Each day, those of us in health communication may consider the patient empowered,
enlightened, engaged, and educated. Whether we ourselves are a patient, a family
member, friend, coworker, or in a physician –patient relationship, we accept the ethi
cal and evidence-based approach for patient-centered care as a cornerstone of
twenty-first century medical practice. Nonetheless, it has been only with recent consensus studies, including those by the prestigious Institute of Medicine and the Joint
Commission in the United States, as well as recent publications and applications in
the United Kingdom by multiple sectors, that an emergence and conventional
wisdom now places effective communication as the foundation for better patient outcomes and safety. In fact, the Joint Commission (2007)suggests solutions that focus
on making effective communication a priority in protecting the safety of patients;
addressing patient communication needs across the spectrum of care; and pursuing
public policy changes that promote better communication between health care
practitioners and patients.
Furthermore, the Joint Commission report warns that failure to provide patients
with information about their care in ways that they can understand will continue to
undermine other efforts to improve patient safety. A recent systematic review on
‘‘Effectiveness of strategies for informing, educating and involving patients ’’by
Angela Coulter and Jo Ellins of the Picker Institute published in the British Medical
Journal (2007), identified 129 systematic reviews plus many other studies, which covered patient-focused quality interventions in four areas: improving health literacy,
improving clinical decision making; improving selfcare; and improving patient
safety. While the results of some reviews were negative (no difference between intervention and control or worse outcome with the intervention)or mixed (positive for
some outcome measures and negative for others), most were positive (beneficial
effect)for the outcomes selected for our overview.
The evidence-informed conclusions suggest that any strategy to reduce health
inequalities must promote health literacy and engagement; that patients could help
select treatments, manage long-term conditions, and increase safety of drug use
and infection control; and that interventions can improve patients ’knowledge andexperience, use of health services, health behavior, and health status. Coulter and
Ellins conclude that the effective use of ‘‘health information materials, decision aids,
self management action plans, and other ‘‘technologies ’’of patient engagement are
most effective when they supplement or augment, rather than replace, interactions
between patients and professionals ’’(2007, p. 27).
Despite the growing evidence in support of the need for communication, the
soft(er)social science historically has been integrated unevenly in medical practice.
Nonetheless, Robert Veatch (2005), suggests that a rapprochement has begun
reuniting humanists and physicians. With the recent evidence and multidisciplinary
developments in developed health systems where economists help prioritize cost (and
clinical)effectiveness, the evidence of communication encouraging patients to play a
more active role in their health care could improve quality, efficiency, and health
outcomes, including the motivating factors of averting errors and improving safety
by using medicines and medical interventions appropriately, ‘‘as directed ’’and
intended for use.
While many of us in education may understand the research and its implication,
the diffusion of policy to support the effective provision of health information takes
time. A recent initiative by the British Medical Journal (BMJ)provides an innovative
approach developed to provide researchers, teachers, and students with reliable and
up-to-date information, together with examples of best practice. The intervention is
entitled BMJ Health Intelligence, in which subscribers can garner evidence, data,
policies, targets, and guidelines on critical public health topics in one web-based
resource. This health intelligence addressed the multidisiplinary nature of public
health policy, including the best practice approach for using evidence for policy
and commissioning decisions, investment and return analyses for various interven-
tions, data and geographical analysis tools supporting local versus national compar-
isons, and real-life examples of local public health initiatives. While this is early in
application, the ideals to bridge trditional medical publishing with the needs of
twenty-first century health are laudatory.
Since the Journal of Health Communication began publication in 1994, health
communication has grown. In fact, a 2006 ranking of impact factor of academic
journals places this journal as third out of the 44 communcation journals published.
Yet, during this period communication has become central in medical and health
education steeped in long-standing tradition. Health literacy at a variety of levels
has developed, social marketing of health issues impacts large audiences, and
e-health has expanded exponentially. It is now up to many of us as health commu-
nicators to ensure that the evidence —scientific and social —translates into policy and
action that fosters effective, ethical, and strategic communication.
References
Coulter, A. & Ellins, J. (2007). Effectiveness of strategies for informing, educating and
involving patients. British Medical Journal , 335, 23 –27.
The Joint Commission. (2007). ‘‘What Did the Doctor Say?:’’Improving Health Literacy to
Protect Patient Safety. Oakbrook Terrace, IL. Available:
http://www. jointcommission.
org/NR/rdonlyres/D5248B2E-E7E6-4121-8874-99C7B4888301/0/improving_health_
literacy. pdf
Veatch, R. (2005). Disrupted dialogue:Medical ethics and the collapse of physician –humanist
communication (1770 –1980). Oxford:Oxford University Press.
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Scott C. Ratzan MD, MPA, MA is Editor-in-Chief of the Journal of
Health Communication: International Perspectives. He also serves
as Vice President, Pharmaceuticals and Global Heath for Johnson &
Johnson.
