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Time to shed more light on the importance of doctor-patient communication

The quality of interaction between patients and their doctors is not often discussed, yet this is an important area that we ought to pay more attention to. I got to think more about this after a recent unpleasant experience at a private clinic in Orchard specialising in eye care.

We know too little about the state of doctor-patient communication in Singapore, says the author.

We know too little about the state of doctor-patient communication in Singapore, says the author.

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The quality of interaction between patients and their doctors is not often discussed, yet this is an important area that we ought to pay more attention to.

I got to think more about this after a recent unpleasant experience at a private clinic in Orchard specialising in eye care.

I wanted to get my eyes checked because of redness and decided to give the place a try because reviews of it online were good.

At the clinic, a staff asked me to do a routine eye-pressure check, using a machine that puffs air into one’s eyes.

The process is as uncomfortable as it sounds, and I politely declined. I tried explaining my condition to the doctor later but she surprisingly snapped at me, irate over my skipping of the eye-pressure check.

“Then you come for what?” she said. Given her feisty protest, I decided to comply.

At the end of my visit, I was shocked that the bill came up to more than S$600.

Apparently, without informing me about the costs, the doctor had me go through other tests at a cost of about S$150 each.

“Glaucoma,” she reasoned, “we have to make sure.”

This, despite my entire ancestry having perfect eyesight and no history of glaucoma. I was then prescribed eyedrops – quite possibly the most expensive eyedrops I ever paid.

My unfortunate encounter was an exemplar of poor health communication.

In the social sciences, the study of health communication is an emerging discipline, and is particularly popular in the United States. Most health communication studies examine doctor-patient interactions, and a number of research attests to a link between quality communication and health outcomes.

For example, at the University of California, Professor Sherrie Kaplan and her colleagues found that patients who asked more questions during consultations reported fewer days lost from work, health problems, and functional limitations due to illness.

Conversely, patients reported more of these problems when doctors were interruptive during conversations.

Poorer control of diabetes and hypertension was found to be associated with patients who had less involvement, control, and exchange of opinions during medical consultations.

Scholars have also been exploring the use of technology to enhance communication and corollary outcomes. For example, a research group based at Georgetown University developed an online portal, called MyCareTeam, to help diabetic patients manage their health.

Patients could view health information pertaining to diabetes, ask health care providers questions, and even upload their blood glucose readings to their doctors.

In a study, MyCareTeam helped reduce average blood glucose (haemoglobin A1C) scores by 2.22 per cent.

While that number may not seem much, the impact is actually substantial – a 1 per cent decrease in A1C scores is associated with a 35 per cent decrease in nerve damage, vision loss, kidney disease, an 18 per cent decrease in likelihood of heart attack, and a 25 per cent decrease in diabetic-related deaths.

In my own research, I screened 1,459 articles in a journal (aptly named Health Communication) catered exclusively to the study of health communication.

I found many articles linking communication quality to immediate effects such as patient satisfaction, uncertainty, anxiety and stress that have the potential to influence health outcomes (eg burnout, depression, physiological outcomes).

That said, most of the evidence is predominately from the US. This begs the question: how is Singapore faring in this aspect of health communication?

We have seen many laudable efforts by the authorities in promoting health, such as the Let’s Beat Diabetes campaign. In terms of public health communication, we have been doing well.

But what is less certain is the quality of our interpersonal doctor-patient communications. Are our doctors communicating effectively and empathetically to patients?

Are clinics getting more or fewer complaints? Are our patients equipped to participate in decision-making processes? Only very few studies investigate such matters in Singapore.

For example, a 2012 study about Singapore nurses published in the Journal of Clinical Nursing found that language barriers are significant between overseas-trained nurses and patients who are not fluent in English, and that there is poor perception of and lack of respect for nurses in general.

The study’s contributions notwithstanding, the sample size of the study was very small. It is imperative, therefore, that Singapore investigates health communication not only more frequently, but on a larger scale so that we can obtain more generalisable results.

I began with a true but somewhat dramatic account. To be sure, I have had the pleasure of consultations with outstanding doctors in Singapore, in both private and public clinics.

I have communicated with doctors who care, who are knowledgeable, who are patient and friendly.

But the problem remains – we know too little about the state of health communication in Singapore, and oftentimes we encounter or hear of unpleasant experiences with health care providers.

My eyes are perfectly fine now. On hindsight, perhaps I could have been more assertive and careful, and ask about the costs involved.

Perhaps the doctor should have been less aggressive and informed me about the costs first. Focusing on who to blame would be remiss of the bigger picture.

As a nation, we need to collectively work towards better health communication, and we can start by understanding its importance.


ABOUT THE AUTHOR:

Chervin Lam is a PhD candidate at the National University of Singapore. He is a recipient of the President’s Graduate Fellowship and co-author of Health Advocacy: A Communication Approach, a book on health campaigns. He is now Adjunct Faculty at the Singapore University of Social Sciences.

 

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