Annals of Family Medicine -- Comments for van Bokhoven et al., 7 (2) 112-120

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Original Research:
Marloes A. van Bokhoven, Hèlen Koch, Trudy van der Weijden, Richard P. T. M. Grol, Arnold D. Kester, Paula E. L. M. Rinkens, Patrick J. E. Bindels, and Geert-Jan Dinant
Influence of Watchful Waiting on Satisfaction and Anxiety Among Patients Seeking Care for Unexplained Complaints
Ann Fam Med 2009; 7: 112-120 [Abstract] [Full text] [PDF]

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Electronic letters published:

The Value of Clinical Communication: James T Hardee (12 March 2009)

The Value of Clinical Communication 12 March 2009

James T Hardee,
Denver, USA
Internal Medicine, Kaiser Permanente
Send response to journal:
Re: The Value of Clinical Communication

This is a wonderful article that, like many before it, confirm the importance of good clinical communication and a strong physician-patient relationship. An interesting aspect of this study is that in patients with unexplained and presumably non-serious symptoms, physician communication is ostensibly more "therapeutic" than the ordering of unnecessary tests.
It is known that ordering unnecessary tests (labs, x-rays, CT/MRIs, biopsies, etc) can lead to unintended consequences and increased cost of care. It is reassuring to find that listening carefully and taking the patient seriously can lead to increased patient satisfaction.
I've heard it said that "patients don't want reassurance, they want empathy and understanding." While this may not be entirely accurate in all circumstances, it does support the notion that a physician's "bedside manner" may be as important as objective testing. That is, indiscriminate testing should not be a substitute for good communication.
Patients' "unreasonable demands" for tests, medications, referrals and the like are often a proxy for continuity, trust and access with a physician or medical system. Conversely, when patients do like and trust their physician and have adequate access to that provider for questions, concerns, and information, the desire for unnecessary testing often decreases.
As this article so nicely demonstrates, physicians should not underestimate the value of the time, understanding and caring they devote to their patients, especially as it pertains to unnecessary testing. Listening and empathy are incredibly valuable and cost-effective communication skills from a diagnostic and therapeutic standpoint.
Finally, I had a Dermatologist colleague say once that "our job is to take seriously that which is not necessarily serious." By that he meant that many of the skin lesions he would see were not of a pathologically "serious" nature, but to the patient who made the appointment, the lesions were quite concerning. Through the use of several of the communication skills mentioned in this paper, he would seek to understand the patient's concern, demonstrate empathy, and then form a medically appropriate care plan.
Competing interests: None declared