January, 2011If you don’t always follow your doctor’s recommendations, you’re not alone.
Every year, millions of people resolve to adopt a better diet, exercise more, or lose weight, but doctors know the likelihood is low that patients will develop new health behaviors and maintain them. In fact, studies show that between 25 and 50 percent of patients don’t follow their doctors’ recommendations.
What prevents patients from acting on their doctors’ recommendations for better health?
The quality of communication between physician and patient is one predictor of whether a patient follows through on treatment, said Kelly Haskard-Zolnierek, assistant professor of psychology at Texas State University-San Marcos. She conducts studies on communication in medical visits and how it affects patients’ adherence to treatment.
“Access to medical care and insurance certainly affect the patient’s ability to adhere to treatment,” Haskard-Zolnierek said, “but the patient must also understand what change in health behavior is necessary and be motivated to make the change.
“Communication with the physician can determine a patient’s understanding of treatment and their motivation to comply,” she continued. “If patients are dissatisfied with the physician’s form of communication, they’re less likely to follow through with treatment. On the other hand, when physicians are affective communicators—when they are friendly and empathetic, and when they give clear information without using medical jargon—patients are more likely to be satisfied with their treatment and to adhere to it.”
Following is a sample of studies Haskard-Zolnierek has conducted on communication between physicians and patients:
· Breaking the ice with humor. Haskard-Zolnierek and her students created the Physician-Patient Humor Rating Scale, the first scale to measure humor in exchanges between physicians and patients. In the physician-patient relationship, humor can serve a positive function by breaking the ice, relaxing the patient and the physician, and encouraging rapport. It can also be used negatively by both physicians and patients, as in criticism, thereby lowering mutual trust and satisfaction. In a study of 246 audiotaped interactions between physicians and patients, the scale corroborated previous research showing that physicians who used humor positively built trust and satisfaction in their patients. It also corroborated prior evidence that the patient’s use of positive humor increased the physician’s satisfaction with the medical visit.
· Training patients and doctors in better communication. In another study, Haskard-Zolnierek and her colleagues intervened in a number of existing physician-patient relationships to see what effect training in communication skills had on the relationship. In one group of 38 physicians and their patients, the physicians were trained in skills such as using empathy, involving patients in their care, helping the patient to adhere to treatment, and helping the patient to understand and implement healthy behaviors. The patients were trained in becoming more active in their own healthcare. As a result of the training, the patients perceived that the quality of their healthcare increased, and they were readier to recommend the physician.
· Speaking a language patients understand. Haskard-Zolnierek is in the process of analyzing data from a study of 200 interactions between Spanish-speaking patients and English-speaking doctors who speak some Spanish. She is expecting to find that the patients are more satisfied when their doctors speak to them in terms they understand. “Of course, a Spanish-speaking patient will understand more about treatment if the doctor speaks Spanish,” Haskard-Zolnierek said. “But a patient will be more satisfied with a doctor who also understands how culture affects his or her health.”
· Working with stroke victims. Haskard-Zolnierek and a colleague at Houston’s Baylor College of Medicine have applied for a grant from the National Institutes of Health to study communication between stroke victims and their healthcare providers. “We want to evaluate the effectiveness of collaborative goal-setting between physical therapists and stroke victims in home exercise programs. We hope that improving communication will improve the patient’s adherence to the exercise program and his or her quality of life after discharge from acute care,” Haskard-Zolnierek said.· Working with cancer patients. She has also applied for a grant to work with the oncology department at Seton Medical Center in Austin, to screen underserved cancer patients for depression and other mental health problems. “I want to examine the relationships between the patient’s mental health, adherence to treatment, and use of health services,” Haskard-Zolnierek said.