Why Aren’t You Listening to Me?

Why Aren’t You Listening to Me?

The CDC recently published an infographic showing facts about patient education

There are some provocative statements:

  • “50 percent of patients walk out of the physician’s office not knowing what they were told or are supposed to do.”
  • “Physicians often over estimate the topics and duration of what they have talked about with their patients.”
  • “Telling patients once … is usually not enough to get the patient’s attention or buy in.”
  • “Patients filter what they hear from their doctor in a variety of ways that physicians usually know nothing about, i.e. the patient’s health beliefs, values, previous experience and illness explanatory models.”
  • “90 percent of adults have difficulty following routine medical advice, largely because it is incomprehensible to average people.”

Those who teach or who are heavily invested in communication with patients may take umbrage at these statements, but hopefully, these statements are based in some research and have some validity. My first reaction is, of course, to say, “Not me, I don’t do that” (denial is always the first step in receiving news you don’t want to hear). They’re talking about other doctors, not me!

We also know about techniques, like “Teach back” and methods to ensure the patients buy into what we are telling them, like Prochaska and motivational interviewing. So, if we accept the researched facts presented, what are our barriers to implementing better communication and change models?

I was asked early at PAMED for my opinion on a teaching topic. The topic was motivational interviewing. Two videos were presented. One was the wrong way, presumably how we mostly do things, and then the right way.

Without seeing the videos, but looking at the length of the videos, about a minute for wrong, and about six minutes for right, I said the problem is not whether we know what to do, it is whether we can (or will) take the time to do it right.

When we are paid for volume, and patients are being seen in a production line to produce maximum RVUs, taking five extra minutes, even with a few of our patients a day, will impede the production line.

So what are we to do? We do care about this, but we aren’t paid for outcomes (better informed, involved and interested patients who do what they need to). That may soon change if the Volume to Value change is occurring (and do not fear, it is coming).

Luckily, there are answers. Here are a few.

Use non-face-to-face methods

Publish (on the web, paper or both) teaching materials. Have a place on your network, website (or in a cloud) where you can keep documents. If you need to explain something to a patient, write it down, keep it as a document, print it out and hand it to people. Make sure it is in their language, and at their educational level. Translation services are available (and required, but that’s another blog). How many times have you explained the same thing to a patient with the same words?

Write it down once, and hand it to the next 100 patients you see with that problem.

There’s nothing wrong with handing some materials to a patient, asking them to read them, and being available to ask questions when they’re done reading. Leave the room, close the door, and ask them to open the door slightly if they have any questions, or leave it wide open if they are happy and can leave.

Use your staff

Do you have a staff member who really enjoys talking to patients? Who is personable and willing to learn motivational interviewing and whatever clinical you need to teach (using the same materials you already generated after reading the above paragraph)? You can be seeing other patients while that staff member goes through the long process of determining the patient’s beliefs, barriers, and so forth.


How many of you ask the patients you see to rate how they feel after the visit? “When I left the office, I had a good understanding of what I need to do?” Strongly agree = 5, strongly disagree = 1. Do it for a week or a month, or forever. “I am ready to do what I need to do to get healthier.” If you consistently get back lower scores, work on it!

We all want good outcomes for our patients and there are many barriers. But let’s not let communication be one of them. So we can say, “I’m so glad we could come to agreement on next steps for you. Following that path is what has led to your good health today.”

Do you have other hints and tips for communicating better? For dealing with cultural, educational, personal, social or environmental issues? Comment below, or submit your own blog!

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