Patient Safety and Quality

Transparency enhances physician communication with patients

Good physician-patient communication is the cornerstone of patient-centered care. Patients want information about their condition and treatment in ways they can understand. Yet, patients are reluctant to engage in information-seeking behaviors during visits. What's more, physicians devote relatively little time to proactively helping patients to understand their medical conditions or the pros and cons of treatment options or medications. A new study reveals that transparency in communication by physicians can do a great deal to alleviate patient uncertainty and engender empathy and respect during medical visits.

Lynne Robins, Ph.D., of the University of Washington, and colleagues analyzed audiotapes of 263 patient visits to 33 physicians providing care to adult patients in eight community-based, university-affiliated primary care practices. Communication was defined as transparent if the physician used nine types of conversational phrases. Some phrases communicated the process of the clinical encounter, such as what will be included in the visit or stages of the physical exam. Some phrases clarified the medical content of the visit and demystified medical terms and jargon. Other phrases centered around the patient's subsequent course of action, e.g., what the patient needed to do next or instructions in how to take their medication.

Physicians spent the greatest amount of time during the encounter demystifying medical terms into lay language and concepts. Other types of transparent communication often included sharing emotions and judgments about the patient's condition, giving reasons for treatment rationale, and orchestrating instructions on taking medications or determining the next appointment. Patients prompted their physicians to be more transparent, but relatively infrequently. They averaged around one prompt per visit to ask for clarification about medical jargon. In half of the visits, patients asked their physicians to share their thoughts. Patients only infrequently asked for additional information about treatment and diagnosis. The study was supported in part by the Agency for Healthcare Research and Quality (HS13172).

See "Identifying transparency in physician communication," by Lynne Robins, Ph.D., Saskia Witteborn, Ph.D., Lanae Miner, M.D., and others in Patient Education and Counseling 83, pp. 73-79, 2011.

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