Can a simple conversation between a patient and a clinician improve that patient’s health outcomes?
Medicine is so predicated on science – which consists of physical interventions, like taking medications and undergoing surgery – that the impact of “just” words may be overlooked.
In research conducted by Sawsan As-Sanie, M.D., MPH (Associate Professor, Obstetrics and Gynecology, University of Michigan Von Voigtlander Women’s Hospital) and her colleagues, the researchers found that involving patients in pain management decisions significantly decreased opioid prescriptions without compromising pain control.
The research involved using a simple visual aid that was used to inform patients about postoperative pain management and the hospital’s guidelines regarding the maximum number of tablets recommended per prescription and the mean number of opioid tablets used by a similar cohort of patients in a previously published study at the institution. Dr. As-Sanie describes the conversation that then transpired with each patient:
“This involves a conversation explaining that opioids are considered the last resort when other less risky treatments are not adequate, but also providing reassurance that we could always change the prescription if needed. Involving patients in these decisions led to a significant decrease in opioid prescribing without compromising patients’ pain control.”
As the researchers discuss, “Patients were then asked to choose their desired number of tablets to receive on discharge. Structured telephone interviews were conducted 14 days after surgery. The primary outcome was total opioids prescribed before compared with after implementation of the decision aid. Secondary outcomes included opioid consumption, patient satisfaction, and refill requests after intervention implementation.”
Studies about the physician-patient relationship have been consistent in two key findings – (a) patients want better communication with their clinicians and (b) effective communications between patients and their clinicians improve health outcomes. Following an extensive review of the Medline database to ascertain whether the quality of physician-patient communication makes a significant difference to patient health outcomes, Moira A. Stewart, PhD (Thames Valley Family Practice Research Unit, Centre for Studies in Family Medicine, University of Western Ontario) made this observation about the power of shared-decision making between a patient and clinician:
“Patients need to feel that they are active participants in care and that their problem has been discussed fully. Patients should share in decision making when a plan for management is formulated. They should be encouraged to ask questions and given clear verbal information supplemented, when possible, by emotional support and written information packages. Agreement between patient and physician about the nature of the problem and the course of action appears to bode well for a successful outcome.”
So, if you are a patient, please make sure at the end of the discussion that you understand the procedure and the medication prescribed; and if you are a clinician, the next time you recommend surgery or prescribe medication, please take the time to explain to your patient. Taking that time may affect the patient’s health outcomes.