Balancing the Art and Science of Medicine

Has medicine become more science than art? What are the benefits of restoring the “art” of medicine? These were a few of the issues explored by Joseph Chazan, MD, a member of the Schwartz Center Leadership Council, as he reflected on changes in medicine over his fifty year career.

As Dr. Chazan notes, the limited number of therapeutic and diagnostic treatment options available fifty years ago meant that medicine was skewed toward “art”. The art involved carefully performing a patient history to tease out clues about the patient’s underlying medical condition. The science was restricted to choosing from a limited number of tests and diagnostic procedures to manage the patient’s condition. Despite the scientific limitations of the time, Dr. Chazan notes that the patient-doctor relationship fifty years ago was strong.

Fast forward fifty years and the balance between art and science has shifted. Dr. Chazan reflects that technological and pharmacological advances have enhanced the practice of medicine but often at the expense of the doctor patient relationship. Yet, he continues, the value of personal relationships in medicine is more important than ever as pressures intensify to manage utilization and spending more carefully. These relationships, he notes, are also an emotionally satisfying aspect of medicine

I think Dr. Chazan’s insights are right on the mark. Keeping the “art” of interpersonal relationships central to medicine makes good sense from an emotional, clinical and economic perspective. How do you balance the art and science of medicine?

Returning the Favor...

Over the last month or so Paul Levy, CEO of Beth Israel Deaconess Medical Center (BIDMC), has highlighted the work of the Schwartz Center several times in his blog, Running a Hospital. Today I’d like to highlight the innovative approach that BIDMC physicians are studying to enhance patient communication and improve clinical outcomes.

Forty two BIDMC physicians, representing one of three health care groups, are participating in the Open Notes project. Open Notes, which began in June 2010, is an evaluation project in which 100 primary care physicians are sharing their notes with 25,000 patients through an electronic health portal.

Proponents of the Open Notes concept argue that it will lead to improved patient understanding of health. Skeptics are concerned that Open Notes will lead to greater patient confusion because of complex medical terminology. While the study results won’t be published any time soon, it seems likely there will be immediate communication benefits: BIDMC lead investigator, Dr. Tom Delbanco noted that he has already begun using clearer language and less jargon. As I discussed last week, using simpler language to communicate with patients should be considered a necessity, not a chore, given the prevalence of low health literacy.

A complete description of the Open Notes project can be found in this month’s issue of the Annals of Internal Medicine. While the project itself is limited to 100 primary care physicians, you can also participate in the project by sharing your opinion (as either a provider or patient) on the benefits of Open Notes by completing a brief survey.

Based on your experience, will doctors’ visit notes improve patient communication or hinder it?

Lost In Translation

Think like a wise man but communicate in the language of the people. William Butler Yeats

An article in last week’s Wall Street Journal, got me thinking about health literacy. Failure to communicate in the language of patients can adversely impact health outcomes. A recent study conducted by University of California San Francisco and Kaiser Permanente found that diabetic patients with low health literacy were 30-40% more likely to experience dangerously low blood sugar than those who understood the medical information presented to them! I was also surprised to learn that limited health literacy is more common than I realized: patients come from all segments of society and the majority are white, native born Americans!

Given the time squeeze created by shrinking office visits I wondered how physicians and health care professionals could adequately address the serious problem of health literacy. A little research turned up several tools that test health literacy in just minutes. The Newest Vital Sign (NVS), available in both English and Spanish, was especially clever. This free program, created by the Partnership for Clear Health Communication(PCHC) with a grant from Pfizer, uses an ice cream nutrition label as the basis for estimating a patient’s health literacy. Other tools such as the REALM Short Form from the Agency for Health Care Research and Quality are also designed to rapidly test a patient’s ability to understand medical information. Results of both of these tests can help physicians understand their patients’ communication needs as well as their medical needs.

Keeping the language in patient handouts and medical forms simple is also important in addressing health literacy challenges. PCHC notes that the average American reads at the 8th to 9th grade level--yet most health materials are written above the 10th grade level! An excellent free tool, Words Count Service, quickly rates the readability of any text you select. It was a really an eye opener to play around on this site. Submit your guesses in the comment section for the grade level rating of this post—I’ll post the answer next week!

I’d also love to hear the tactics you’re using to deal with the communication challenges created by low health literacy.