Research-based, Easily Learned Techniques for Medical Interviews That Benefit Orthopaedic Surgeons and Their Patients

Better physician-patient communication is linked to increased patient satisfaction and patient adherence to medication and treatment regimens as well as to improved clinical outcomes. Practicing orthopaedic surgeons have received limited formal education in the communication skills necessary for patient-centered care; yet, we perform over 100,000 medical interviews during our careers. Patient-centered care involves treating patients as partners, involving them in decision-making, and enlisting their sense of responsibility for their care while respecting their individual values and concerns. We have tended to focus mainly on the technical aspects of our care-giving. We do not seem to be very good communicators. In 1998, the American Academy of Orthopaedic Surgeons (AAOS) conducted an extensive national survey to which 807 patients and 700 orthopaedic surgeons responded. The patients and surgeons were asked to rate orthopaedic surgeons with use of the same categories. Patients rated technical skills as important (“hightech”) but valued communication skills equally (“high-touch”) (Table I). According to this survey, 75% of the orthopaedic surgeons believed that they communicated satisfactorily with their patients, but only 21% of the orthopaedic patients reported satisfactory communication with their physicians. This gap was most evident in categories such as listening and caring and time spent with the patient. Our most common deficiency in our daily interviews with patients remains a failure to demonstrate an empathic response. We can all learn to communicate better. During the past twenty years, effective tools for teaching and assessing physician communication skills have been developed. Communication skills are being taught in medical schools and residency programs. Beginning with the class of 2005, the United States Medical Licensing Examination will require medical students to pass a clinical skills-assessment examination by interviewing standardized patients at designated national testing centers. Furthermore, the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties now link assessment of communication skills to accreditation of residency programs and to maintenance of certification for practicing physicians, respectively. Busy orthopaedic surgeons must continue to build communication skills to deal with the challenges of shifting patient expectations, language and cultural barriers, increasingly complex medical treatments, and constraints from managed care. Good communication skills improve medical care and reduce lawsuits. Skillful interviews improve diagnostic accuracy by gathering a superior quantity and quality of data. Physicians with adept communication skills establish rapport with their patients and consequentially improve the patients’ compliance with treatment. Effective interviews also improve patient outcomes, reduce medical errors, and make the specialty of orthopaedic surgery more enjoyable. Malpractice suits often are the results of differences in expectations between the patient and the physician. Beckman et al. reviewed depositions from sixty-seven malpractice claims and reported both the preponderance and the types of communication problems described in these depositions (Table II). Good communication helps physicians to understand patient expectations, thereby reducing liability exposure.