different angles.

Dr Ofri believes that communication is the “single most powerful tool” in medicine. “The patient you are seeing now may be one of 20 for you – but, remember that you are the only one to them,” she echoed.

Source