Stephen Wilkins, MPH, is a thought leader, researcher, entrepreneur and blogger at Mind the Gap whose areas of expertise include patient engagement and physician-patient communications. He has over 20+ years experience as a hospital marketing executive, consumer health behavior and patient-centered communications expertise. Wilkins shared with attendees a definition of patient-centered communications, provided practical examples of patient-centered communication skills in a hospital setting, contrasted a patient-centered style of communications with the more traditional physician-directed or paternalistic communication style and shared evidence demonstrating the benefits of clinician adoption of a patient-centered communication style and skills. Wilkins identified the top 5 clinician-patient communication gaps found in most hospitals, including examples along with how these clinician-patient communication gaps impact the patients, clinicians and the organization. The webinar also provided strategies for closing the identified clinician-patient communication gaps.

1. The Patient Journey
A Patient Guidance System helps fill in clinician-patient communication gaps
and reinforce important messages through the entire patient journey of an
acute care episode to improve the e-patient experience.

2. Patient Guidance System
Smart
Checklists for
Patients
Delivered online
and available 24/7
from home

3. 5 Clinician-Patient Communication Gaps
Compromising Your Hospital’s Outcomes,
Quality/Safety and Patient Experiences
Prepared by:
Stephen Wilkins, MPH
3

4. Who I Am
• Patient/Patient Advocate/Care Giver
• Former Hospital Executive
• Health Behavior and Communication Researcher
• Entrepreneur
• Writer and Thought Leader
My Personal Story And Professional Experience Underscore The
Following Belief:
That the simplest and most cost effective way of fixing much of
what is wrong with health care today is by improving the way
clinicians and patients talk to each other.
Introduction
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5. Why Is Clinician-Patient Communications Important?
The quality of patient-physician communication is associated with better
processes and outcomes, including patient self- management
behaviors, adherence, satisfaction and health status.
Clinician – Patient communication is the primary process by which medical
decisions are made and patients are diagnosed and treated.
Introduction
The Problem With Physician-Patient Communications Is The Illusion
That It Occurred
Patient-physician communication is therapeutic
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6. Who Says We Have A Communication Gap?
Our Patients Say We Are Great Communicators!
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2005 2006 2007 2008 2009 2010 2011 2012
Usually/Always
Sometimes/Never
Clinician Demonstrates Excellent Communication Skills
6

7. Our Patients Say
We Are Great
Communicators!
During this hospital stay who often
did doctors/nurses:
• Treat you with respect?
• Listen carefully to you?
• Explain things in a way you could
understand?
Compared to what?
Who Says We Have A Communication Gap?
% of Patients That Said Always
Source: U.S. Department of Health & Human Services, www.hospitalcompare.hhs.gov
Doctors "always" communicated well
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8. Who Says We Have A Communication Gap?
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9. “Often patients are, in fact, overly patient; they put up with unnecessary
discomforts and grant their doctors the benefit of every doubt, until
deficiencies in care are too manifest to be overlooked.
Generally speaking, one can assume that the quality of care
is, actually, worse than surveys of patient satisfaction would seem to
show. Patients need to be taught to be less patient, more critical, more
assertive.”
Avedis Donabedian. Quality in Health Care 1992
Who Says We Have A Communication Gap?
9

10. A Few Words About Clinician-Patient Communication & Gaps
Patient & FamilyClinician
• Knowledge
• Previous Experiences
• Language & Culture
• Beliefs & Motivations
• Attitudes & Assumptions
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11. The Truth Behind Patient Ratings Of Clinician Communications
Olson, D. P., & Windish, D. M. (2010). Communication discrepancies between physicians and
hospitalized patients. Archives of internal medicine, 170(15)
11

12. Olson, D. P., & Windish, D. M. (2010). Communication discrepancies between physicians and
hospitalized patients. Archives of internal medicine, 170(15)
The Truth Behind Patient Ratings Of Clinician Communications
12

13. Olson, D. P., & Windish, D. M. (2010). Communication discrepancies between physicians and
hospitalized patients. Archives of internal medicine, 170(15)
The Truth Behind Patient Ratings Of Clinician Communications
13

14. Olson, D. P., & Windish, D. M. (2010). Communication discrepancies between physicians and
hospitalized patients. Archives of internal medicine, 170(15)
The Truth Behind Patient Ratings Of Clinician Communications
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15. • Dosages (56%),
• Schedule (68%)
• Purpose (64%)
• Side effects (11%)
of these
patients
The Truth Behind Patient Ratings Of Clinician Communications
15

16. Did The Doctor Discuss Your Fears And Concerns About
Being Hospitalized With You?
Olson, D. P., & Windish, D. M. (2010). Communication discrepancies between physicians and
hospitalized patients. Archives of internal medicine, 170(15)
The Truth Behind Patient Ratings Of Clinician Communications
16

