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Posts tagged with "communication gaps communication skills trainig"

Communication, a Challenge to Participatory Medicine

Communication or the exchange of thoughts, opinions, or information by speech, writing, video or signs that include body language continues to be a hotly debated,   difficult to execute practice in healthcare. There have been hundreds of studies over the years that reinforce the correlation between good communication among patients and providers and improved health outcomes. Health information gathered from patient interviews, laboratory tests, face-to-face exams email interactions, and e-visits, is essential to guiding strategic health behaviors of patients and providers, enabling them to collaborate on treatment decisions and ongoing health monitoring. Participatory medicine depends on the availability of health information to all members of a care team.

However, low expectations regarding teamwork and communication have for many years encouraged a culture where teamwork and collaboration are difficult to achieve. It’s ironic that ever since the publication in 2000, of the original IOM report, To Err Is Human,  healthcare  organizations have worked hard to improve  patient systems and patient safety  but most have failed to address poor communication habits that  would enhance  information sharing. It is clear that when health care professionals do not know what their colleagues are doing to manage a patient they are seeing, and when patients do not have the opportunity to share the information held by their providers,  all the patient safety rules in the world cannot compensate.

During the past 25 years there has been a lot of talk about the need for training medical students in communication skills. It was not until June, 2004, that a communication skills component was added to the U.S. Medical Licensing Exam to test medical students on their ability to gather information from patients, perform a physical examination and communicate their findings to patients and colleagues.

 The Agency for healthcare Research and Quality has developed CAHPS,   (Consumer Assessment of Healthcare Providers and Systems) a public-private initiative to develop standardized surveys of patients’ experiences with ambulatory and facility-level care. These surveys ask consumers and patients to report on and evaluate their experiences with health care in areas such as the communication skills of providers and the accessibility of services. The results of these surveys help determine where there are strengths and weaknesses in the system.   CAHPS also publishes guidelines for patients to help them understand the important communication skills they need to improve their ability to share information with providers. These guidelines include four areas:

  1. Record Sharing- patient access to the electronic health record
  2. Patient Question Lists – what to ask the doctor at a typical visit
  3. Feed Forward – a questionnaire filled out by the patient prior to receiving care
  4. Coached Care- teaching patients how to ask the right questions and be more assertive during a face-to –face visit with their physician

Other organizations including many hospitals and medical centers strive to enforce good communication habits among their physicians and encourage their patients to participate in their care and collaborate with their providers. Many payers work with enrollees to help them understand communication skills needed in their increased participatory role. 

As e-Patients become more invested in the partnership model they have to improve their own ability to share information. Health care consumers are inherently well-equipped to judge the ability of their clinicians to communicate with them effectively. Helping them understand when and how to ask the right questions and be more aggressive about speaking up when they do not understand an explanation is a leap forward toward better communication for better healthcare.

Dealing with Guilt, Isolation and Fear when Adverse Medical Events Happen

I recently attended a forum entitled Medical Error: The Power of Apology, Action and Forgiveness. Paul Levy, CEO of the Beth Israel Deaconess Medical Center in Boston (BIDMC) led off the program with a discussion of his initiative to make public all occurrences of preventable medical events at the BIDMC. Levy pointed out that hospitals are the fourth ranked health hazard in the nation! He recommended a “laser-like” focus on quality that engages all stakeholders in healthcare that might help ameliorate this outrageous statistic.

Dr. Tom DelBanco, M.D., Professor of General Medicine and Primary Care, at Harvard Medical School was the lead speaker at this forum. For over 30 years Dr. DelBanco was Chief of the Division of General Medicine and Primary Care at the BIDMC. He is also a founding Chair of the Picker Institutes in the USA and Europe, an organization that documents patient experiences with care and works with patients to improve health services.

Dr. DelBanco reminded us that patients or care givers advocating for patients who have been injured in the health care system often suffer guilt, fear and isolation when an adverse event occurs. These emotions are equally shared by the doctors and nurses who have been involved in medical errors. Dr, DelBanco pointed out that disclosure and communication could effectively help resolve the emotions that surface after these occurrences. His talk was followed by two patient presentations whose horrific experiences with medical errors were a powerful reminder of how things can go wrong without intent or provocation and how those wrongs could have been made tolerable if the doctors had admitted their error, showed compassion and maintained communication with their patient.

As an individual whose career has been devoted to understanding communication, teaching communication skills and using communication tools, I see a unique opportunity for healthcare institutions to attack the syndrome of emotions resulting from an adverse medical event by: (1) implementing high standards-based quality measures that help to insure that everything humanly possible is in place to avoid these medical errors and (2) providing training to healthcare professionals in the elements of communication. In times of stress, when guilt, isolation and fear overtake the individual who realizes that a mistake has been made, the tendency is to avoid all contact with the problem.

In the digital era we run the additional risk of increasing the communication gap between patients and doctors as one-on-one interactions are replaced with virtual interactions. Open communication will not come about by itself. A deliberate and thoughtful plan is needed to help healthcare staff learn how to explain these situations and talk through these issues with patients. Encouraging those difficult conversations will go a long way in making everyone feel better about themselves and the situation.