BOSTON — Harvard Medical School assistant professor and Boston Children’s Hospital physician Dr. Dennis Rosen has a simple idea to radically change medical care in the United States — improve communication between medical professionals and patients.
His theory is the basis of his new book, “Vital Conversations,” published this month by Columbia University Press.
“The reason I wrote the book is because of a growing sense of pervasive dysfunction in the medical system,” said Rosen, who grew up in Toronto and Israel, and currently lives in Newton. “There is a lot of emphasis on doing things efficiently, which generally means seeing more patients in less time. The reality is that results in lower quality care, worse outcomes and less satisfaction for all involved.”
“Vital Conversations,” Rosen’s second book, is intended for people in the medical field, as well as the general public. It addresses the problem at multiple levels, using examples from his experience with immigrants in Israel, where he attended medical school and served as a resident, as well as his 18 years of practice in Boston as a pediatric pulmonologist. Chapters address the advantages of tailoring medical care to meet the needs of patients in accordance with their values; how differences in culture, belief systems and disease conceptualization can affect the relationship between physicians and patients; the role of communications-skills training; and the effect of bias, stigma and health literacy.
Rosen provides moving examples of actual patient scenarios. Stories about Ethiopian Jewish immigrants to Israel engaging in the practice of removing an infant’s uvula and about Ultra-Orthodox Jews who rely on approval of religious leaders illustrate the need for understanding subtleties of cultural practices, and establish Rosen as a caring and empathetic physician with a wealth of experience to share.
“Having transitioned between different cultures and societies multiple times allows you to see the common problems for what they are,” said Rosen, adding that communication has been a common problem in all the different places he has practiced.
As a practitioner, Rosen continues to work to improve communication at every level, and speaks about the topic here and in Israel. Fluent in English and Hebrew, he has been studying Spanish for the past two years because he considers it key to the practice of medicine in the U.S.
“I really see the problem at multiple levels,” Rosen said. “My hope is that by making people more aware of this there will be a groundswell of pressure to bring about real change… Realistically, what is going to sway the people who pay is the recognition that ensuring good communication actually results in better and less experience care.”
Dr. Rosen’s Tips for Patients to Improve Communications During an Office Visit
Prepare an agenda, including a list of questions.
Be honest and open about concerns.
Bring someone with you to the visit to clarify questions or help take notes.
Know the names and doses of medications you are on, as well as adverse reactions in the past.
Speak up if something isn’t clear.
Before leaving, be certain you understand what to do for treatment and under what circumstances you should seek further medical care.