The U.S. health care system is the most costly in the world, comprising about 18% of GDP, and yet health outcomes, measured by such statistics as infant mortality and life expectancy, are less favorable than in many other countries. In Vital Conversations, Dr. Rosen has written an important book, one might say a vitally important book, about physician- patient communication. The book contains many practical suggestions for physicians and patients. The widespread adoption of these suggestions would produce two worthy results – improved patient health outcomes and reduced health care costs.
As a practicing physician for nearly two decades, Dr. Rosen has identified from personal experience numerous negative consequences of inadequate physician-patient communication. For example, patients often don’t understand the importance of taking their medications as directed and as a result don’t feel better, requiring additional treatment. Another example: Patients being discharged from hospital are often not clear about new medications and continuing treatment at home, about lifestyle changes that may be needed (say, after a heart attack), and about signs that should prompt the patient to seek immediate medical attention. And, they often don’t set an early appointment with their family doctor to follow up on their hospitalization. The result often is re-admission to hospital within 30 days of discharge, where many such re-admissions were preventable.
Dr. Rosen makes many of his points by citing personal experiences, often quite riveting, from his practice. He urges doctors to be sensitive to emotional and cultural factors in the lives of their patients.
A frequent complaint of both physicians and patients is that doctors spend too little time with each patient. This occurs because many health organization administrators, in the interest of controlling costs, put pressure on doctors to see more and more patients per day. One unintended result is that physicians spend less time on patient histories and prescribe expensive tests that might otherwise have been unnecessary had they taken more time with the patient. So, costs go up instead of down. There is also a generalized sense of being in a hurry, which adversely affects the quality of the communication taking place and leaves many doctors and patients unsatisfied.
A major challenge for the health care system is to modify incentives so that there is improved physician-patient communication, particular where the benefits are experienced elsewhere in the system. For example, family doctors who spend more time on preventative medical care may reduce the number of hospital admissions as a result. Doing so may not produce any financial gain for the family doctor but does improve patient health outcomes and reduces overall health care costs.
This book should be studied by health economists, those responsible for health care policy and implementation, and those responsible for medical education. Many individual physicians can improve their own practice by adopting some of the many suggestions provided. And there are valuable tips for patients, such as preparing lists of questions before their visits, and bringing a family member or friend along on such a visit.
Overall, Vital Conversations has the potential for having a large and positive impact on the practice of medicine.
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Excellent read for those interested in healthcare and improving health outcomes.
Reviewed in Canada on March 8, 2019
