Posts Tagged poor communication

It’s Your Life at Stake in the Hospital — speak up


Hospitalization is dangerous because of your illness and because poor communication increases the risks.  The simple fact is:  patients who speak up get better care than those who are quiet and unassuming.  As Gomer Pile’s sergeant would say:  I CAN’T HEAR YOU!

A recent article in Consumer Reports (CR) February 2015 “How Not to Get Sick(er) in the Hospital” puts a focus on communication in the hospital and is worth reading.

CR makes some good points:

  • You should be treated as a partner with the health care team.  As a partner you should expect explanations in language you can understand.  You should expect to know the plan, when and why tests are done and what results mean.  If x-rays or blood tests are done ask the doctor “what was the result”.
  • You should not be a silent partner.  If you are not getting information or do not understand what is going on you are risking your life.  Be courteous but speak up and ask questions and get ANSWERS not platitudes like “you just need some rest”.  Reasonable questions are things like:  “why do I need a CT scan”, “why am I in intensive care”, “why do I have a fever”, “what did you find during surgery”?
  • The doctors or physician assistants (PA) or nurse practitioners (NP) are in charge — the nurses are not.  If you have questions about medical or surgical issues insist on talking the doctor or PA or NP.  If you need an extra pillow or help getting to the bathroom talk to the nurse.  If you ask your nurse about the result of a test expect a vague answer “it’s just fine, get some rest.”  However, the nurses know what medications have been ordered and what is available “if needed or PRN”.  If you have a headache ask “what has the doctor ordered in case I have a headache”?  “nothing — well please call the doctor now since I have a headache”.
  • You need “your people with you”.  Family or friends should be present as much as possible and they should make contact with the health care providers both doctors and nurses — at very least each time they visit they should introduce themselves to the RN at the desk to see how things are going.
  • Who is available day and night?  It is a very reasonable request to know the name of the nurse in charge or the name of the doctor on call and to have them contacted if there is a problem.   If you are under the care of Hospitalists they are in the hospital 24/7 so it is very reasonable to request to talk to one of them at any time if needed — even on the phone, if that is adequate.  “They are busy” is sometimes true but not for hours at a time.  The nuclear option is to ask to speak to the “hospital administrator on call”  — a request that always gets their attention.
  • In any healthcare setting:  you are not out of line to point out that a doctor, nurse or therapist failed to wash hands or use hand sanitizer.  “Please wash your hands”. You do not want germs from other patients brought to you on caregiver hands.
  • Doctors will spend more time with you and answer more questions if they are comfortable — ask them to “have a seat”.  A room with no seats is unacceptable — that, you can tell your nurse.
  • Choose the right hospital in the first place.  Check the ratings of hospitals on the CMS website called “Hospital Compare”.  Driving a hour to a better hospital is absolutely worth your time and may save your life.  This is not like going to a fast food restaurant.  At this point in 2015 there is still a huge difference between hospitals — advertisements do not  mean a hospital is good.
  • Keep a written record — if you have a test write it down and leave a blank to fill in the result.  You really don’t need all the details — “you had a blood count and it was normal” is a fine answer.  If asked about your notes just say you have some difficulty keeping track of what is going on since you don’t feel the best — if you felt your best you would not be in the hospital!

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Communication Skills — you’re not listening

warning not listening

Laura Landro of the Wall Street Journal wrote an article “The Talking Cure” which appeared today (4/9/13).   She makes several good points:  1) 39% of patients feel doctors communicate poorly,  2) better communication improves health and reduces cost and  3)  there are ways to help doctors communicate more effectively.

These points are difficult for doctors to accept, especially the 39%.   Yet, the data is undeniable;  the oracle of Wall Street speaks truth.  Although, most physicians do not like to hear such comments from the lay media the message has been communicated well and with empathy.

Many years ago the Iowa Health System had doctors at one clinic participate in a communication study.   The patients were told that at the end of the clinic visit they would be given a test about what was wrong with them and what instructions they should follow.   A ton of bricks fell on the clinic.  The patients all had a pencil and paper and they would not let the doctors leave the exam room until the they had the answers to the impending quiz.  After all, the patients did not want the doctor to look bad.  The doctors tell the story of the experiment with fond memories and a feeling of gratitude for the lesson in communication.   The patients did pass their tests!

The Wall Street Journal article comments on the “4 habits” of good communication for health care providers:  1) create rapport  2) elicit patient views (and listen), 3) demonstrate empathy, and 4) assess patient ability to follow a treatment regimen.  It takes a lot of practice to think about the evidence-based practice-guidelines and simultaneously do those 4 things.

Doctors in training generally find video recording of patient interactions both  stressful and time consuming.   Video-based training takes time away from the operating room and clinic — but is that bad?   College communication majors become very comfortable with video training — they see themselves in the video recording and they use the sessions to hone communication skills.  Perhaps physician training programs should take a lesson from the department of communications.

Medical knowledge is a package within a wrapper.  That wrapper is communication skill which may be as important as the package itself.

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