17. Clinician-Patient Communication Gap #1
#1 Lack of Clinician-Patient Agreement Where It Matters
 Patient’s diagnosis
 Severity of their diagnosis
 Treatment plan/care plan
 Acceptable outcomes
Agreement between patient
and physician about theses
issues is a crucial indicator and
outcome of high-quality
communication.
Sarkar, U., et al. (2011). Patient-physicians’
information exchange in outpatient cardiac
care: time for a heart to heart? Patient
Education and Counseling, 85(2), 173-9
Problem Diagnosis Treatment
Clinician-Patient Disagreement At One Point Prevents Effective
Forward Progress
17

18. Clinician-Patient Communication Gap #1
#1 Lack of Clinician-Patient Agreement Where It Matters
Chief Health Concerns & Priorities
Patients With Self –Reported Multiple Chronic Conditions & Poor Health Status
Clinicians’ Perspective
Regarding Chief Health Priorities
Patient Perspective
Regarding Chief Health Priorities
• Pain
• Unable to sleep
• Unable to eat
• Dizziness
• Cough
• Hypertension
• Uncontrolled A1C
• Not taking medications
Zulman, D. , et al. (2009). Patient-Provider Concordance in the Prioritization of Health
Conditions Among Hypertensive Diabetes Patients. Journal of General Internal Medicine.
18

19. Clinician-Patient Communication Gap #2
#2 Focus Is On The Disease - Not The Person With A Disease
 Fears & Concerns
 Beliefs & Attitudes
 Relevant experiences and expectations
 Their life & hopes
“There is another process that is common in consultations too: the active
decision (by clinicians) to stop listening (to the patient) when we have heard
as much as we need to know. Launer, J. The Art Of Not Listening. QJM 2007
What’s Missed by the Clinician is any understanding of the context of the patient’s life
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20. Clinician-Patient Communication Gap #3
#3 Focus Is On Technology - Not The Patient
“Hospital Rounds” today seem to take place away
from the bedside of the patient – rather they are
centered around the virtual construct of the
patient called the “I Patient.”
The “I Patient” is getting fantastic care… but the
real patient in the hospital bed wonders where
everyone is.
Abraham Verghese, MD 2011 Medicine 2.0
What’s being lost is the therapeutic benefits of touch and talk
20

21. #3 Patients Need To Feel Listened To And Understood
Feeling Listened
To & Understood
Patient Trust
Low
High
Low High
Non-Compliance
Compliance
Patient trust in their clinician is critical to information
sharing, adherence, activation and satisfaction.
Clinician-Patient Communication Gap #3
21

22. #3 Patients Need To Feel Listened To And Understood
Clinician-Patient Communication Gap #3
Chief Health Concerns & Priorities
Patients With Self Multiple Chronic Conditions & Poor Health Status
Clinicians’ Perspective
Regarding Chief Health Priorities
Patient Perspective
Regarding Chief Health Priorities
• Pain
• Unable to sleep
• Unable to eat
• Dizziness
• Cough
• Hypertension
• Uncontrolled A1C
• Not taking medications
22

23. Patients don’t know what they don’t know until they are
faced with having to do it – Just giving patients
information is not enough
#4 Clinicians & Patients Think And Speak Differently
Clinician-Patient Communication Gap #4
Chief Health Concerns & Priorities
Patients With Self Multiple Chronic Conditions & Poor Health Status
Clinicians’ Perspective
Regarding Chief Health Priorities
Patient Perspective
Regarding Chief Health Priorities
• Pain
• Unable to sleep
• Unable to eat
• Dizziness
• Cough
• Depressed
• Hypertension
• Uncontrolled A1C
• Not taking medications
23

24. Self Care Management Instructions For
Heart Failure Given To Patient By Clinician
Clinicians’ Perspective
Regarding Type Of Information Exchange
Needed - Patients Need To Know What To Do -
Patient Perspective
Regarding Type Of Information Needed
- Understand the “What“ But Need To
Know How
• Strategies for overcoming barriers
• Goal setting
• Skills
• Self confidence
• Support
• Diet
• Exercise
• Take medications
• Self monitoring
Patients don’t know what they don’t know until they are
faced with having to do it – Just giving patients information
is not enough
#5 I Am Busy – Just Do It
Clinician-Patient Communication Gap #5
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25. #5 I Am Busy – Just Do It
Clinician-Patient Communication Gap #5
25

26. Five Types Of Clinician-Patient Communication Gaps - Hospitals
• Lack of Clinician-Patient Agreement Where It Matters
• Focus Is On The Disease - Not The Person With A Disease
• Patients Need To Feel Listened To And Understood
• Focus Is On Technology - Not The Patient
• I Am Busy – Just Do It
The 5 Clinician-Patient Communication Gaps
Patient-Centered Care
26

27. Clinician-Patient Communication & Engagement
27

28. Thank You
Stephen Wilkins MPH
stwilkins@gmail.com
408-448-1537 (PST)
@Healthmessaging
www.adoptonechallenge.com
Mind the Gap Blog
28
Coming in this Fall

29. The Patient Journey
A Patient Guidance System helps fill in clinician-patient communication gaps
and reinforce important messages through the entire patient journey of an
acute care episode to improve the e-patient experience.

30. Patient Guidance System
Smart
Checklists for
Patients
Delivered online
and available 24/7
from home