Patient-Provider Communication: Shared Decision-Making Enhances Care

Effective patient-provider communication results in optimum patient outcomes and includes shared decision-making between the patient and provider, weighing the pros and cons of treatment, and making an informed decision as a result. As a 24-year survivor of terminal leukemia, I favor this type of mutual respect regardless of the provider’s specialty or role. From my experiences with providers, shared decision-making, or patient centeredness, provides more empowerment for the patient and fosters trust and confidence in the health care provider.

Patients often begin medical interactions with a power imbalance. Their lack of initial health literacy makes it difficult to navigate the treatment landscape. Communication encourages and empowers the patient, especially when providers are emotionally present and validate patients’ health concerns during this initial discussion. Historically marginalized groups may find navigating this process intimidating. In addition, language barriers may also hinder effective communication. In this case, a proficient medical interpreter is required.

Clinical encounters usually begin with a discussion of symptoms and the patient’s health and family history. This initial conversation is important as it can avoid ineffective and inappropriate care, misdiagnosis, and future litigation. Understanding family history can prompt the provider to run needed tests earlier, as opposed to later on when a treatment plan is being implemented, and discussion of these histories can also rule out certain medications.

As the communication process continues, patients should also take an active role in choosing their treatment options and become full participants in getting well. Physicians may have a great bedside manner, but may still not be fully engaged in shared decision-making. Patients should avoid secrecy and also be honest with their providers. For example, if they miss a dose of their medication for whatever reason, they should feel comfortable sharing this information. Non-adherence could potentially influence the patient and provider’s decision to remain on the medication or switch to an alternative treatment.

With the growth of technology in the medical setting, communication extends beyond the provider’s physical space. The patient portal plays an important role and provides alternative ways to communicate. Therefore, it is important that patients know how to use the portal, and that the provider takes the patient portal-generated health concerns seriously. The handling of patient messaging and lab results through the portal influences the patient’s satisfaction and confidence in the health care team. Providers should inform patients how to use the portal before they leave the office.

Honest communication with the pharmacist concerning medications can result in the desired treatment outcome. In addition, the pharmacist can devise a plan to help the patient remember to take medications as prescribed. Questions from the pharmacist can prevent bad drug interactions, and by ensuring that the patient understands the prescription label, the pharmacist can reduce potential cases of over- or under-dosing. The pharmacist can also help translate medical jargon and explain the medication instructions in layman’s terms. However, pharmacists should ultimately respect patients’ privacy and adjust accordingly to the context cues of the individual’s situation. This honest communication between patient and pharmacist results in fewer medication errors, unnecessary patient discomfort, and greater patient satisfaction.

All parties involved have a responsibility to be involved in the process of getting well. Patients should continue to learn about their medical condition and providers should stay up-to-date on the latest standard-of-care. This self-education helps to ensure informed consent of suggested treatment options. It does not serve the patient well to be passive throughout the treatment process. The key is to be an informed, active participant while not overbearing when communicating with a medical care team, as they have the medical expertise. In the same vein, providers who assume the authoritarian role do not serve the patient well, as they prematurely halt honest communication on the patient’s ongoing symptoms.

It’s important for patients to understand that they may seek second opinions on major decisions or in situations in which they do not feel comfortable with a particular course of action. Too often, patients fail to advocate for themselves, fearing that they may invoke an adversarial relationship if they question the provider’s decisions; however, good providers welcome second opinions. Furthermore, institutions often have different options. A second opinion may uncover a more viable course of treatment.

Effective patient-provider communication is critical to the healing process and it begins the moment the patient makes contact with the staff and continues even after the patient fills his prescription at the pharmacy. All parties are vital to ensuring and encouraging that the patient adheres to a course of treatment that will provide the best possible outcome. Communication works best when it is shared between patient and provider.