Doctor-patient communication in rheumatological disorders

Organized educational programmes and individual educational counselling are primary means by which health care providers equip rheumatic disease patients with the skills and knowledge necessary to monitor and manage variable symptoms. Many outpatients educational programmes were evaluated in the 1980s. In brief, well designed programmes are generally effective in improving knowledge and compliance with a regimen, and in reducing pain, depression, and disability. However, most persons with arthritis never use such programmes. Greater emphasis is needed on education of patients at the time of the clinical encounter, where the greatest opportunity lies for reaching the greatest number. Researchers have examined the dynamics of the doctor-patient interaction during the clinical encounter. Results show that: better information sharing leads to improved patient satisfaction, compliance, and health outcomes; information sharing could be greatly improved; and doctors and patients can be trained to improve information sharing, resulting in improved outcomes. A review of attribution and decision-making theory and the empirical literature on doctor-patient communication suggests a number of techniques that could be usefully incorporated into the management of each patient. These include: (1) encouraging patients to write down their concerns before each visit; (2) addressing each concern specifically, however briefly; (3) asking patients what they think has caused their problems; (4) tailoring treatments to patients' goals and preferences as possible; (5) explaining the purpose, dosage, common side-effects and inconveniences, and how to judge the efficacy of each treatment, including length of trial; (6) checking patients' understanding; (7) anticipating problems in compliance with treatment plans, and discussing methods to cope with common problems; (8) writing down the diagnosis and treatment plan to help patients remember; (9) giving out written materials that are now widely available; (10) reinforcing patients' confidence in their ability to manage their regimen; (11) using ancillary personnel in patient education; and (12) referring patients to organized programmes in the community.