When reflecting on why some patients feel this way, Dr. Gibofsky believes that older patients tend to still view physicians as authority figures whom they shouldn’t contradict or interrupt, while younger patients are more assertive and challenging—perhaps because they have the ability to research a condition on the Internet. Cultural norms play a role as well.
Promoting Advocacy Groups
Although the survey reported that four of five physicians believe that patients who participate in RA support groups tend to be able to live better with RA, less than one-quarter of patients currently participate in a support or patient advocacy group.
“I think this is due to a lack of awareness or access to support groups and other services,” says Cindy McDaniel, a U.S. member of the RA NarRAtive Advisory Panel and senior vice president of Consumer Health & Impact for the Arthritis Foundation. The organization, the largest arthritis patient advocacy group in the world, has more than 20 support groups in communities throughout the country, plus online links to other community-based groups. In addition, the foundation offers free educational resources and tools for physicians and patients.
Ms. McDaniel says, “We encourage physicians to tell patients about us and what we can offer.” A new tool, called the Arthritis Research Finder, lets patients type in their ZIP code to see what types of resources are available within a certain radius of their home.
Improving Communication
So what can rheumatologists do to improve communication with patients? Dr. Gibofsky recommends physicians do the following:
- Whenever possible, allocate more time during appointments for discussions regarding the effect of disease on the patient’s quality of life. If necessary, schedule additional appointments.
- Understand that as a physician, you don’t have to address all of a patient’s concerns. Often, others—such as a nurse educator or practice management support group director—can address concerns that patients may not feel comfortable bringing up with the physician.
- Be sure your exam room is arranged so that it’s conducive to conversations. For example, make sure a computer screen is not positioned between the physician and patient, because this minimizes eye contact.
- Learn how to speak in the patient’s language. Realize they may not understand scientific terms or phrases. Pause every few sentences, and ask the patient if they understand what you’re saying.
- Encourage patients to ask open-ended questions; probe when necessary.
- Learn the skill of active, involved listening.
In addition, Ms. McDaniel suggests that physicians ask their patients to do the following:
- Encourage patients to do their homework, such as researching their condition and treatment options on the Internet, before an appointment.
- Encourage patients to be honest about how they feel now and on the days since their last appointment. Patients should discuss the biggest challenges and the things they miss out on due to having RA.
- Let patients know they can bring a relative or friend to their appointment. This person can provide a third-party perspective on how the patient is really feeling, especially if that patient may minimize their symptoms. The other person can also serve as another set of ears to understand and help reinforce what was said during the appointment afterward.
- Encourage patients to track their disease activity and the tasks they can and cannot do between visits to provide a good foundation for discussion during appointments.
What’s Next?
Now that the second phase of the survey is complete, the RA NarRAtive Advisory Panel, which is directed by 39 healthcare professional and patient advocacy group leaders, will work to develop tools and resources to help improve patient-physician dialogue identified by the study’s findings. These solutions will strive to change the narrative around RA to bridge gaps between beliefs and practices, and overall improve RA management.
