Doctors Talking with Patients/Patients Talking with Doctors: Improving Communication in Medical Visits

By Debra L. Roter; Judith A. Hall | Go to book overview

7
Talk and the Quality of Care

One can think of the quality of care as residing, ultimately, in the health of the patient, and some experts on quality do define it that way. But health, or lack of it, is determined by many factors besides the nature of the care actually rendered to the patient. Stress, for example, weakens the immune system, and economic factors also influence people's health in a variety of ways. A low-income mother has trouble affording medications for her children; poorly educated people may not fully understand the need for regular care; a breadwinner in a minimum-wage job puts his or her job at risk by taking time off to visit the doctor. Medical care providers may have little or no influence in these areas.

Because a person's state of health has many causes, most research on the quality of care focuses on the process rather than the outcome of care. Process refers to those things that providers actually do, and fail to do, in the clinical situation. This approach recognizes that doing the "right" thing doesn't guarantee a well or even an improved patient, but it at least permits systematic study of what the health care providers have done for a patient.

Although there is often uncertainty in the profession, even disagreement, over what constitutes appropriate medical care, standards have been developed for the handling of many medical conditions; some examples are ear infection, acute myocardial infarction (heart attack), diabetes, chronic bronchitis, gonorrhea, burns, and urinary tract infection. The standards set for such conditions typically cover certain facts from the medical history and physical examination, the adequacy of the diagnostic process, and the development of plans for managing the illness. By applying these standards

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