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 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 18  |  Issue : 2  |  Page : 50-54

Doctor-patient communication in thyroid conditions: Impact on outcomes


1 Department of Endocrinology, Apollo Hospital, Navi Mumbai, Maharashtra, India
2 Department of Endocrinology, M.S. Ramaiah Memorial Hospital, Bengaluru, Karnataka, India
3 Department of Liberal Arts, IIT Hyderabad, Sangareddy, Telangana, India

Date of Submission07-Mar-2022
Date of Acceptance05-Jun-2022
Date of Web Publication22-Jul-2022

Correspondence Address:
Shraddha Namjoshi
Department of Liberal Arts, IIT, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/trp.trp_6_22

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  Abstract 


Thyroid disorders are common conditions in the population that have repercussions on health, fertility, quality of life (QoL), and overall well-being. A literature search was conducted using PubMed database, using the key search words “thyroid disorders,” “QoL,” and “doctor‒patient communication.” The impact of thyroid disorders on patients' QoL, overall well-being, and the patients' outlook toward their prognosis necessitates better and more detailed communication between patient and provider. Thyroid disorders can have lasting psychological impacts and patient coping depends on effective management of these. An empathetic clinician can play a major role in boosting patient confidence and improving patient satisfaction, well-being, and adherence to treatment, resulting in improved outcomes. Physicians must identify the unmet needs of their patients and potential areas where their patients may need greater support and bridge the gap between the information that they are providing and patient-expected information.

Keywords: Doctor‒patient communication, quality of life, thyroid disorders


How to cite this article:
Lathia T, Selvan C, Namjoshi S, Badhe S. Doctor-patient communication in thyroid conditions: Impact on outcomes. Thyroid Res Pract 2021;18:50-4

How to cite this URL:
Lathia T, Selvan C, Namjoshi S, Badhe S. Doctor-patient communication in thyroid conditions: Impact on outcomes. Thyroid Res Pract [serial online] 2021 [cited 2022 Sep 29];18:50-4. Available from: https://www.thetrp.net/text.asp?2021/18/2/50/351646




  “Patient Expected Versus Physician Delivered”: Understanding the Gap in Patient‒Physician Communication In Thyroid Disorders in India Top


Thyroid disorders are common conditions in the population that have repercussions on health, fertility, quality of life (QoL), and overall well-being. Thyroid disorders also come with a strong social stigma fuelled by pervasive misinformation.[1] Such conditions (chronic conditions where symptom management is involved) require additional effective communication from health-care providers for the patients to successfully understand the diagnosis and treatment journey.[2],[3] Research in communication is gaining popularity and medical training curricula are being reformed to include training physicians to be empathic and humanistic in their treatment attitude.[4],[5] While this change has been adopted in most of Europe and the US, it has only taken root in recent years in the Indian medical system. Undoubtedly, it needs to be further encouraged with communication training, understanding of support needs, furthering a beyond-symptoms approach, and an emphasis on psychosocial factors alongside the medical ones. An empathy-driven holistic approach is crucial in the real-world setting. Time spent with the patient is important in building confidence and rapport.[6],[7] With high patient influxes and a nonstandardized health-care system, Indian physicians often face the challenge of time constraints, with an average consultation (for nonspecialist care) lasting between 2 and 5 min.[8]

While for a physician caring for a person with thyroid disorders, the management might seem simpler as compared to someone who for instance has diabetes, conveying this to the patient and reassuring them that, when well-managed, thyroid disorders do not come with major health consequences such as diabetes, could allay concerns and anxiety significantly.

The impact of thyroid disorders on patients' QoL, overall well-being, and the patient's outlook toward their prognosis[9],[10] necessitates better and more detailed communication between patient and provider. The current article aims to review different thyroid disorders, the importance of establishing effective communication with patients, and their impact on compliance, patient satisfaction, and outcomes of treatment.


  Hypothyroidism Top


Hypothyroidism is a chronic condition affecting 2%–11% of the population associated with insufficient thyroid hormone production.[11],[12],[13] Inadequately treated hypothyroidism carries an increased risk of mood disorders such as depression[14] and can have a significant impact on the patient's QoL.

