More broadly and measurably, research into the degree
of care used by physicians in patient-physician communication
has been shown to improve patient outcomes. One review of
randomized controlled trials on patient-physician communications
reported that the quality of communication in the history-
taking and management-discussing portions of the interactions
influenced patient outcomes in 16 of 21 studies.
Outcomes influenced by such communication include emotional
health; symptom resolution; function; pain control; and
physiologic measures, such as blood pressure level or blood
sugar level.1 The review identified specific elements of effective
communication. For example, patient anxiety was reduced
in patients whose physicians encouraged questions and also
encouraged them to share in the decision-making process. In
individual studies, effective communication skills have been
correlated to such positive outcomes as adherence to therapy,2,3
understanding of treatment risks,4 and—in some settings—
even to a reduced risk of medical mishaps or malpractice
claims.
Obviously, improvement in these types of outcomes is a
core goal of long-term patient education aimed at managing
chronic illnesses (eg, diabetes and asthma). The high perceived
value of effective communication in disease prevention, health
maintenance, and quality-of-life, in fact, may be precisely why
managed care companies have now outsourced these communication-
intensive responsibilities to disease management
vendors. Such is an indictment of the limited capabilities of
individual physicians to provide such long-term and consistent
communications. It is also an acknowledgment of the critical
nature of direct human communication and support
in achieving good medical outcomes. Examples of how direct
contact influences medical outcomes are studies that have
documented the way in which disease management programs
can lower health-related costs, reduce emergency department
visits,26 control chronic disease, and increase patient
satisfaction