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DOCTOR-PATIENT RELATIONSHIPS

Doctors' communication skills are key

January 3, 2011

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HOW WELL doctors and patients communicate, particularly about end-of-life decisions and alternative treatments, is critically important, but not as simple as your editorial implies (“Evidence mounts of problems in doctor-patient relationships,’’ Dec. 30).

Most practicing physicians were trained in a system in which saving lives was the ultimate measure of success, and death was considered a failure. Medical schools have historically not taught students how to deliver bad news to patients, with the result that many physicians today simply do not know how to have these conversations. While medical education has evolved in recent years, there is still not enough attention paid to developing the communications skills of aspiring clinicians.

The issue is further complicated by the long-standing relationships that some doctors have with their patients, which studies have shown make it more difficult for them to accept and communicate a poor prognosis. After all, physicians are human beings, too, and telling a patient who you have come to care for that he or she is likely to die is among the most difficult conversations to have.

Doctors and patients are also just beginning to understand the potential benefits of palliative care, a relatively new medical specialty in the United States that focuses on relieving suffering and improving quality of life rather than offering a cure.

As an example, a recent study led by Dr. Jennifer Temel at Massachusetts General Hospital found that offering early palliative care to patients with metastatic non-small-cell lung cancer led to significant improvements in quality of life, less aggressive care at the end of life, and longer survival. Results such as these should make it easier for physicians and other clinicians to introduce the possibility of palliative care to patients at diagnosis, when it can do the most good, rather than waiting until the end of life.

If we are to improve the doctor-patient relationship and health outcomes for patients, our health care system must be based on more than just technical skills, efficiency, and productivity. Good communication and emotional support must have equal value.

Beth Lown, MD
Boston

The letter writer is the medical director at the Schwartz Center for Compassionate Healthcare, a nonprofit organization based at Massachusetts General Hospital.