Talking to Patients in the 21st Century

摘要: STYLES OF PARENTING AND PRACTICING MEDICINE HAVE followed remarkably similar trajectories over the last half-century, with authoritarian tones firmly banished from both arenas, and old phrases of admonition advice overhauled to communicate cheerful encouragement, mutual understanding, respect. It is only a matter time before “Good job!” its equivalents are heard as often in nation’s examination rooms on playgrounds. There signs that parenting pendulum may be reaching end swing: Amy Chua’s 2011 memoir Battle Hymn Tiger Mother elicited vigorous national debate comparative merits different child-rearing styles. No such reactionary murmurings have surfaced medicine, however, experts continue rewrite scripts for this newly democratic, time-challenged, increasingly electronic profession. Four Viewpoints issue JAMA address some changes physicians’ speaking writing habits will necessary accommodate new models practice. Judson colleagues emphasize even today medicine retains an “asymmetry power” likely skew every exchange between physician patient. Just “whitecoat hypertension” complicate cardiac evaluation, so entity they term white-coat silence probably attends most basic clinical conversation. How do patients smile nod think themselves, “I no idea what person talking about”? Any firsthand experience layered misunderstandings can accumulate care realize equals befuddlement regular basis. What do? et al enumerate variety tools prodding ask questions. Some pedagogic, like teach-back method urges summarize heard. self-evident, allocating more each patient visit (although simple appealing intervention has, bizarrely, become prohibitively expensive). In end, none fixes considered by entirely satisfactory, conclude fundamental reengineering required make comfortable enough all questions should. White Danis suggest one way experience, simply rearranging office furniture. Computers newest barrier patient, figurative literal sense. store dispense information, when stop working, does work. Even so, has figured out good place put these machines. inpatient setting, computers wheels; office, wind up desk. Either way, generally positioned faces screen. Why not change everyone’s perspective, suggest, opening those tight triangular configurations? Let look at screen together, just might watch television together. The still navigator, but relevant data reviewed jointly, activity bound foster communication collaboration. also, note, create unless physicians learn specific language skills pilot through their own health records. chart digital image appear jointly viewed As McAfee points out, world now brimming “direct-to-patient” communications televisionor Internetbased. These originate pharmaceutical companies, hospitals, media-based physicians, public authorities, or large array alternative proponents. temptation shut cacophony room very strong. Doing difficult but, case tobacco-related service announcements discusses, really quite foolish. All material should productively integrated into patientphysician dialogue. Finally, Tinetti Basch propose revolutionary agenda. They it sacrosanct realms medical research opened input, help patients’ voices