S1: Welcome in San Diego. It's Jade Hindman on this episode of KPBS Midday Edition. A new book lays out how breakdowns in communication can stand in the way of health care , and how empathetic communication can fix that. This is KPBS Midday Edition. Connecting our communities through conversation. The US health care system has a lot of problems. Soaring insurance premiums and out-of-pocket costs are pushing more and more Americans into medical debt. Many patients wait months for important appointments , and physician burnout has reached new highs in recent years. But my next guest argues there's another problem. A communication breakdown between patients and health care providers. Doctor Neil Farber is a retired professor of internal medicine at UC San Diego. now , after 40 years of experience as a physician and a patient , he's out with a new book. It is called Treating a Broken System A Physician's Cure for the Health Care Crisis. Doctor Farber joins me now to talk about it. Welcome to Midday Edition.
S2: Thank you very much.
S1: So you you approached this book from several lived experiences as a physician , as a patient and as a family member. And I want to start with that third perspective , because this story begins with a doctor's visit for you and , well , for your wife , Terry. Really? What was that experience like for the both of you?
S2: It was devastating. It's the only way to put it. She had migraines for a long period of time , but there was a change. Who went to see a neurologist who said get an MRI , which we did. He called her while I was at work and told her that she had something abnormal in her brain and said , go see a neurosurgeon right away. That's the only thing she heard. I sort of raced her home to be with her because she was absolutely in tears. We went to see a neurosurgeon who looked there and said , this is your tumor and this position , uh , position. Here it is in this film. I can remove it and give you another year or two a life , or I can do a biopsy and you can go through chemotherapy. Um , she started crying. He just stood there and looked at her , and I held her and started crying myself. And I knew this was not the way to give bad news to people. Mhm.
S1: Mhm. What do you think went wrong there in that.
S2: I you know it's interesting because I had always been interested in communication with patients my whole career. That was one of my areas of expertise and interest , and I never got taught how to give bad news because no one had ever come out with anything about doing that , per se. We knew about empathy. We knew about being with patients and communicating with them , but never giving bad news. Until this guy named Robert Buchman came out with a book in 1992 about how to give bad news to patients , well , this was only five years later , so you wouldn't expect that , especially specialists would have paid attention to that. So they had no way of knowing how to do it. Hmm.
S1: Hmm. I know that your wife , Teri passed away in 2022. I'm very sorry. Thank you about that. But , um , this has led you down this path to to help physicians who may have been sitting where that physician was sitting. Um , as a physician yourself. Why was that experience being there with your wife so illuminating?
S2: It was illuminating because I had I didn't see empathy on their part. And we are taught to be as physicians , we're taught to be objective. And empathy is not sympathy. It's not feeling the feelings , but it's rather understanding a patient's feelings. But many physicians haven't been taught how to understand patient's feelings , and I knew that basically I had to spread the word about how to do this.
S1: Is that something you can teach , though?
S2: Yeah , well , you can teach somebody to care. You can't teach somebody to care. I mean , obviously that's that's something somebody feels or doesn't feel when they're interacting with patients , but assuming they care. And most physicians , I think , do care. You can teach them the structure for how to express that caring in an empathetic way. Hmm.
S1: Hmm. Do you think that , um , structure of communication is changing from from what you experienced? Are hospitals making a bigger effort to enhance doctor patient communication?
S2: They they are. They very much are. Especially for students and residents , for practicing physicians , if they want to or if they are designated by their patients as not being very caring. Hmm. But otherwise , not necessarily. Right.
S1: Right. Well , why is communication so important on an ethical and even a legal level , especially when it comes to informed consent?
S2: Well , for informed consent , absolutely. And that's , that's that's a legal aspect for an ethical aspect or just caring for the patient , one needs to be able to communicate adequately with the patient , because it's been shown that patients who don't have that aspect don't have a physician who can communicate with them , they're much less likely to , for example , take their medications or see the physician on a regular basis. And that means they don't get the care that they need.
S1: I see , and you also write about your own experience as a patient in 2024 with an acute appendicitis. What did you learn from navigating the system on that side of things?
S2: I had physicians who really cared about me , but what I experienced was an inability to get some appointments in a timely manner. And that is because physicians have so much clinical clerical work placed upon them that they have less time with patients , they have less time to do all the work they need to do and therefore getting burned out , and they either reduce their hours , go into concierge medicine where they've seen less numbers of patients , or absolutely leave medicine altogether. And therefore there's been a wholesale lessening of the number of physicians who are available to see patients. Hmm.
S1: Hmm. So in all of these experiences , you know , you're talking about burnout. You're talking about some of the reasons why a physician may not be able to communicate in a way that's more empathetic. What do you teach people in physicians about about being more empathetic?
S2: So I teach them the the methodology for doing so. The pushback I get is we don't have time to do this. And the answer to that is , um , when I started researching it , because it never was given to me , I just found time Myself and made up time other , other ways. But the the answer is by approaching administrators , explaining the problems that the physicians have , and working together with administrators to solve those problems so the physicians have more time with their patients and are therefore less burned out. And once we get that accomplished , we can then also institute re-education for those physicians in how to communicate and how to get bad news.
S1: So what does working together with administrators actually look like in the interest of patients?
