On the initiative of the Federal Advisory Board for MS Patients (BBMSE), the DMSG recently issued a flyer providing doctors with “tips” for diagnosing multiple sclerosis: recommendations such as “take your time for the patient” or “use simple language”.
Why do I get upset when I read something like this? Perhaps because I don’t feel taken seriously. It is a consensus that as a doctor, we take our patients seriously – after all, the well-being of our patients is the maxim of our profession.
Challenges in the doctor-patient conversation
On the other hand – hand on heart – it is a fact that not every medical conversation is successful and medical communication is not always optimal, which is not always due to a time problem. The doctor-patient conversation is a complex situation, especially when it comes to communicating fateful diagnoses or even life-threatening situations. In such a situation, the tension is high, and not only on the patient’s side. There is also the knowledge gap. On one hand there is the medical expertise, on the other hand the person seeking advice, who must trust in the knowledge of the doctor. The characteristics of patients (social status, education, cultural factors, etc.) are different and require different communication, without it always being immediately clear. A current issue is also that many patients come with pre-information from the internet. They thus become active themselves, but sometimes demand treatments through their activity that are not appropriate in the respective situation and provoke a conflict of interest.
So it is absolutely legitimate and necessary to think about the doctor-patient interaction, because it is the basic prerequisite for a successful treatment relationship – and therefore the initiative of the BBMSE is to be welcomed.
Medical communication as part of training
Perhaps it reassures you to hear that medical communication now has a much higher value in the training of medical students than it was in the past. All medical faculties in Germany maintain teaching clinics (skills labs) where, in addition to practical skills, medical conversation is also trained – partly with actor patients who simulate difficult conversation situations. Thus, students are already prepared for the doctor-patient conversation within their studies. This welcome development will contribute to meeting the demands of patient organizations for empathetic and socially competent communication.
However, I think another development will sustainably change doctor-patient communication, or is already doing so. Personally, I rarely experience in today’s information society that, for example, the diagnosis of multiple sclerosis catches patients by surprise. Usually, those affected have already informed themselves so thoroughly on the internet and in social networks that the diagnostic clarification by the neurologist is perceived more as a confirmation than as a surprise.
Specialized knowledge required
This ever-growing group of patients then primarily wants to receive fact-based information and targeted advice in the context of their personal life situation. Not that empathy wouldn’t play a role in such a situation, but equally important is a high level of specialized knowledge from the practitioner. Such specialized knowledge cannot necessarily be expected from every practitioner, who often has to cover the entire and ever-increasing breadth of the field of neurology. The leveling of the knowledge gap made possible by the internet opens up new opportunities for patients, but often also requires different forms of communication and knowledge transfer. This is the strength of specialized MS centers, which are needed more than ever today.
After I wrote about the outpatient specialist care (ASV) for MS at the beginning of the year, the circle closes here. It is to be hoped that the new offer will also improve communication with MS patients.