Most commonly, laboratory test reports play a major role in creating treatment plans for patients with hypothyroidism rather than clinical symptoms. Physicians are primarily guided by these reports. Often, patient-requested treatments or diagnostic tests, that may not always be useful, can delay or interrupt the physician's course of treatment.[15] While most physicians provide support and information that they believe is appropriate for patients, patient-expected communication may fall short. This gap between the patient-expected and physician-delivered communication may cause patients to be dissatisfied with their health-care experience and further impact adherence to treatment plans and in turn, effective coping.

Medically, strong evidence suggests that a subset of individuals on levothyroxine supplementation continue to have symptoms and may never feel the same as they did before the diagnosis.[16] Patients frequently face dysthymia and fatigue-related symptoms.[17] Combination replacement of LT4 and LT3 has been suggested to have some benefits in this subset.[16],[18] Taking time to explain to patients the need for lifelong treatment, the possibility of residual symptoms due to limitations of medical science, and ongoing open communication to encourage compliance to therapy is crucial.

A qualitative study of patients' attitudes and perceptions showed that patients generally adhered well to treatment but were often unable to obtain clear, reliable information about their condition.[19] This is indicative of the dearth of patient education which may further cause patients to take uninformed decisions regarding their treatment plans. It is strongly suggested that this process be patient-centric and that providers understand and acknowledge patient concerns while familiarizing them with the course of treatment.[20]

For many female patients, a diagnosis of hypothyroidism can give way to possible fertility concerns.[21],[22] Many young women face shame and guilt, and disclosure to partners, family members, and relatives can be troubling.[23],[24] For young women considering marriage, the stigma of hypothyroidism-related infertility can be severely distressing considering the criticism and rejection if their condition is disclosed.[23] The burden of not disclosing the diagnosis adds to the shame and guilt that affects well-being.

As pregnancy progresses, the likelihood of hypothyroidism increases.[20] Pregnant women must be sensitized regarding recurrent testing and regular monitoring of thyroid function during pregnancy.[25] A session of reassuring yet realistic prepregnancy information can help address these concerns. The fact that with adequate replacement of LT4, the outcomes related to fertility and pregnancy are comparable, can be explained to the patients without causing alarm, and the risks can be outlined objectively. For patients tackling infertility, the health-care providers working together with the patient to devise a follow-up plan is crucial before and throughout the pregnancy. Consequently, when the impact of a condition extends to emotional and social aspects, so should the communication between physicians and patients.

Introspection for clinicians managing hypothyroidism is as follows:

• Consider offering reassurance to the patient about the safety of long-term levothyroxine therapy

• Consider describing levothyroxine therapy as hormone supplementation and not a drug to allay patient fears

• Consider discussing and briefing the patient about the long-term course of hypothyroidism, conditions, and concerns that may go alongside hypothyroidism such as weight gain and hair fall

• Consider prepregnancy counseling for the patient to help them draw up an effective plan of managing hypothyroidism before and during pregnancy

• Consider specific counseling for patients who may have a lack of success in assisted reproductive technique even after ongoing appropriate treatment to improve thyroid levels.


  Hyperthyroidism Top


Hyperthyroidism is caused by excessive thyroid hormone production and is frequently associated with anxiety and panic.[26] Common symptoms include weight loss, unexpected mood changes, and ophthalmologic symptoms with a marked impact on the cognitive functioning of the patient as well.[27] Thyroid-associated ophthalmopathy is characterized by the altered appearance of eyes (swelling of eyelids, prominent eyes, staring look, restricted eye movement, and redness of eyes) and changed visual function. The bodily change affects people's attitude and behavior toward them and their own interactions with other people. These patients often struggle to change social behavior and avoid social withdrawal.[28] Despite this, research examining the QoL, the need for counseling, and providers' contributions to helping patients facing this condition are scarce. Existing studies using QoL questionnaires have shown poor QoL in patients with thyroid eye disease.[29] All of these point to a pressing requirement for further research and training toward ways of helping patients manage this condition better.


