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COACHING HELPS PATIENTS MAKE MOST OUT OF OFFICE VISITS

 "" PHOTO — Coaching patients in how to talk with their physicians about their pain results in better outcomes and higher satisfaction, according to research conducted at UC Davis.
 
Coaching patients in how to talk with their physicians about their pain results in better outcomes and higher satisfaction, according to research conducted at UC Davis.
   

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"The idea of the subservient, submissive patient is obsolete," says Kravitz.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."

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  "The idea of the subservient, submissive patient is obsolete, patients are incredibly powerful drivers of what doctors say and do. But they need training in how to be effective patients." — Richard Kravitz  
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