Valuable tips for medical consultations. Patients speak up for themselves

Patients are very capable of participating in discussions about  the quality of communication that takes place in the consulting room. They have also given valuable tips for doctors and patients in this situation. This is evident from recent publications by researchers from the universities of Ghent, Utrecht, Liverpool and Verona, together with NIVEL, in scientific journals that include Patient Education and Counseling.

During a medical consultation there are two parties communicating with each other: the doctor and the patient. Remarkably patients are hardly ever systematically involved in the issue of what exactly good communication is for them. Courses to train people in communication skills are developed by professionals. But is this approach right? Why are the patients not asked what they think is important for communicating with their doctor? There is, after all, no reason not to involve them in systematically evaluating the quality of care, argues Professor Jozien Bensing from the Netherlands Institute for Health Services Research (NIVEL). To study this, she initiated the GULiVER-study, an international project involving researchers from Belgium (Ghent), the Netherlands (Utrecht), UK (Liverpool), and Italy (Verona) in which lay people were asked to evaluate videos of medical consultations and to give their opinions on them.

Empathy
In the study, 35 panels, consisting of a total of 259 people and spread over the four countries, were shown the same video clips of medical consultations. These clips all showed situations in which the patient showed an emotion or a concern, followed by the response of the doctor. The panel members evaluated the doctor’s response by giving it a rating between 1 and 10. The average ratings varied between 3.7 and 7.6. Subsequently, the panel members discussed the good and the bad points seen in the clips. Jozien Bensing says: “The study shows that in all the countries involved, the highest quality ratings were given when a doctor clearly showed empathy. So we may conclude that this is what patients want most: for a doctor to empathize with their patients and to show understanding for what they are going through.”

Remuneration
In communication skills training given to medical students, empathy has been found to be an important component as the scores given by health professionals and by panels of lay people hardly differed. “The communication skill trainers are doing the right thing, which is one positive conclusion drawn from this study. But unfortunately that doesn’t tell us anything about daily practice,” Bensing continues. “Introducing standards for medical practice has without doubt improved the quality of medical treatment but care is under pressure of becoming less personalized. There is less attention paid to a patient’s personal situation. In addition, the increasing move towards efficiency in health care means that an empathic approach towards patients is often lacking in practice, even when doctors consider empathy as a core value in the medical consultation.” You often hear that ‘doctors just don’t have time for empathy that is something that the nurse has to do’. Bensing believes that if nothing happens, empathy, which is at the heart of medicine gets under pressure. She continues: “This is something that is really important to patients, which is why it would be a good idea for health care insurers to include it in their agreements with doctors. After all, if you show the ‘empathic approach’ in the doctors’ remuneration, you also acknowledge its importance. This has a symbolic value and acts as a signal to others.”

Tips
After viewing the video clips and discussing the communication skills, the panel members formulated tips for achieving more effective consultations from a patient perspective. This has inspired the Dutch Federation of Patients and Consumer Organisations (NPCF) to developing a ‘communication chart’, consisting of the in the study collected, illustrated by cartoons (www.mijnzorgveilig.nl). The tips are addressed to doctors as well as patients. One interesting aspect of this is that many tips for doctors were mirrored in the tips for patients. According to the participants, a good consultation is the responsibility of both parties. The tips reflect the panel members’ sensitivity for continuity of care with tips covering the whole process from the preparation before the consultation, the consultation itself and the aftercare.
One tip for doctors is that they should not create a doctor-patient distance by asking the receptionist or assistant to perform pre-consultation triage. In addition, they should find out beforehand who will be coming for consultation; this prevents unnecessary questions being asked and patients are assured that the doctor is concerned about their case. During the consultation, it is important to make eye contact, to show understanding and to be honest. After the consultation patients always want to know the result of their tests, even if it turns out that there is nothing wrong. This reassures them and, even when the symptoms continue, they are less likely to worry that there has been an administrative fault or that the doctor has not seen their test results.
Patients are advised to prepare well for the consultation beforehand, for example, by keeping a diary on the course of their symptoms and to think in advance about what they want to ask the doctor. During the consultation it is important that they are completely honest about the severity of their symptoms and that they tell the doctor what they have done to reduce them, for example, if they have used non-prescription drugs or consulted alternative therapists. It would also be a good idea for them to always inform their doctor when their symptoms disappear after the consultation. This takes hardly any effort if it is done by email.

Personal history
“Patient-centered communication means that first and foremost doctors have to know exactly who is sitting opposite them in the consultation room,” Bensing writes in one of her publications. “For this purpose, drawing up a joint agenda in the beginning of the medical consultation may help to fine tune communication between the doctor and patient. And this requires firstly giving patients the space to bring their own story to the foreground, as is described in the tips.”

Funding
- The current research falls under the research programme of Jozien Bensing who was awarded the SPINOZA prize.
- Ministry of Health, Fund for patient-oriented research (Fonds PGO)

Partners GULiVER study
- NIVEL / Utrecht University, Professor Jozien Bensing (projectleader)
- University of Verona, Professor Christa Zimmermann
- University of Liverpool, Ian Fletcher, PhD
- University of Ghent, Professor Myriam DeVeugele
- Dutch Federation of Patients and Consumer Organisations (NPCF), Alice Hamersma