A recent article in the New York Times entitled "Lost in Clinical Translation," written by Theresa Brown, an oncology nurse, laments "the huge comprehension gap that exists between what we in health care say to patients and what those patients actually understand."
To put it in more dramatic terms, up to 80 percent of the medical information patients receive is forgotten immediately, reports the Wall Street Journal, and nearly half of the information retained is incorrect.
The problem is, doctors and patients exist in two very different realities.
Doctors have a limited amount of time to devote to each patient. Twenty minutes seems to be the norm for primary care physicians. That doesn't leave much time to find out what's on a patients mind, let alone attend to their body.
The patient, meanwhile, operates in a state of anxiety. Fear is the dominant emotion. It's scary to be sick, and the treatment options can be complex and confusing. Add to that the drugs and dosing regimen and you have the perfect brew for stress and anxiety. No wonder there's a comprehension gap.
"Given the trend to shorten direct contact with physicians, the observed opportunities to spend time speaking with a patient have been significantly reduced," notes David B. Case, M.D., past governor and president of the New York Chapter of The American College of Physicians. He points to an alternative way to aid the communications gap. "Physicians occasionally use their electronic medical records to print out information and instructions in lieu of actually going over the details in person. Having something written down and having another family member or friend present usually satisfies the need to accomplish the transfer of information for the usual patient visits."
There are occasions, however, which are not routine visits. These are the ones in which adverse findings must be disclosed to the patient, requiring a more detailed explanation and the implications. Sometimes diagnostic and treatment options that carry significant risks must be discussed. These critical visits usually require more time and preparation on the part of the physician.
Even if there was enough time, the paradigm does not change too much. "Once the thought of loss of health, sickness, surgery or even death comes up," Dr. Case observes, "most people will lose their rational thinking and go to the darkest place. Even though the physician may provide a comforting and sensitive delivery of the issues, the words of medicine and science are interpreted as threatening."
To put it another way, "A pair of kidneys will never come to the physician for diagnosis and treatment," notes Dr. Philip Tumulty of Johns Hopkins, reported in the Wall Street Journal.
"They will be contained within an anxious, fearful, wondering person, asking puzzled questions about an obscure future, weighed down by the responsibilities of a loved family, and with a job to be held and with bills to be paid."
Much of the re-assuring hand-holding, so important to the recovery process and to patient-satisfaction, falls on the shoulders of the hospital chaplain who is trained to bridge the doctor-patient communications gap.
"We as physicians dread these moments when we must begin the process of informing our patients about actual or impending serious illness," says Dr. Case. "Wouldn't it be ideal to have a chaplain sitting in with us at these critical visits -- to remain with the patient afterwards and provide emotional and spiritual support at a level of proficiency that we physicians are not formally trained to provide. And, finally, the chaplain could assure that the patient understands what the physician has explained."
In recognition of their contribution to patient care, today's professionally-trained hospital chaplains are being included more and more as important members of the medical team.