Rheumatologist-Patient Communication Pitfalls

Picture this – You’ve just been diagnosed with Rheumatoid Arthritis (RA) and have a million questions running through your mind: "What does that mean for my future? Will I be able to live a normal life? Can I have kids? Can I care for them? Can I work? Will the meds I take for the disease kill me? Can I afford them? It’s OK, I will just have my doctor tell me what to do.”

This scenario sums up my patients' initial reaction to the diagnosis of RA. The responses from the doctors and patients to this are so very varied; however, one thing that holds true is that without a strong commitment from both the patient and the doctor to work as a team, the journey of managing the disease can be a difficult one.

So, what are these communication pitfalls that inhibit shared decision making between a patient and doctor?

The first communication pitfall can start with the first visit. I have found that it is crucial to build a relationship with my patient which should be initiated at the very beginning. I do my best to help my patients understand that they have a voice and know I value their opinion. This mutual understanding builds a better relationship and encourages my patient to be involved in their care.  [[{"type":"media","view_mode":"media_crop","fid":"50228","attributes":{"alt":"Ellen M. Field, M.D.","class":"media-image media-image-right","id":"media_crop_5348130211464","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6120","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":"Ellen M. Field, M.D.","typeof":"foaf:Image"}}]]

The next communication pitfall can happen if the patient isn’t honest about their condition and if the doctor isn’t asking the right questions. In my practice, I have found that conversation should always start with an honest description of what pain they are having and where; how daily activities are impacted; if they are struggling at work; and, if they are having difficulty caring for family. In turn, instead of asking such broad questions like "How are you feeling?” I ask more pointed questions. I take into account my patient's lifestyle and their wishes for how to proceed with an agreed upon treatment plan; however, that can only happen after I give my patient the tools to properly make informed decisions.

Another communication pitfall is when a patient is overwhelmed with the plethora of treatment information given by the doctors in such a short amount of time. It’s my responsibility as the doctor to thoroughly review all treatment options with my patients as well as the tools and resources to help him/her make the best decision. It is important to use tools that don't make one option more preferable, but gives patients the information they need to determine what option best fits them and their lifestyle. It’s important to give patients enough information about their disease without overwhelming them. I give them literature and recommend websites to enhance their learning.

There are many patient blogs and websites that provide helpful tools and resources such as JointDecisions.com, which also has an active Facebook page where patients can connect. In addition to reviewing options and resources, I explain the benefits and potential risks of each treatment and discuss the modes of administration including oral agents, self-administered subcutaneous injections, and IV meds given at my office in our infusion suite where I offer them the opportunity to discuss their concerns with other patients while taking a tour of our suite. I discuss the frequency of administration of each drug as well as the need to monitor them with blood tests and visits. We discuss affordability and options to help with financial responsibility when applicable. Then we discuss brands options. An important part of this process, particularly in the follow-up, is that when a drug is not helpful, I reassure my patient that the drug failed them, not them failing the drug – and we proceed with other options.

Dr. Ellen M. Field will host a live Facebook chat, “Seeing Eye to Eye: Remedying Miscommunications between Doctors and Patients,” at 7 p.m. EST, July 21. The chat will be hosted by Joint Decisions.

The last, and in my opinion one of the most important, communication pitfalls is when a patient doesn’t feel comfortable asking questions. In my practice, it is imperative for patients to have their questions and concerns addressed at each visit or between visits. Knowing that either I, or one of my office staff members, will communicate with them is key. Patients have the responsibility as well and must continue ongoing education about their disease and treatments. They can then empower themselves to participate in the care of their illness. I always encourage my patients to ask questions.

In closing, shared decision making is the tool for me to present the highest clinical evidence as the medical expert while taking into account a patient's expertise in knowing their goals and preferences. It has a direct effect on the quality, safety and costs to our healthcare system. Shared decision making should be the standard for patient-centered care and can be done effectively irrespective of age or education level. Since RA is a chronic disease, having an honest and upfront relationship with my patients makes shared decision making possible.

I strongly encourage my (and all) patients to be their own advocate, surround themselves with caring friends and family, and be an active partner in controlling their disease. It's a team approach to fight the effects of RA!

Ellen M. Field, M.D., is a rheumatologist for the Lehigh Valley Health Network in Bethlehem, Penn.

Disclosures:

Joint Decisions receives sponsorship from Janssen Biotech, Inc.