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September 14, 2000

Medical School professor named to nation's first chair focusing on patient care

Before they can graduate, Pitt medical students must be able to interpret an electrocardiogram, perform a pelvic exam and demonstrate many other clinical skills.

Some day, they may also have to show that they can communicate effectively with patients.

A draft proposal to establish minimum standards for doctor-patient communication skills will be circulated for comment among School of Medicine faculty this fall prior to being taken to the school's curriculum committee, said Robert M. Arnold, who was appointed this summer as the school's first Leo H. Criep, M.D., Chair in Patient Care.

"It would be groundbreaking for a medical school to say, 'Before you graduate, you need to show these competencies in promoting the doctor-patient relationship,'" Arnold said.

Groundbreaking but overdue, he suggested. Even with today's high-tech MRIs and PET scans, the most powerful diagnostic tool in medicine remains the human voice, Arnold said.

"Talking to patients is still the most effective way of achieving a diagnosis, according to every study that has been done. It's also the strongest way to develop a good relationship with the patient and to instill trust and patient satisfaction, which correlates with positive health outcomes," said Arnold.

"And yet, the doctor-patient relationship was almost ignored in medical schools until 15 or 20 years ago. The view was that anybody can talk, and given that anybody can talk, we don't need to pay particular attention to the communication skills that are needed between doctors and patients."

Most medical educators now recognize that even the most technically gifted physicians may need help with their bedside manners. Pitt's medical school initiated its own patient-centered curriculum in 1992.

To renew the school's emphasis on the doctor-patient relationship as a core element of health care, it established the Criep Chair, the first endowed chair focusing on the patient-doctor relationship and patient-centered care. The chair was named for the late Leo H. Criep, a nationally recognized pioneer in immunology and Distinguished University Professor at Pitt who pushed for better doctor-patient communication through his writing, mentoring and financial gifts.

The $1.5 million Criep Chair is endowed mainly by gifts from the Criep family, UPMC Health System, Pitt's Department of Medicine and the Jewish Healthcare Foundation of Pittsburgh.

Susan Santa Cruz, Criep's daughter, said: "We have established this chair to address the deterioration of the doctor-patient relationship in today's technology-based, bottom line-oriented health care system."

Arnold, chief of the Pitt medical school's section of palliative care and medical ethics, and a faculty member here since 1988, was named to the Criep Chair this summer after a two-year, national search.

"For the Criep family to say, 'In a school that is a top 10 NIH [National Institutes of Health]-funded school like Pitt, we're going to make doctor-patient relations as much of a priority as genetics and other research specialties' — that says a lot about the Criep family as well as what our medical school thinks is important," said Arnold.

Creation of the new chair also says something about the current state of doctor-patient communication. "Recent studies show that when physicians start an interview with a patient, they interrupt the patient within the first 20 seconds, which means it's very hard for patients to get their story out," Arnold said.

Communicating with patients' families also is crucial, he said. For example, rather than asking family members, "What do you want to do?" it's better to ask, "What would your loved one have wanted?"

"The latter question will yield better answers, while decreasing the amount of stress for the family," Arnold noted.

While Americans wax nostalgic about the old, pre-managed care family doctor who made house calls, it's impossible to know whether today's doctor-patient communication is any worse than yesterday's, according to Arnold.

"It's clear that doctors did more talking with patients in the past because there were fewer [diagnostic] things to do back then," he said. "Unfortunately, we don't have any tapes of doctors talking to patients 30 or 40 years ago.

"Some of it may be that we tend to view the past through this 'golden age-a-scope.' People like to say, 'When I was growing up, it was so much better…' but it's unclear to what extent that's true."

— Bruce Steele

Filed under: Feature,Volume 33 Issue 2

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