  Thyroid Disorders and Goiter Top


Goiter is another significant consequence of thyroid disorders which typically is an irregular growth of the thyroid gland which may be caused by disturbances in thyroid levels.[30] While the physical impact of goiter is apparent, the effect on the QoL is significant during pretreatment but is shown to improve after treatment is administered.[31] Goiter does however also have its own consequences on interpersonal interactions and social experiences of individuals. With changes in appearance, individuals may be highly conscious of the visibility of the goiter and have a major impact on social interactions. Further impacts on pregnancy also cause concern in patients and require counseling and support from health-care providers.[32]

Introspection for physicians treating hyperthyroidism and related concerns is as follows:

• Consider reassuring the patient that symptoms such as fatigue, weight loss, feeling restless, and anxiety, are a feature of hyperthyroidism and will respond to treatment

• Consider discussing that the response to antithyroid drugs is variable resulting in varied treatment timelines

• Consider discussing the possible consequences of hyperthyroidism on their work and personal life

• Consider addressing concerns such as disclosure at the time of marriage

• Consider addressing the social difficulties that patients may face due to conditions such as goiter and exophthalmos.


  Thyroid Cancer Top


Over the past three decades, there has been an increase in the number of people diagnosed with thyroid cancer.[33] Near-total or total thyroidectomy is recommended for the management of thyroid cancer which can lead to a change in voice or permanently low calcium levels and hypothyroidism which requires lifelong treatment.[34] Radioiodine has had an important role in the treatment and management of thyroid cancer.[35] However, the various perceptions over any kind of “radiotherapy” or treatments that involve the word “radioactive” or “radiation” tend to cause apprehension among patients.[36] The word “cancer” itself evokes real fear in the patient's mind.[36] The clinician has the daunting task of explaining to the patient that timely and appropriate treatment of thyroid cancer carries a good prognosis (98% progression-free survival). However, despite this, the support requirements for patients cannot be disregarded. The high rate of good prognosis often causes health-care providers and caregivers to disregard the support needs of the patients.[37] The support and survivorship concerns.[38] of patients need to be addressed appropriately and promptly by health-care providers.

Introspection for physicians regarding thyroid cancer is as follows:

• Consider the profound psychological impact of the use of the word “cancer” and “radioactive” despite the good prognosis of most thyroid-related cancers

• Consider referring to a mental health professional to address the patient's coping with diagnosis and treatment

• Consider discussing the support needs of patients before, during, and after treatment

• Consider addressing concerns faced by the patient's family and how they can support the patient in the best possible way.

In clinical settings, we observe physicians and other health-care workers communicating empathically using the limited tools available to them. This results in them providing detailed and important information regarding the diagnosis, treatment, and recovery. However, most literature also points toward the need for patients to be provided support and acknowledgment of the psychological impact of their condition. Thyroid disorders specifically are shown to have a lasting psychological impact, and patient coping depends on effective management of these. The focus of further research toward developing tools that aid physicians to provide patient-important information and create a holistic approach that takes care of both the physical and mental health needs of patients.


  Conclusion Top


Thyroid conditions have more than a physical impact. They have a profound impact on the individual's mental health, social interactions, and overall QoL. The effects of these conditions on emotions, physical appearance of patients, and other concerns can make them difficult to cope with. For most physicians, the experience of working with a patient with thyroid disorders can be routine, but the lived experience of the patient can be filled with turmoil, emotional upheaval, and a long period of treatment and recovery which means coping with these for extended periods of time. An empathetic clinician can play a major role in boosting the confidence of the patient and improving patient satisfaction, wellbeing, and adherence to treatment and resulting in improved outcomes. However, going further than that, physicians must identify the unmet needs of their patients, potential areas where their patients may need greater support, and bridge the gap between the information that they are providing and patient-expected information. With introspection, empathic communication, and an acknowledgment of the patient's needs beyond symptom management, physicians can make the journeys of diagnosis, through treatment and toward recovery, easier to navigate for their patients.

Financial support and sponsorship

This study was financially supported by an educational grant by Abbott India Ltd.

Conflicts of interest

There are no conflicts of interest.



 
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