Studies around the world and across cultures rate the relationship between patients and physicians as good. However, this does not mean that it cannot be improved. The cornerstone of the doctor-patient relationship is and remains communication, which represents both an opportunity and a challenge. Fortunately, the position of patients has changed significantly - away from a one-sided exchange of information towards participation and greater empowerment.
Of course, the arrival of digital media has also left its mark on this communication. Patients can find medical information much more easily and digital media now also play a major role in concrete communication. Nevertheless, direct dialogue with the physician remains very important. We have just conducted a study that clearly shows that trust in physicians remains high. It is and remains one of the main drivers of adherence and compliance for any medical intervention.
So we are experiencing two trends: on the one hand, patients are becoming more empowered, and we physicians no longer have a monopoly on providing information. Transparency has increased. The exchange of information is bidirectional, so we can finally enable a genuine participatory decision-making process.
On the other hand, doctors' time was and is limited. This means that contact time must be utilised more effectively in order to increase the value of communication. For example, a patient asks during the daily ward round: "when is my next CT appointment?" or the physician asks: "Has the consultation actually gone ahead yet?" These are all organisational issues that could certainly be resolved in a different and better way, not at the expense of precious time for patient-centred communication. Colleagues from other healthcare professions can help here, also with the support of digital media.
It would also make sense to organise closer networking between the medical professions. For example, there could be preliminary discussions before the patient goes to hospital, where all relevant information that already exists about the patient is collated and made available. Empowerment also means, for example, telling the patient: "Please come to our appointment with all available findings".
I am in favour of reorganising and prioritising medical interactions by separating organisational issues from treatment-related issues. This means better involvement of all medical professions and favouring direct communication strategies. We physicians are still too conditioned to do and organise everything ourselves; we have not learned to delegate. One example: A patient is to be discussed in the tumour meeting, but the doctor responsible has suddenly fallen ill. What happens now? The patient needs her treatment, but the tumour meeting goes ahead without her case. I think physicians need to delegate much more and see themselves as part of an interprofessional and interdisciplinary team and not put everything on their own shoulders.
In the six years of my studies, I didn't have a single lesson on how to work together with nurses, carers and other professional groups. That's out of date and more than inadequate! I recently asked my youngest assistant to summarise how many different interdisciplinary and interprofessional activities were carried out on a patient with ovarian cancer. During the two weeks in our clinic, there were 144 people from different professions who were directly and indirectly involved with the patient. All these people tended to communicate with each other in an unstructured way or not at all. And it was not uncommon for the patient to say: "Nobody was there, nobody spoke to me".
This means that communication should not only be trained for during studies, but must also be further developed during continuing medical education and in the course of professional life. We conducted a study with 1,500 students and physicians, which showed that doctors are afraid of giving bad news. But we also saw that the more a physician or student deals with the topic of communication, the less afraid they are.
My hypothesis is that dealing with communication not only reduces anxiety, but also the risk of burnout. And we know that we are losing (too) many in the healthcare sector to it. This is the physician's perspective, but patients also need the space to deal with their illness and proactively organise this together or get a second opinion, for example. We are now organising courses with self-help groups where we empower patients to conduct clinical trials themselves. This will further change the hierarchy between physicians and patients. We talk about co-scientists when patients are involved in research. Of course, this takes time and professional structures.
One thing is really very important to me: the demands on communication will increase in the future - not only because digitalisation is increasing, but also because therapies are becoming much more complicated and multimodal. We have to take many more individual factors into account in the context of personalised medicine - and we also have to explain these, step by step!
However, communication is almost completely ignored in the current debate on personalised medicine. There is a dispute about who pays for what - usually it's about testing and therapy with targeted drugs - but nobody is talking about the money needed for additional education and information. We urgently need a change of mindset and structure here. If we don't get additional resources for communication and improving structures, the dream of personalised medicine will become a vision that we will never achieve.
I invite my colleagues on a journey together towards a change of perspectives and structures!