I've enjoyed the discussion on doctors-nurses-patients communications.  I 
would point out that many health professionals can communicate quite 
effectively in 10 minutes.  Those who rush out of the room after two-three 
minutes while the patient is in mid-sentence, might take a closer look at 
their own health and stress level.  In today's often frenetic pace and 
lack of interconnectedness, healing is more than a prescription pad or the 
latest test.

Charles Jackson
Program Manager
Humana Foundation, 500 W. Main St., Louisville, KY 40202
502-580-1245 telephone\voice-mail
502-580-1256 fax



"Julie  McKinney" <julie_mcKinney at worlded.org> 
Sent by: healthliteracy-bounces at nifl.gov
07/26/2006 12:07 PM
Please respond to
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Subject
[HealthLiteracy 311] Re: Communications






Thank you, Vera, for elaborating on the 10-minute-appt. and training of
doctors issues. 

As for the 10-minute appt., it makes sense that we need to advocate from
the insurance and HMO's. Laurie Anson, you have had success with the
"cumbersome process" of making changes from within the HMO system. Any
suggestions on how we could advocate for longer appointments for those
who need them? 


>From a financial perspective, if payers could allow patients with low

literacy skills or other communication barriers a longer appointment to
allow for clear understanding, then they would likely make up for it by
reducing the documented higher rate of emergency room visits and longer
hospital stays that lower literacy patients ultimately have.

As for training doctors, you mention the workshop "Teaching in a
Busy Clinic." Is it something that other programs could access and use? 

Many people have mentioned the "teach back" method, which has been
suggested for years by the Len and Ceci Doak in their book "Teaching
Patients with Low Literacy Skills". Does your program include this
simple and quick method in the communication piece of medical training?
Do other programs use this in their training? It seems to me that if we
could train all providers to use this one very simple method regularly,
then it would go a long way.

Thanks again everyone for all this feedback!

Julie


Julie McKinney
Discussion List Moderator
World Education/NCSALL
jmckinney at worlded.org


>>> vtaylor at msm.edu 07/25/06 11:36 AM >>>

Hello.  This is Vera Taylor, Director of the Faculty Development Program
at The Morehouse School of Medicine (MSM). Since I am not a physician, I
asked Janice Herbert-Carter, MD, and Director of Education in our
National Center for Primary Care (NCPC) to elaborate on a couple of
questions.  Here is her reply to the question about improvement in
communication:

                 The ten-minute appointment problem is a money issue. That 
would
have to be addressed by payers.  If patients are dissatisfied with the
care they get in 10 minute appointments, they need to complain to their
insurance companies/HMOs, etc.  Increased teaching of cultural
competence/working with diverse populations is one educational change
that would be beneficial.  Increased numbers of physicians coming from
more diverse backgrounds would be beneficial too.  But part of that
issue involves the educational system in grades K-12, i.e. increasing
the "pipeline" to med school for people of color.  That has nothing to
do with medical education per se.  Rather that is a societal issue.
Janice

Here is Dr. Herbert-Carters response to "how we train our doctors to
communicate with patients:" 

                 Students learn it in each of their rotations third year 
by
direct observation and role modeling by their residents and faculty.  In
first and second year, they learn it in FOM 1 and 2 (fundamental of
medicine which includes Human Values, Introduction to Patient Care and
Psych all of which incorporate learning about patient communication).
Residents are expected to come here knowing how to communicate but then
also benefit form role modeling and bedside/clinic teaching by faculty.

I'd like to give one example of how we are trying to instill new ways of
"doctors teaching doctors" in our Faculty Development Program.  MSM
faculty, community-based physicians, and other health professionals
enrolled in our yearlong program take a workshop entitled "Teaching in a
Busy Clinic." Participants are taught and get feedback on a model that
includes coaching, facilitating, and affirming differences.  They then
model the new behavior when students or residents rotate through the
offices. This is a slow process to change a system and should be one of
many initiatives to improve doctor-patient communication and care. 


-----Original Message-----
From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Julie McKinney
Sent: Friday, July 21, 2006 9:47 AM
To: healthliteracy at nifl.gov
Subject: [HealthLiteracy 283] Communications

Thanks for the support and suggestions. So far, we have: putting one's
hand on the Dr.'s sleeve, writing questions down before the visit,
asking questions early in the visit, bringing someone with you, and
writing a note or other formal complaint if needs are unmet. 

These are all great suggestions. But why is it that they all put the
burden on the patient? It's true that patients (all of us) have to be
bold, know that we have the right to clarify everything, and use
techniques like these. But there should be some burden on the health
providers as well. 

How can we work with doctors and other providers, as well as the systems
themselves, to promote improvement in communication? How should we train
our doctors differently? What can we do with the 10-minute appointment
problem? What other system improvements can we advocate for?

Vera, it sounds like you are from a school of medicine, and Ruth, your
title is "director of navigation services" (sounds like something all
health communitites should have!). Can either of you elaborate on how
the training of doctors, and policy affecting health care delivery
systems can be improved?

Is anyone else out there who is involved with medical training or
policy?

Thanks,

Julie

Julie McKinney
Discussion List Moderator
World Education/NCSALL
jmckinney at worlded.org

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