Background
In a medical institution, the treatment of diseases starts with communication between doctors and patients; interactions between doctors and patients take place through communication. A doctor comes to infer a patient’s disease status through the patient’s explanations. The patient may better understand his or her own condition through the doctor’s explanation and learn about the treatment method and other key information. Indeed, doctors set the directions in medical judgments and treatments, based on information obtained via conversations with their patients. Patients are also more likely to follow their doctor’s diagnosis and a prescription if the doctor positively explains the treatment process. Accordingly, effective communication between doctors and patients can be seen as important to enable accurate diagnoses and treatments [
1,
2]. Doctors may establish treatment plans through communication with patients, and patients come to receive medical services through interactions in the treatment process. However, if communication between doctors and patients is not smooth, a patient may distrust the doctor’s medical service, and adherence may decrease. In other words, if communication between doctors and patients is not satisfactory, the quality of medical services can deteriorate, and the economic costs, including medical expenses and the treatment period, that the patient has to bear would increase [
2,
3].
As the medical paradigm shifts to patient-centered medicine, patients have been made to make decisions on their treatment to actively participate in the treatment [
4]. If communication between doctors and patients increases due to the provision of patient-centered medical services, this may not only relieve a patient’s symptoms but also reduce the uncertainties, patient’s stress and depression, medical accident risks, etc. that come with treatment, all of which may be caused by a lack of communication. In addition, unnecessary examinations and treatments would be reduced, positively affecting the medical process, such as through reduced medical costs and so forth, and treatment results [
5‐
7]. In particular, as aging is progressing globally and the number of chronically ill is increasing around the world, not only have medical expenses increased but also the personal burden on health care. Chronic diseases are a major cause of death and require continuous treatment and management. As doctor–patient communication is increasingly reinforced, patients will be able to understand the treatment process and alleviate their diseases through effective health management. That is, if medical information is exchanged by improving the communication between doctors and patients, doctors would be able to provide treatment methods suitable for each patient. Thus, we expect that the adherence of patients with the diagnoses of doctors will be enhanced, thereby resulting in improved treatment results [
8‐
10].
As such, the importance of doctor–patient communication is being emphasized, but there is an aspect that doctor–patient communication is still unilaterally performed. Research on health communication has already been conducted focusing on the measurement of health communication, including measures for doctor–patient communication and doctor–patient mutual understanding, among others; however, there is currently insufficient research that materializes the obstacles to doctor–patient communication and that analyzes measures to reinforce their mutual communication [
11‐
13]. Accordingly, in this study, we intend to derive the priorities for smooth communication between doctors and patients through an AHP (Analytic Hierarchy Process) analysis. This study aims to extract obstacles that obstruct doctor–patient communication and then analyze differences in perception regarding doctor–patient communication. We intend to synthetically derive the doctor–patient’s viewpoint of health communication and present a strategy to improve the doctor–patient relationship.
Discussion
In this study, we intended to suggest measures for establishing positive relationships between doctors and patients by uncovering differences revealed in doctor–patient communication and then resolving these. As a result of this study, for physicians, we consider professionalism as an important factor in health communication. Professionalism is a core competency of doctors, who are responsible for providing medical services; doctors’ professionalism acts as an important part of building trust between doctors and patients, which was found to be consistent with existing research findings [
23]. Since doctors are expected to provide accurate diagnoses for patients, doctors largely focus on clearly communicating the results of diagnoses to the patients, rather than emotionally empathizing with them.
In addition, among the sub-items of professionalism in this study, the accuracy of diagnoses and prescriptions appeared as the top item, similar to the results of previous studies that have stated that state-of-the-art medical knowledge, high-level clinical competence, and communication skills are key elements necessary to represent the doctor’s professionalism [
26,
27]. For health communication, studies have simply defined doctors’ professionalism as having clinical skills and expert knowledge and believe that what the physicians do is playing a role in instructing patients about diagnosis and treatment recommendations, regardless of patient preference [
28]. However, in recent years, the definition of doctors’ professionalism has included, among others, a kind attitude toward the patient and polite speech, which also acts as an important factor, even in terms of the quality of medical services. Patient satisfaction is induced by the professionalism of the healthcare provider, and this professionalism includes a specific explanation of the treatment period and the smooth communication with the medical staff, among others [
35].
In the case of patients, unlike doctors, we considered that the most important factor in health communication was mutual intelligibility. This was found to be similar to the conclusions of previous studies that patients generally desire to share their thoughts on the causes of their diseases with doctors. Thus, the communication skills of doctors may form a positive doctor–patient relationship that would eventually lead to an improvement in treatment results [
36,
37]. The communication styles of doctors can be divided into doctor-centered and patient-centered styles. The doctor-centered style is a communication style in which a doctor unilaterally directs information on treatment and can be seen as communication that focuses only on treatment. On the other hand, the patient-centered style indicates that doctors and patients communicate with each other; in this case, the patient’s accepting attitude is shown to be active. Accordingly, it is judged that the quality of medical care services could be improved if the information necessary for treatment is obtained from patients through patient-centered health communication, and then mutually cooperative relationships could be established.