S2: So there's one place that looking at the at the literature because it didn't happen with me , unfortunately. But looking at the literature , there's one place where it was accomplished very successfully. And this is at the Mayo Clinic in Rochester , where physicians and administrators sat down together. The administrators listened to what the physician's problems were , and then authorized the physicians to make changes in those problems in the in the structure , so that the problems would go away and then get other physicians involved working with them. Um , burnout was basically eliminated. There were changes that made it better for the physicians and the patients. And in the in the long run , the institution made more money doing that , not less money. And that's the fear of administrators.
S1: Aside from having , you know , a patient load that just does not allow time for much conversation between a patient and a doctor. What other challenges stand in the way of empathetic communication?
S2: The electronic progress record , the patient portal , all those messages that come in dealing with insurance companies for prior authorizations , writing letters , dealing with other physicians , all that. Yeah.
S1: Yeah. Yeah. So , I mean , as we talk about physician burnout then and and time as a resource , I have to ask about the role of artificial intelligence in healthcare today. How is AI changing the dynamic between patients and doctors?
S2: Well , there are some places that are experimenting using AI for in the exam room to take all the information and write a note. The problem is it is not always accurate. And so the physician needs to carefully edit the note afterwards , which means there is no time difference between the way it is now and with AI. Eventually there will be , but not right yet. Not there yet , not there yet.
S1: There's a chapter in your book called Always waiting. Which is all about the period of uncertainty between tests and results. What's that? Such , uh. Or why is that such a slow process?
S2: Um , oftentimes the pathologists who do the tests and , and examine the tissues are not there. They've they've left. And there's less numbers of pathologists to do all the work. In addition , patients are getting older. The tests are more complicated and and require more intensive examination. So you have less numbers of of pathologists to do the work with more work to do.
S1: Your book outlines several ways patients can better advocate for themselves in medical spaces. What suggestions do you have for for our listeners?
S2: Um , a couple of things. One is in the book , I give several tips about how to interact with their physicians , for example , bringing a list of the problems and issues they want to address , bringing their medications , etc.. In addition , patients , when they are evaluated by the institution about how their physician did if the physician was good , say the physician was good , but that they didn't have enough time with me , and that will give administrators the message that something needs to be done.
S1: Is some of that caused by redundancies?
S2: Some of it's done. Some of it is caused by redundancies and by lack of efficiency. Yes. Yeah.
S1: Yeah. Um , on the other side , what can physicians do better to empower patients to self advocate?
S2: Um , encourage them to give them a review that says , I , I'm glad you like me , say you like me , but tell them that there wasn't enough time. And next time , bring in your list. I want to hear from you. I want to hear who you are. I want to hear your values. Mhm.
S1: If there's time.
S2: If there's time.
S1: Um , what can family members and friends do to help loved ones advocate for themselves in those spaces? Because sometimes having a supportive voice in the room can really go a long way.
S2: Yeah , absolutely. And I encourage patients to have a loved one in , in the room to help advocate for them. If the loved one can't be in the room , then , um , basically ask the physician if it's okay to do a zoom call or , or telephone call. When I had to have part of my kidney removed , even though I'm a physician , I asked my daughter , who's a pediatrician , to be on the phone on the other end to make sure that I was doing the right thing.
S1: Um , now , looking to the future. I mean , what needs to change for the medical system to be a system that works , that's that's effective and safe for everyone.
S2: I think the main thing is that , as I said , administrators and physicians and patients need to be in in concert with one another as a collaborative effort to approach to different things that will make it better not only for the physicians , but the patients.
S1: And , you know , we started this conversation with your your wife , Terri , and I'd love to end the conversation with her , too. Sure. If she were here with us today , what do you think she would say about this book?
S2: I think she would probably say everything in it is real , and people need to read this because , you know , it happened to us. It doesn't necessarily have to happen to them.
S1: As plainly put. I mean , and that that makes me wonder too. Um , talk talk a bit , if you can , about the consequence of not having empathetic communication.
S2: It causes if someone is an empathetic towards the patient. The patient ends up not not trusting the physician. They end up oftentimes more depressed , and it can impact negatively on their ultimate outcome.
S1: How much is listening part of being an empathetic communicator? Communicator?
S2: Yeah , definitely. Um , the physician needs to take the time to listen to the patient and understand what the patient's values are , what they're going through , etc. and the only way of doing that is taking the time to hear what they're not only communicating verbally , but non-verbally. Mhm.
S1: Um , as a , a physician yourself , um , when you hear about health disparities , um , what what runs through your mind in terms of of how much communication plays a part in that?
S2: I think it does. Um , you know , there's there are many people who don't get the kind of care that they would otherwise get if they were able to communicate one on one with a physician. And , um , everyone , everyone has hidden biases. And we now know that physicians have hidden biases , too. And that can play a role in how much you're communicating , how much you're listening to what the patient is saying. Mhm.
S1: You know , ultimately , what do you hope people take away from this book , whether you're a physician or a patient or even an administrator?
S2: Um , the main thing I want everybody to understand is that we have to work together to solve these problems. It's not something that an administrator can just throw something at the physicians or say to the physician , you just need to be resilient. It it needs change. And the only way we can make change that's effective for both the patients and the physicians and yet still benefits the health institution is work together.
S1: All right. I've been speaking with Doctor Neal Farber. His new book is called Treating a Broken System A Physician's Cure for the Health Care Crisis. Doctor Farber , thank you so very much.
S2: Thank you very much for having me.
S1: That's our show for today. I'm your host , Jade Hindman.
S3: Thanks for tuning in to Midday Edition. Be sure to have a great day on purpose , everyone.
