Vital Conversations

Vital Conversations: Improving Communication Between Doctors and Patients

Copyright Date: 2014
Pages: 264
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  • Book Info
    Vital Conversations
    Book Description:

    The health-care system in the United States is by far the most expensive in the world, yet its outcomes are decidedly mediocre in comparison with those of other countries. Poor communication between doctors and patients, Dennis Rosen argues, is at the heart of this disparity, a pervasive problem that damages the well-being of the patient and the integrity of the health-care system and society.

    Drawing upon research in biomedicine, sociology, and anthropology and integrating personal stories from his medical practice in three different countries (and as a patient), Rosen shows how important good communication between physicians and patients is to high-quality -- and less-expensive -- care. Without it, treatment adherence and preventive services decline, and the rates of medical complications, hospital readmissions, and unnecessary testing and procedures rise. Rosen illustrates the consequences of these problems from both the caregiver and patient perspectives and explores the socioeconomic and cultural factors that cause important information to be literally lost in translation. He concludes with a prescriptive chapter aimed at building the cultural competencies and communication skills necessary for higher-quality, less-expensive care, making it more satisfying for all involved.

    eISBN: 978-0-231-53804-6
    Subjects: Health Sciences, Sociology

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
    (pp. ix-xii)
    (pp. xiii-xvi)
    (pp. 1-30)

    The first, and so far only, time I was hospitalized was when I was eighteen and had become dehydrated a few days after developing a relapse of mononucleosis. Soon after my arrival at Rambam Hospital in the northern Israeli city of Haifa, I began to develop ulcers inside my mouth. These soon spread to cover my gums and inner cheeks and were exquisitely painful. By the end of my second day there, I was unable to drink or eat anything.

    I was weak, in a lot of pain, and utterly demoralized. I had been battling mono for the previous six...

    (pp. 31-50)

    The parents of a seven-year-old child named Isabelle brought her to see me for a third opinion about how best to manage her obstructive sleep apnea (OSA). This is a condition in which the muscles of the throat collapse during sleep, blocking the flow of air into the lungs and preventing normal breathing. This leads to repeated choking and gasping for air that interrupt the child’s sleep. It also causes repeated drops in blood-oxygen levels, which, when severe, can cause injury to the brain, heart, and other organs.

    Isabelle and her parents had traveled quite a distance to see me...

    (pp. 51-80)

    During my pediatrics residency in Israel, much of my on-call time was spent in the pediatric emergency room. The hospital where I trained, Kaplan Medical Center, is located in Rehovot, a small city about half an hour southeast of Tel Aviv. Rehovot is home to the Weizmann Institute of Science and the Faculty of Agriculture of the Hebrew University and has a mixed population of scientists and other academics, career military officers, and mostly middle-class Israelis. Rehovot is also home to a sizable community of Ethiopian Jews, who settled there after immigrating to Israel in the early 1990s.

    Much of...

    (pp. 81-114)

    In the coming pages, I’ll explore how the wide range of subjective individual experiences of, and responses to, the same “objective” disease, its associated discomfort, and/or loss of function directly affect how patients interact and communicate with their physicians.

    Many scholars distinguish between the objective and subjective aspects of poor health by usingdiseaseto refer to the former andillnessto the latter. In his bookPatients and Healers in the Context of Culture, the psychiatrist and anthropologist Arthur Kleinman defines disease as

    a malfunctioning of biological and/or psychological processes, while the termillnessrefers to the psychosocial meaning...

    (pp. 115-140)

    A few months after starting my pediatrics residency in Israel, a three-month-old baby boy named Tomer was admitted to our department because of the onset of seizures. However, it was clear that there was much more going on with him as well. Although still very young, we could see that he was already developmentally delayed. His muscle tone was lower than would have been expected for someone his age, he didn’t maintain eye contact, and he had not yet begun to smile.

    Based upon the chief resident’s previous experience with other babies who’d presented like this in the past, he...

    (pp. 141-160)

    Much of an experienced physician’s diagnostic process relies uponheuristics, mental shortcuts used in decision making that are based upon experiential knowledge and developed over a lifetime, based both upon personal experience as well as on that of others. Heuristics predispose people toward certain options when presented with choices, and once entrenched they are difficult to avoid without conscious effort. In decision making, these shortcuts can be beneficial but also detrimental, leading to serious errors of judgment, especially when employed in circumstances outside one’s usual frame of reference. For physicians, this can happen when dealing with unusual disease presentations and...

    (pp. 161-190)

    In the previous chapters of this book, I’ve shown how differences in cultural frameworks and belief systems can result in significant miscommunication between patients and their physicians. However, even when both speak the same language—literally and metaphorically—the presence of such factors as pain, fear, and emotional stress, which accompany almost every patient-physician interaction to one degree or another, can lead to significant misunderstanding, on the part of the patient, of what she is being told by her physician. The resulting confusion can be especially momentous when it extends to treatment recommendations and have far-reaching consequences for the patient’s...

  12. 8 PUTTING IT ALL TOGETHER: Creating a Better Clinical Encounter
    (pp. 191-214)

    In the final chapter of this book, I’ll focus mostly on those things that individual patients and physicians can do to improve their interactions with one another. In doing so, I’ll make a lot of use of the termsmedical encounterand patient or physicianvisit. For the purposes of this discussion,medical encounterwill describe the entire time spent by the patient within the medical system, from the moment he enters the clinic or hospital until the time he leaves.Visit, however, will refer only to that portion of the encounter during which the patient and the physician directly...

  13. NOTES
    (pp. 215-236)
  14. INDEX
    (pp. 237-248)