Dr. Lee Reussner, an otolaryngologist at Lawrence Memorial Hospital asks his patient Joseph Timberlake, Wichita, how he is feeling shortly before performing a thyroplasty surgery to improve Timberlake's voice Thursday, Jan. 14, 2009 at the hospital. Studies show that a good relationship and better communication between doctors and patients leads to better health care.

Have you ever left the doctor’s office with unanswered questions?

Have you ever fibbed about your health condition?

Have you ever forgotten what a doctor advised once you got home?

Have you ever unloaded a bunch of problems on your doctor during an annual wellness exam?

These are examples of how communication can break down between a doctor and patient and result in less quality care.

“There is a lot of research that shows when patients have good relationships with their doctor, care really is better,” said Dr. Jeff Brady of the Agency for Healthcare Research and Quality. “There needs to be open dialogue.

“Providers obviously rely on what patients tell them when it comes to diagnosing and even treating a condition, so it’s clearly important to have communication.”

According to the 2007 National Healthcare Quality Report, Kansas adults said their health providers explained things clearly only 57 percent of the time and showed respect for what they had to say 58 percent of the time. Kansans felt that doctors spent enough time with them only 49 percent of the time.

Be proactive

Brady said the No. 1 thing that consumers can do to improve their care is to become more engaged and active in their care.

“I think most agree that providers don’t make decisions for patients. They want to inform them, so that they can make decisions about themselves on their own,” he said.

Dr. Lee Reussner, of Lawrence Otolaryngology Associates, agrees.

“It is extremely important, I think, for patients to participate in their care. To not just go in and expect the physician or nurse practitioner to do all of the work,” he said.

In other words, he said, patients need to come prepared.

Reussner said communication problems often happen before the patient walks in the door. That’s because they don’t bring along the necessary medical information. They should come armed with medications they are taking and past medical history. He suggests keeping such information in a written or computer file that can easily be accessed and updated.

Patients also should check on lab tests and X-rays.

“This is an extremely common problem. They just assume that we will easily have access to them or that their primary doctor will send them, which often doesn’t happen.”

He also encourages patients to write down what they are specifically looking for during a visit, so the doctor and patient can make the most of the appointment.

Dr. Kimberley McKeon, of Lawrence Family Practice Center, also suggests making a list of symptoms, what kind of treatment the symptoms have received if any, and what might make it better or worse.

“That just helps them clarify their thought process before they come in because, unfortunately, we have time constraints as well.”

Precious time

Brady said time pressure is one of the top factors that cause communication problems.

“I think providers are rushed with full waiting rooms and limited time to see patients or more limited than they would like,” he said. “People are perceptive and so patients pick up on that, and in some cases they may feel like they can’t ask questions because of that sort of ever present rush feeling that is just part of the encounter.”

That’s why that preparation work is critical.

McKeon said one of the common problems she faces is when someone schedules a wellness exam, but then comes with a list of 10 other problems. She said people also tend to schedule a visit for a common cold, but then will bring up abdominal pain that they’ve had for a year. Obviously, time becomes an issue with either of these examples. McKeon schedules about 10 minutes for acute matters, 30 minutes for wellness exams, and 20 minutes for problems such as abdominal pain.

“Usually if it’s one big problem and a couple of minor ones, it’s not necessarily an issue,” she said. “But if they come in for five big things, then some of that is not going to be communicated effectively because of time constraints.”

Friends or foes?

Honesty is the best policy when it comes to health matters, and Reussner said sometimes friends and family provide the best insight.

“I have all the time where a patient comes in and I ask, ‘Why are you here?’ They will say they are fine, but the spouse will say, ‘You are not. You quit breathing five times every minute when you breathe at nighttime.’ In those cases, it is nice to have a family member that can say, ‘Look, it’s a little bit more than what he’s telling you here,’ ” Reussner said.

He also suggests bringing family along to help take notes and digest information.

“Sometimes when a new diagnosis is given of cancer or something, someone’s mind just kind of goes blank and you really can’t focus on what happens after that.”

On the flip side, McKeon said sometimes family members are a distraction. For example, mothers tend to talk for their teenagers. Also, teens tend not to divulge as much information in front of their parents. She also said wives tend to talk for their husbands, which can be good and bad.

“Sometimes it’s helpful because they don’t speak up as much, but sometimes it gets kind of distracting,” she said.

Dose of medicine

When it comes to medications, McKeon encourages patients to be forthcoming.

“One of the biggest problems we have is people don’t consider a lot of the over-the-counter stuff as medication even if they are taking it regularly, especially some herbal products, and some of those can have interactions with the medications we prescribe,” she said.

She said some women who take oral contraception don’t inform them and those can interact with antibiotics and make the oral contraceptives less effective.

When prescribing a new drug, McKeon said it is impossible to go over all of the side effects, so she typically goes over the big ones. So does Reussner.

“I can tell you there’s no way to go over 100 percent of all the side effects for every medication,” he said.

The doctors suggest patients read over the side effects that come with the medication and call immediately if there are concerns.

Brady said there’s a level of complexity that goes along with how to take a medication that’s not always appreciated by the patient.

“When a new medication is started for a patient, a flag should go up for everybody involved that there’s some things to pay attention to, to make sure that effective communication is happening, so that patients really understand how to use the medication,” he said.

He encourages patients to ask questions such as:

• What is this supposed to do?

• What should I do if I accidentally take more than the recommended dose?

• How many refills can I get?

• Is it OK to substitute a less-expensive generic medicine?

That last question is one that Corrie Edwards, of the Kansas Health Consumer Coalition, wants to stress. She often finds that doctors don’t know how much drugs cost or how much the insurance covers.

“That’s why you need to be very prepared going in and not afraid to ask questions,” she said. “We find in our work with consumers that patients aren’t asking near enough questions.”

Doctors need work, too

Doctors realize that they need to do their part as well.

McKeon said doctors struggle with using too much medical jargon. “As much as we try to watch that, I think that is always a problem,” she said.

Reussner admits it is easy to forget. He said it is helpful when doctors can write down information for patients to take home instead of just telling them verbally. But, he said, “It can be difficult to make that happen 100 percent of the time.”

Reussner also encourages feedback from patients.

“If a patient doesn’t like the way they were notified about a lab test, they should notify the doctor. It helps us to do a better job,” he said.