The majority of physicians use language that is too difficult for their patients to grasp, according to a computer study of hundreds of thousands of encrypted email conversations between doctors and patients.
The research also revealed some of the tactics used by some clinicians to overcome communication obstacles.
Experts on health literacy, as well as key health-care organizations, have recommended that physicians explain things to their patients in simple terms to avoid confounding individuals with the least health literacy.
However, the majority of physicians, according to the report, did not do so.
Only around 40% of patients with inadequate health literacy had clinicians who spoke to them in basic terms.
As physicians and patients depend more on encrypted messaging, an invention that has quickly developed during the COVID-19 epidemic, effective electronic communication is becoming more crucial.
The research discovered that physicians who scored highest on evaluations of how well their patients understood their treatment tended to adjust their electronic communications to their patients' degree of health literacy, regardless of where they were on the spectrum.
"We uncovered a mix of attitudes and abilities that is crucial to physician-patient communication," said Dean Schillinger, MD, UCSF professor of medicine and primary care physician, and co-first author of the article, which was published in Science Advances on Dec. 17, 2021.
"We were able to demonstrate that this kind of 'precise communication' is critical to all patients' comprehension."
The researchers used computer algorithms and machine learning to assess the language complexity of the physicians' statements as well as their patients' health literacy.
The study sets a new bar for the scale of research on doctor-patient communication by using data from over 250,000 secure messages exchanged between diabetes patients and their doctors through Kaiser Permanente's secure email portal.
Typically, research on doctor-patient communication is done with much smaller data sets and often does not use objective metrics.
The algorithms determined whether patients were treated by physicians who spoke the same language as them.
The researchers next looked at the general trends of individual clinicians to determine whether they tended to customize their communications to their patients' various degrees of health literacy.
"Our computer algorithms extracted dozens of linguistic features beyond the literal meaning of words, looking at how words were arranged, their psychological and linguistic characteristics, what part of speech they were, how frequently they were used, and their emotional saliency," said Nicholas Duran, Ph.D., a cognitive scientist and associate professor at Arizona State University's School of Social and Behavioral Sciences and the paper's co-first author.
Patients' ratings of how well they understood their physicians paralleled their feelings about their doctor's verbal and written interactions.
Nonetheless, the evaluations were closely linked to the doctor's written communication approach.
"Unlike a clinic encounter, where a doctor can use visual cues or verbal feedback from each patient to verify understanding," said Andrew Karter, Ph.D., senior research scientist at Kaiser Permanente Northern California Division of Research, "in an email exchange, a doctor can never be sure that their patient understood the written message." "Our results imply that physicians should modify their email communications to match the complexity of the language used by their patients."
Language As A Barrier To Minorities Receiving Treatment.
Many individuals, particularly members from minority groups, find going to the doctor to be daunting.
People from minority groups are especially uncomfortable in hospital settings for a variety of reasons, including fear and previous negative experiences.
When individuals do go to their physicians, there are a number of hurdles that might prevent patients and doctors from communicating effectively.
One important factor is language.
Patients' and physicians' differences in class, culture, education, and even personality may all affect how well a visit goes and how well patients and doctors understand each other.
Patients, on the other hand, have a right to be understood.
It should not be necessary to communicate in English in order to get quality medical treatment.
According to the United States Census Bureau, 60 million people in the United States speak a language other than English at home.
A doctor's appointment is a two-way dialogue.
Doctors have an obligation to know their patients and communicate with them in a manner that they can comprehend.
Patients have the right to ask questions and participate in the dialogue until they grasp what the doctor is saying.
Many patient bills of rights expressly say that patients have the right to receive information in the manner that best suits their needs.
You have the right to obtain information about your health in words you can comprehend, as well as the planned course of therapy and recovery prospects, according to Indiana University Health.
You have the right to information about your illness that is suited to your age, language, and comprehension level.
You have the right to request language interpretation and translation services from the hospital.
Patients with visual, speech, hearing, or cognitive disabilities have the right to obtain information from their healthcare professional in a format that is appropriate for them.
Despite these guarantees, individuals from various minority groups often have trouble obtaining healthcare, get subpar treatment, and have worse health outcomes than their peers.
Patients with weak English skills, for example, were less likely to have informed consent documents and were more likely to have drug issues and remain longer in the hospital.
Much of my current work at the Regenstrief Institute and Indiana University School of Medicine focuses on understanding healthcare communication, whether it's between patients and doctors or between healthcare teams.
I'm especially interested in learning how technology may be used to enhance communication and, as a result, people's health.
Patient portals, which enable people to access their medical information and send encrypted communications to their doctors, are one technology that might help patients and doctors communicate better.
For some patients, having access to their own medical records and the ability to compose questions in their own time, rather than having to rush through an in-person visit when they may not be able to process what a doctor is saying, can help them better understand and manage their health and get their health needs met.
Despite this, we discovered that 52 percent of hospitals in the United States do not provide a patient portal in a language other than English, restricting the number of patients who may benefit from patient portals.
Furthermore, accessing and navigating patient portals, regardless of language, requires a high level of literacy.
This is a two-way conversation. You have the right to be heard.
And to keep asking questions until you fully comprehend what your doctor says.
Communication difficulties, whether intentional or not, may contribute to and worsen healthcare inequities.
~ Jai Krishna Ponnappan
You may also want to read more about Artificial Intelligence here.
Further Reading
Dean Schillinger, Precision communication: Physicians' linguistic adaptation to patients' health literacy, Science Advances (2021). DOI: 10.1126/sciadv.abj2836. www.science.org/doi/10.1126/sciadv.abj2836
