United Press International - October 13, 2003
Merrie Spaeth

A recent estimate suggests that medical misunderstandings and miscommunication costs the United States more than $70 billion a year. That is a lot of aspirin and more than the entire Federal Government's annual spending on education.

The Partnership for Clear Health Communication, a coalition of medical groups, foundations and drug companies, says that 80 percent of patients forget what the doctor tells them almost immediately and what they do remember, they remember incorrectly.

It is not hard to figure out the impact. Patients take medication incorrectly, don't follow a prescribed treatment, prolong an illness or aggravate a condition. They may miss more work or suffer more pain.

There are many reasons why physicians and patients aren't on the same page. Physicians speak a different language. They use terms patients don't use. Communication is traditionally verbal, with the doctor presenting a diagnosis or recommendations face-to-face with the patient. Frequently, the physician only goes through the information once.

If the patient is ill, he or she may not listen as acutely as when they are well. If the topic is something like cancer, the patient may be frightened, further eroding his or her ability to listen closely.

There is a status gap between physicians and the rest of us. While we call them "doctor," many doctors call their patients by their first name.

Finally, Americans are the least scientifically literate nation in the developed world. Even if the physician does everything right, we as citizens don't know nearly enough basic science to listen intelligently.

The role of communication in health care is getting serious attention. The New England Journal of Medicine is paying attention to the issue, and the new commissioner of the Food and Drug Administration has made it a priority. The issue also involves requiring individuals to be more involved in, responsible for and accountable for their own health care. We cannot do this with the circumstances outlined above.

Of course, the very best doctors figured this out long ago. Dr. F. David Winter Jr. is an internist at Baylor Health Care System in Dallas. Winter says he takes communication beyond what a patient can remember or verbally recall. He encourages his patients to bring a written list of their medications and their questions. During consultations, he also keeps a note pad handy to jot down his thoughts. He gives that, or a copy, to patients and he discusses his recommendations and instructions. "I know all about doctor handwriting," he says, "so I ask the patient to read what I've written back to me."

Hospitals around the country are actively experimenting with new methods. Northwestern is using drawings, visuals and video to explain things. They recognize that not only do we live in an MTV age, but also that many people are visual learners.

Following Dr. Winter's approach, and building on it, physicians and nurses should also take a lesson from conference planners -- who always put small pads and pencils at every seat. This simple tactic signals that the attendee is encouraged, indeed expected, to take notes. This would radically change communication. Just by getting the patient to write down the instructions, and glancing at them to make sure they've been written correctly, the physician would gain an advertising tool, repetition, which is a key element for memory, and a "take away" in addition to the verbal instructions or illegible prescription.

Finally, we are paying the price for decades of shunning science education. Our twelfth graders rank near the bottom in science achievement among the industrialized nations. The new No Child Left Behind law provides $1 billion for the National Science Foundation to develop results oriented partnerships between local school districts, universities and colleges.

But more funding won't solve the attitude issue. It is time to take fewer "junk food" courses -- like "The Politics of Hollywood," offered at the University of Texas-Austin, or "The History of Electronic Dance Music," available at the University of California-Los Angeles which also makes available "Gay and Lesbian Perspectives in Pop Music." These may be interesting, but they should come after a young adult has taken a basic anatomy course with curriculum beyond sex education and hygiene.

Next time you see your own doctor, take along a copy of this column -- and bring your own pad.

-- Merrie Spaeth, Director of Media Relations for President Reagan, is President of a Dallas-based consulting firm and is a regular commentator and writer on communication issues.
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