Hello.  This is Vera Taylor, Director of the Faculty Development Program
at The Morehouse School of Medicine (MSM). Since I am not a physician, I
asked Janice Herbert-Carter, MD, and Director of Education in our
National Center for Primary Care (NCPC) to elaborate on a couple of
questions.  Here is her reply to the question about improvement in
communication:

	The ten-minute appointment problem is a money issue.  That would
have to be addressed by payers.  If patients are dissatisfied with the
care they get in 10 minute appointments, they need to complain to their
insurance companies/HMOs, etc.  Increased teaching of cultural
competence/working with diverse populations is one educational change
that would be beneficial.  Increased numbers of physicians coming from
more diverse backgrounds would be beneficial too.  But part of that
issue involves the educational system in grades K-12, i.e. increasing
the "pipeline" to med school for people of color.  That has nothing to
do with medical education per se.  Rather that is a societal issue.
Janice

Here is Dr. Herbert-Carters response to "how we train our doctors to
communicate with patients:" 

	Students learn it in each of their rotations third year by
direct observation and role modeling by their residents and faculty.  In
first and second year, they learn it in FOM 1 and 2 (fundamental of
medicine which includes Human Values, Introduction to Patient Care and
Psych all of which incorporate learning about patient communication).
Residents are expected to come here knowing how to communicate but then
also benefit form role modeling and bedside/clinic teaching by faculty.

I'd like to give one example of how we are trying to instill new ways of
"doctors teaching doctors" in our Faculty Development Program.  MSM
faculty, community-based physicians, and other health professionals
enrolled in our yearlong program take a workshop entitled "Teaching in a
Busy Clinic." Participants are taught and get feedback on a model that
includes coaching, facilitating, and affirming differences.  They then
model the new behavior when students or residents rotate through the
offices. This is a slow process to change a system and should be one of
many initiatives to improve doctor-patient communication and care.      


-----Original Message-----
From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Julie McKinney
Sent: Friday, July 21, 2006 9:47 AM
To: healthliteracy at nifl.gov
Subject: [HealthLiteracy 283] Communications

Thanks for the support and suggestions. So far, we have: putting one's
hand on the Dr.'s sleeve, writing questions down before the visit,
asking questions early in the visit, bringing someone with you, and
writing a note or other formal complaint if needs are unmet. 

These are all great suggestions. But why is it that they all put the
burden on the patient? It's true that patients (all of us) have to be
bold, know that we have the right to clarify everything, and use
techniques like these. But there should be some burden on the health
providers as well. 

How can we work with doctors and other providers, as well as the systems
themselves, to promote improvement in communication? How should we train
our doctors differently? What can we do with the 10-minute appointment
problem? What other system improvements can we advocate for?

Vera, it sounds like you are from a school of medicine, and Ruth, your
title is "director of navigation services" (sounds like something all
health communitites should have!). Can either of you elaborate on how
the training of doctors, and policy affecting health care delivery
systems can be improved?

Is anyone else out there who is involved with medical training or
policy?

Thanks,

Julie

Julie McKinney
Discussion List Moderator
World Education/NCSALL
jmckinney at worlded.org

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