Barry Alpert is learning that the gift of gab can be as critical to his medical practice as skill with a scalpel.
Doctors say poor communication with patients is a leading cause of missed diagnoses. Lawyers say the problem is cited in many malpractice lawsuits."A lot of malpractice cases go away simply because they like the doctor," said Pittsburgh attorney Edwin H. Beachler III.
Alpert, a cardiologist at West Penn Hospital in Pittsburgh, said he can't evaluate his own communications skills. But he said patients have come to him after having difficulty dealing with other doctors.
He said he suspects some of his own former patients may have the same complaint about him.
Alpert is not alone. Roughly 80 percent of 300 doctors surveyed nationwide by the pharmaceutical division of Miles Inc. regard effective communication with patients as "extremely important"; only one-third said they communicate "very well."
"A lot of physicians are exceptionally sensitive about their relationships with their patients," Alpert said. They don't want to be told how to conduct their practice.
In an effort to improve his abilities, Alpert took part in a seminar offered by Miles at West Penn earlier this year. The four-hour program has been presented this year at two dozen hospitals, medical schools and health maintenance organizations around the country.
Vaughn Keller, who led the Pittsburgh session, told doctors part of the problem stems from differences in background.
Physicians are trained to rely on a rigorous decision-making process in making a diagnosis, Keller said. Patients, on the other hand, rarely get right to the point with physicians, said J. Gregory Carroll, a corporate training specialist at Miles, a West Haven, Conn., company.
"A patient may start by telling a story about lower back pain and may be warming up to something they're not ready to talk about," Carroll said. "The patient may wait 'til the end of the interview, when he has his hand on the doorknob, to say, `Oh, by the way, doctor, should I be worried about this swelling. . . ."'
Doctors need to be able to recognize when a patient is hedging and should try to draw out relevant "pieces of the clinical puzzle," he said.
"It's not just an educational gap. It's really two different world views," Keller said.
Terminology can be a problem, too.
Keller urged seminar participants to encourage their patients to be more open about medical problems and said doctors should give specific instructions for medication, exercise, therapy and other treatment.
The extra effort Keller and Carroll prescribe can have benefits for doctors. Several attorneys said better relations can reduce a physician's chance of being sued for malpractice.
"The doctors who don't get sued are the ones who take the time to explain, `This could happen or this could happen' and give their patients what we call informed consent," said Beachler.
"Without exaggeration, in half if not three-quarters of these cases, one of the complaints these people have is they don't like the way they were treated."
A typical patient's hospital stay might involve seeing four or five doctors. "Sometimes, you feel like you're on a conveyor belt," said Pittsburgh attorney John C. Conti, who represents physicians.
In the last decade, many medical schools added courses designed to teach students how to conduct efficient discussions with patients.
"It's one of those things that people used to say, `Well, you pick it up," said Dr. Stanley K. Dorst, who teaches a required course, introduction to patient care, at the University of Pittsburgh School of Medicine.
Dorst disagrees that communication is "part of the art of medicine" and can't be taught. "It's a skill and you need to practice it."