In addition, the patients selected checking whether the treatment content is perceived as the top factor among the sub-items of mutual-intelligibility. These results were found to differ from existing study results that negative interactions between doctors and patients are mainly induced by nonverbal communication errors and that non-verbal communication, including the coldness of the doctor’s facial expressions and the doctor’s emotional message indicating boredom for the patient’s explanations, is the main cause of lower patient satisfaction with medical services [
13]. After the doctor informs the treatment process to the patient through diagnosis, it seems necessary for the physician to receive feedback from the patient with respect to the treatment process—for example, whether it was understood by the patient or whether the patient had any questions, among others. Furthermore, when a doctor and patient build a sense of trust between each other, the patient will naturally express his or her feelings of needs, expectations, and inconveniences to the doctor. This sense of trust can be formed when doctors utilize nonverbal communication, such as through expressing their sympathy for the patient’s words, and so forth. Through a doctor’s body language, such as their facial expressions and postures, which the patient comes to confront after entering the examining room, the patient would form a rapport with the doctor and explain his or her conditions in detail [
23,
38]. Therefore, a physician needs to judge a patient’s individual situation, to present a treatment process appropriate for the patient, and to check whether the patient understands it through sufficient explanations so that the patient may carry it out. For doctors to effectively communicate a treatment process to patients, mutual understanding centered on communication must be the basis, and smooth health communication would be able to improve the quality of medical care and safety in the treatment process.
In the meantime, doctors selected reliability as the top factor in health communication, whereas patients selected fairness. It was found that this differs from existing study findings that patients are able to trust doctors when physicians show respectful manners and sympathizing attitudes to them, and thereby, the quality of communication could also be improved [
39,
40]. Fairness implies that a doctor will fairly treat all patients, regardless of their social status or personal relationships. It seems that doctors’ discrimination against patients according to the latter’s social status, personal closeness, and personal connections can interfere with the relationship between patients and doctors. Physicians need to work hard to make patients better understand their own disease status, without the latter feeling alienated. Through this, it is judged that if treatment is performed from the patient’s point of view by resolving the potential misunderstanding that the relationship would be unfair between doctors and patients, it would be of great help in improving the outcome of treatment from a long-term perspective. On the other hand, doctors viewed reliability as the top factor in health communication. Doctors believe that clinical skills are an important part of communication behavior with patients and consider it an important factor in giving patients a sense of trust based on counseling to understand the patients’ medical history, explaining diagnoses and prognoses, and providing accurate treatment methods, among others. Patients complain that they tend to lose their trust for doctors because they cannot receive satisfactory medical services due to the physician’s actions of unilaterally providing treatment information and instructing treatment methods, among others, without being aware of the patient’s situation. Therefore, to increase reliability for patients, doctors should be able to improve the quality of medical service by sharing the information they have regarding monitoring during the diagnosis and treatment processes, through sufficient conversations with the patient, to obtain accurate information necessary for the patient.
In this study, we presented factors that interfere with health communication and suggested measures to resolve these, from the viewpoints of both doctors and patients. However, recently, telemedicine treatment has been performed for chronic disease management using mobile medical devices, and untact healthcare due to COVID-19 are increasing. It is expected that the important factors of health communication would differ according to face-to-face and untact healthcare. In future studies, if the factors that hinder the communication between doctors and patients are identified through an additional analysis on this point, it is expected that the service quality of continuously increasing untact healthcare would be improved.
Conclusion
In this study, doctors judged that professionalism and reliability were more important than fairness and mutual intelligibility in communication with patients, and patients considered mutual intelligibility and fairness to be more important than professionalism and reliability. To establish a positive relationship between doctor and patient, while communicating with the patient centered on his or her treatment, a doctor needs to have regular conversations about whether the patient understands what he or she is about to go through and whether the patient is in an environment where the treatment process can be performed. Patients should accurately describe their disease status to increase the accuracy of diagnoses and participate in the treatment process by continuously exchanging opinions with their doctors. To enhance health communication between doctors and patients, doctors should reinforce communication with patients by communicating from the patient’s point of view and by providing consistent medical services; patients should be able to reinforce communication with doctors by trusting doctors and faithfully participating in the treatment process. Based on this, if patient-centered medical services are provided, it is judged that a successful treatment strategy can be established based on the patient’s personal preference.
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