While medical school curricula concentrate on the physician-side of doctor-patient relationships,
Richard Kravitz, UC Davis School of Medicine professor of internal medicine and director of UC Davis Center
for Health Services Research in Primary Care, is exploring ways to help patients be more effective.
What if patients, he wondered rather than their doctors were coached in communication skills?
Kravitz and his colleagues offered patients seeking pain control 20 minutes of education about pain
management and helped them rehearse a patient-physician dialogue about controlling their pain. A health
educator sat with each patient immediately preceding the doctor's visit, using medical records to help
target each patient's needs. Patients who received standard educational materials and counseling on pain
management served in the control group. After two weeks, patients who received individualized coaching
reported less pain than patients in the control group.
"The idea of the subservient, submissive patient is obsolete," says Kravitz. "Patients are incredibly
powerful drivers of what doctors say and do. But they need training in how to be effective patients."
Studies with similar formats also have shown promising outcomes. One involved patients with ulcer disease
who were coached to interact better with their physicians and had better functional outcomes than patients
in a control group. Another study showed that patients with diabetes actually achieved better blood sugar
control after they were coached to participate more actively in their own care.
One report that looked at multiple studies related to patient-centeredness found that interventions designed
to "activate" patients were more consistently associated with good physical health outcomes than interventions
aimed solely at doctors.
"These findings do not indicate that patients or doctors are by themselves to blame
when things go wrong in the doctor-patient relationship," emphasizes Kravitz. "Communication
is a two-way street. 'Activating' patients or empowering them to take a bigger role in medical
decision-making is just one aspect of good patient care."