“When it comes to promoting behavior change, one of the
physician’s first jobs should be to think of himself or herself as
an obstacle remover,” Polonsky says.
Often, physicians are eager to find ways to improve
communication with their patients, says Susan McDaniel, PhD,
a professor of psychiatry and family medicine at the University
of Rochester Medical Center. She has spent most of her career
teaching communication skills to primary-care physicians.
As health-care reform unfolds, she says, there are increasing
opportunities to expand that same teaching to all kinds of
McDaniel is developing the Patient- and Family-Centered
Care Physician Coaching Program. She spends half a day with
a physician, observing his or her interactions with patients and
providing feedback and suggestions.
Early on, physician leaders and administrators worried that
the medical doctors might resent being told what to do. Instead,
she’s found, “they are amazingly receptive and responsive.”
The program is so successful that she’s now training five more
psychologists to shadow and coach the faculty physicians. “I’ve
been surprised by how popular [the program] has been,” she
says. “I think it meets a need for people who may not be focused
on their communication skills, but really do want to be the best
they can be.”
Of course, physicians are only half of the equation. Haskard-
Zolnierek has found that when both patients and physicians are
trained in communication, physicians report lower stress and
greater satisfaction with the relationship than they do when
just one of the pair receives training (Health Psychology, 2008).
“Both people are bringing different perspectives and skills and
levels of communication. If you only focus on one of the two
people, you may be missing an important piece,” she says.
Just a few minutes of coaching can encourage patients to
ask questions and seek out information. As she imagines it,
that training could take any number of forms. Clinics could
mail or email pre-visit information to patients, priming
them to make a list of topics they hope to discuss during
their next visit. Electronic training kiosks in waiting rooms
could guide patients through similar steps to prepare for their
consultation, she says. “Even if it’s not much training, patients
become sensitized to the idea of becoming involved,” Haskard-Zolnierek says.
Ho has also explored the feasibility and effectiveness of
training patients to communicate more effectively with their
physicians. In one project, she and her colleagues trained
patients to talk with their physicians about their use of
complementary and alternative medicine (CAM). Studies
show most patients don’t tend to bring up their CAM usage
at medical appointments — a problem since some alternative
therapies could interfere with conventional medicines. Ho and
her team conducted a workshop to help patients build four
skills: preparing a list of questions before the appointment;
being proactive by initiating the CAM conversation; disclosing
all CAM use; and asking relevant questions. After the
workshop, more than half of patients mentioned their CAM
use within the next two physician visits — a positive sign,
Ho says. Follow-up surveys also indicated that more than 80
percent of participants demonstrated the “be proactive” skill
while meeting with their physicians (Patient Education and
The results are encouraging, she says, but they’re just a first
step. She’s exploring the creation of an online training session
to reach more patients. She also hopes to do further research
to flesh out what successful physician-patient conversations
should look like. In the case of CAM, she points out, good
communication is more than simply knowing which herbs
a patient takes. It’s about fully understanding each patient’s
health-care preferences and habits.
“The communication is really important, but we really
need to think about what you can accomplish from that
communication,” she says.
Joining the team
To date, most research on health-care communication
focuses on a two-person, patient-physician dynamic. But
that tight circle is expanding. “There is more and more
emphasis on health-care teams,” says Haskard-Zolnierek.
This team-based approach, commonly known as integrated
care or patient-centered care, is gaining popularity across the
country. The Patient Protection and Affordable Care Act, for
example, includes several initiatives that promote integrated
care by encouraging health-care providers — including
psychologists — to participate in “health-care homes” as part
of health teams.
While promising, the team-based approach is still quite new,
says Polonsky. He’s just beginning to see such collaborations
in diabetes care, where teams may include certified diabetes
educators and nutritionists along with physicians and nurses.
Bufka adds that successfully integrating psychologists into
health-care settings involves providing behavioral care beyond
traditional mental health duties. In such cases, for instance, a
psychologist may help patients with compliance or help them
develop strategies to maintain a healthy weight.
One big advantage of the group approach: Team members
can reach out to patients to provide information and answer
questions that time-crunched physicians aren’t able to. “We’re
seeing some creative things happening where we can leverage
physician time,” Polonsky says. “I think psychologists can play a
role in that — there are real opportunities there.”
After all, Ho adds, “We might have the best medicine in
the world — but it won’t be successful if the patient doesn’t
understand it.” n
Kirsten Weir is a writer in Minneapolis.