Good doctor–patient dialogue: The key to effective treatment

Indeed, nowhere is this relationship more important than in psychiatry, where the dialogue between patient and doctor is an integral part of the treatment plan.

This article discusses how good doctor–patient communication can improve the treatment of mental illness and offers practical advice for patients who want to enhance the dialogue with their psychiatrist.

The therapeutic relationship
Interestingly, both patients and psychiatrists identify the quality of their relationship with one another as the most crucial factor in psychiatric care. Such relationships can last for decades or days and are usually amicable with positive effects.

Some experts believe that the relationship between a doctor and a patient may be beneficial in its own right. It is true that patients who are satisfied with the quality of care they receive are more likely to respond to treatment than patients who are dissatisfied. From the patient’s perspective, good psychiatric care typically involves the establishment of a “helping relationship” in which they feel understood by their doctor. Patients also want to feel that the doctor has allowed enough time for discussion and understands their current problems and needs.

Communication aids diagnosis
It seems clear that a good doctor–patient relationship, built on mutual trust and sharing of information, leads to better treatment, but why? First and foremost, good communication helps the doctor make an accurate diagnosis. Unlike many physical ailments, which can be diagnosed using specific tests, psychiatric illnesses tend to be diagnosed from a broader evaluation of the patient.

To diagnose schizophrenia, for example, the doctor will require a detailed description of the patient’s symptoms:

• They may seek additional information from the patient’s relatives and friends;
• They will assess the patient using questionnaires and rating scales;
• They may order physical tests and investigations to rule out other problems;
• They will usually monitor the patient for weeks or even months before arriving at a final diagnosis.

Patient commitment is crucial
The second crucial way in which doctor–patient dialogue influences care is by encouraging patients’ commitment to their treatment. By taking an active role in the management of their illness, patients tend to feel empowered and motivated to work with their doctor. Accordingly, patients who have a positive relationship with their psychiatrist are more likely to attend appointments, complete tasks such as keeping symptom or mood diaries, and take prescribed medications. In particular, good doctor–patient communication allows medication issues such as unwanted side effects or a lack of effectiveness to be reviewed, discussed, and hence overcome.

Furthermore, both an accurate diagnosis and a greater patient commitment have been shown to lead to better outcomes, including fewer and/or less severe symptoms, improved quality of life, and a greater chance of recovery.

Communication aids in practice
In recent years, researchers have developed practical methods for enhancing doctor–patient communication in the setting of mental illness. Importantly, many forms of mental illness can cause the sufferer to have trouble communicating their concerns and needs to their healthcare team. The approaches vary in detail but share the goal of facilitating a structured, open dialogue with the ultimate aim of improving medical care. These tools are especially useful for vulnerable groups, such as patients with:

What is the evidence?
The use of doctor–patient communication aids is still relatively limited and their true value to patients remains to be established. Nevertheless, the early signs are promising. It has been proven that the majority of patients believed that 2-COM helped their psychiatrist know more about their illness, and in nearly two-thirds of cases, 2-COM revealed problems that had previously gone unnoticed. In addition, six out of 10 patients said that 2-COM helped them discuss available treatment options, including drugs and talk therapy.

Practical tips for improving dialogue
Even when communication aids are not used, patients can take simple measures to improve the quality of their relationship with their doctor and healthcare team. Here are some ideas:

• Remember that today’s doctors understand that an informed patient is an ally and not an enemy. The majority of doctors encourage patients to take more responsibility for their health and appreciate the dialogue.
  
  
• Do not miss medical appointments, even if you do not think there is anything new to discuss. Regular contact is important for building a good relationship with your doctor.
  
  
• In-between seeing the doctor make a note of anything you would like to discuss at your next appointment, such as particular worries, new symptoms, or possible side effects of your medication. Your notes should help jog your memory during the actual consultation.
  
  
• Become an expert patient. Educate yourself about your illness, its causes and risk factors, the treatments available, and how it is likely to progress. If there are things you don’t understand, ask.
  
  
• Be honest: If you feel that your current treatment plan is not working then make sure your doctor understands. There is usually another treatment for you to try.
  
  
• Follow your doctor’s advice. This includes taking medication as instructed, completing any “homework” assignments, and avoiding behaviors that are likely to exacerbate your symptoms.
  
  
• Know your healthcare team. Identify the health professionals who have been assigned to care for you, understand each of their roles, and know how to contact them if necessary.

For an interactive explanation of Schizophrenia and Bipolar Disorder, how they are diagnosed and treated please click on the appropriate link: Schizophrena or Bipolar Disorder

Next month on PatientHealthInternational
The relationship between female hormone levels and mood will be the subject of a feature article on “Bipolar disorder and the menopause”.


Additional reading list

Healthy Minds (American Psychiatric Association). 

Medline Plus.

Mind (National Association for Mental Health).

National Institute of Mental Health.

Royal College of Psychiatrists.  

World Psychiatric Association.