September 13th, 2009 by Christian Seebode

So what about patients communicating? Patients communicate because they need to. Their primary source of building sustainable relationships is communication. The most important aspect of communication is that it happens and that it is diverse. There’s more than meets the eye to this dumb analysis. It’s not to be taken for granted that communication with patients happens at all. Provider centric health care delivery too often reduced the patient to a list of symptoms and management of abstract artifacts like patient records or billing statements. It’s obvious that excluding the patient form communicating with all parties involved in the healthcare delivery process leads nowhere. Why?

Patients communicate knowledge

Patients know a lot about their illness. The systematical investigation of patient knowledge is a well established procedure. Patient knowledge evolves in time, sometimes long time. Some patients are experts on their own behalf. The patient experience has been underestimated but gains momentum on the road from patient to consumer. There are many aspects of connecting patient knowledge to healthcare delivery. One aspect is the knowledge about managing an illness. Outpatients are on their own most of the time and learn to handle their disease. Not only chronic conditions but also simple behavior i.e. to avoid pain or a special sleep – wake cycle may be important. This knowledge may be used to improve the consumer experience. A simple but valuable tool to capture this experience would be an electronic diary where the patient shares his experiences. Access to this information would not only be relevant to manage this patient but to allow other patients to profit from this. Another aspect of patient knowledge is its relevance for research. Supporting research whether scientific or product research may be a powerful and new perspective for patients (Hanley et al.). However this is not for free. The fact that eHealth tools, specifically Patient Centered IT produces lots of data for statistical purposes the data has to be carefully checked for being representative or systematic influences. At least qualitative pictures may be taken.

Research on patient communication and behavior in its simplest form is very much related to the way collective intelligence tools may assist.

Patients communicate needs

Whether verbal or non verbal patients expresses needs in healthcare delivery. Needs are not only expressed as complaints and requests for therapy the focus here is on communication itself. Communication is the bridge to connect patient needs to all activities concerning healthcare delivery.

The complexity of treatment and care demands full attention of patients and healthcare providers. Patient safety is directly dependent of their ability to tell their safety needs and can be enhanced by promoting active participation in improving their own safety (Entwistle). As communication is so central to patient needs and his path through healthcare delivery any attempt to lower communication threshold is helpful. The patient connected via computer support to communication activities is more prone to self disclosure (Joinson).

Communication is therapy

Looking at medical practice the significance of communication in therapy is very ambivalent. On one side there’s a whole therapy approach dedicated to communication. Psychotherapy mainly consists of communication. What else? It doesn’t matter. On all other sides exactly this, the therapeutic effect of communication, is dismissed in many other disciplines. The focus is mainly on other non-psychic aspects of illness. Whether this makes sense or not a very important aspect of therapy is patient compliance. If a patient follows therapeutic regimens or not or if he or she is convinced of the therapy is crucial for therapy outcomes anyway. With a patient centered view the focus shift more from just following a predefined plan (compliance) to actively influence the path convinced that this is the way (adherence). This distinction is important for achieving better health outcomes and defines a whole new need for communication. The switch from passive to active patients is accompanied by enhanced motivation and a positive self-perception. Communication through the internet may facilitate this (Andreassen). With the possibility for easy access to communication it seems the patient is willing to influence his path in a positive way. Synchronous and asynchronous communication possibilities should support any step in healthcare delivery. This is not a big deal for the software that supports these dialogues in Patient Centered IT Sites. But responsiveness is an issue. So the care team needs enhancement by call- or online center people with medical knowledge. And the amount doctors may be relieved from paperwork by electronic communication and records they step more into patient communication.

Communication is sharing information

Sharing information among patients is as important as sharing between doctor and patient. Doctor means teacher so this represents a lot of the original vocation. Improving patient knowledge and health literacy with communication means that there’s enough time and possibility to let a patient understand every step in healthcare delivery. A restrictive approach to communication is not recommendable and must be avoided. The case of negative issues has been discussed but represents not the general picture of the situation between physician and patient. Learning and education is central to understanding. A patients needs access to information and communication channels as mentioned above but also a possibility to support explicit and implicit sharing of information and knowledge. In an ideal relationship patients are always oriented within their path in healthcare delivery. Patient Centered documentation of clinical pathways may provide implicitly provide situation and progress of the patient. A patient may browse the steps of the pathway within a website and attach communication artifacts like tags or even complete dialogues to it hence progressing implicitly while communicating. A good understanding of the situation and healthcare delivery process is an important precondition for good patient collaboration. Explicit patient education as prescribed for therapeutic intervention may be claimed as a precondition to advance on the clinical pathway.

Communication is diverse

Diversity is one of the biggest obstacles for good communication. People are different. This is true among patients and between patient and physician too. Different languages and cultural backgrounds is just one example, the social and family situation another. Multilingual communication and cultural services are important parts of patient centered care. For Patient Centered IT especially the involvement of family members in healthcare delivery is of particular interest. Some treatments require maximal participation and support of family members. Other situations like in medical tourism require logistic planning for family members too. However it is important that family members are supported by Patient Centered IT as a primary communication target. This together with respect of multilingual and cultural diversity assures maximal consideration for communication diversity.

Conclusion

Communication is central to healthcare delivery. Patient Centered IT tries to provide sound communication models to support good communications. Documentation of clinical pathways together with communication and interaction possibilities leverages patient collaboration. Collaboration and communication not only support better outcomes but may trigger public health research.

Pattern

Clinical Pathways

Links:

  1. Hanley B, et al. (2004), Involving the public in NHS, public health and social care research
  2. Entwistle (2005), Advising Patients About Patient Safety: Current Initiatives Risk Shifting Responsibility
  3. Joinson, A.N. (2001), Self-disclosure in computer-mediated communication: The role of self-awareness and visual anonymity
  4. Andreassen et al. (2007), European citizens’ use of E-health services: A study of seven countries
  5. http://en.wikipedia.org/wiki/Physician
  6. http://patient-centered-it.com/2009/08/29/information-for-patients/
  7. http://en.wikipedia.org/wiki/Clinical_Pathway
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