Improving Medical Outcomes

The problems faced by medical doctors and automobile mechanics are in some ways quite similar-something isn't working right and must be fixed. They must both figure out the cause of malfunctions and determine the appropriate treatments. Yet, the mechanichas no need to worry about an automobile's psyche; the specific mechanical factors are the only ones that come into play. In health care, however, the factors influencing outcomes are broader, more complicated, and colored by the underlying psychologicalfactors of those involved. These factors have profound effects. Doctors are often influenced by patients' description of symptoms, yet information is often incomplete or inaccurate or colored by the patient's own experiences. The doctor's own demeanor maygreatly affect outcomes, as can the doctor's ability to interpret the ever-expanding medical literature. These underlying influences are often not acknowledged, and yet they can have far-reaching consequences. Acknowledging these psychological factors and learning how to overcome them is the first step in improving communications between doctors and patients and to improving diagnosis and treatment. Here, the authors offer strategies for remedying the situation and moving forward to a better understanding of doctor-patient visits and their outcomes.