Communication is critical to success in medicine. Our patients depend on us to help them understand their disease and the risks that it may pose. In previous blogs I have commented on how vital effective communication can be in determining outcome — much of my writing has focused on the success associated with outpatient doctor-patient relationships. We now know that when doctors and patients engage, patients become invested in their own health care and are more likely to comply with lifestyle modifications and take medications as prescribed.
However, when a patient is ill and hospitalized, a entirely new level of complexity is added to the communication mix. The role of patient places one in a difficult position — you lose control, you lose your individuality and you may often become frightened due to the uncertainty of the clinical outcome. The dynamic of communication in the acute hospital setting may be quite different in that the patient may be interacting with a new team of health care providers that they have no previous relationship with.
In addition, disease related factors such as pain, fever, and sedation may play a role in a patient’s ability to comprehend what is being said to them at any given moment in the hospital setting. I can now speak to this from personal experience — this last week I became an unexpected patient. I spent several days navigating illness and a complex yet compassionate hospital system. My experience as a patient has inspired this particular blog — and has inspired me to become a more effective communicator in my practice.
Recently in the New York Times, two articles were published that discussed different aspects of physician communication with patients. Both pieces are important and should be read and carefully digested by both patients and physicians (as well as any other health care provider).
In the first article, author Theresa Brown discusses the discussions that physicians and other health care providers commonly have with patients during a time of illness. Particularly in the hospital, teams of providers at all levels enter a patient’s room and discuss all aspects of the case (both with the patient and amongst one another.) It is interesting to realize just how much of what is said during these encounters is “lost in translation.” During periods of illness, even the most educated and medically sophisticated patient can have difficulty comprehending exactly what the medical team is trying to convey. Pain, worry, and emotional fatigue may all play a role in a patient’s inability to comprehend the clinical situation, the possible diagnoses, the testing required and the treatment plan.
In a separate article, authors Gilligan and Sekeres explore whether or not there are effective ways in which we may be able to teach better communication skills to physicians in training. Several studies have demonstrated that no amount of training will convert an introvert to an extrovert communicator — however, communication training may open a health care provider’s eyes to the profound impact that their interaction with patients may have on outcome. Once a provider is aware of the impact communication may have, they are more likely to be able to better engage patients and engage in a more effective way.
During my unexpected role as a patient this week, I often did not understand what to expect — even with my years of medical training and experience. I could only focus on my symptoms and my fear of the worst possible outcome scenarios. During my patient experience, I interacted with many physicians, nurses and other team members — ER doctors, specialists, imaging technicians, transporters, etc. My particular providers were very compassionate and spent a great deal of time attending to my needs and explaining their thought processes, differential diagnosis and treatment plans.
However, I was unable to process most of what was said. I was often distracted by pain and my ability to assimilate and comprehend information was limited by the sedation I had been appropriately given. Ultimately, emotion and fear would come to the forefront and dominate my thoughts, further limiting my ability to actively and effectively communicate with the medical team managing my hospital care. My caregivers were dedicated and wanted only the best outcome for me and my family.
I was often confronted with large amounts of clinical information and I began to hear only pieces — I would latch on to particular words such as surgery and potential complications and would lose focus — no longer able to follow the conversation. My ability to think rationally and effectively process clinical information (as I would as a physician) was severely impaired. I can only imagine what the experience would have been like for a non medically sophisticated person.
Fortunately, as the week progressed, my condition improved and I was ultimately discharged from the hospital. My physicians and nurses spent time later in the week making sure that I understood what had happened to me and what the next steps would be. My hospital stay and treatment provided me with new insights into the patient experience. I now am able to envision ways in which I can improve my own interpersonal skills with my hospitalized patients — by actively taking time to make sure that each patient understands and truly hears what is being said to them.
From my experience, one of the keys to promoting understanding is to provide time for questions — from both patient and family — during the inpatient hospital visit. My caregivers did this often and it did provide comfort and some semblance of control (as much as one can have in an ill fitting hospital gown.)
In addition, providing small, easily digestible bits of clinical information at several points throughout the day seemed to improve a patient’s ability to process and comprehend their condition, treatment and prognosis (at least it did in my case). Although is is not practical for the physician to make multiple stops to the patient room throughout the day, phone calls for updates by the treating physician and visits by other providers such as nurses, PAs and NPs can make a difference in patient understanding and comprehension.
As Ms. Brown rightly states in her Times piece, hospitals and medical care are well focused machines — most providing efficient, quality life saving care. We must remember, however, that we are treating patients — human beings with emotion and fear that can certainly impact a disease process. We must take time to ensure that we not only provide the high quality efficient care but we also are able to care for the human being lying in the bed in the awkwardly draped hospital gown.
I am glad to be home from the hospital. I am grateful for the wonderful care and compassion that me (and my family) received from many over the last week. I am happy to be sitting outside in the sun writing this blog today. I am excited about the opportunity my experience as a patient has afforded me. I will take what I have learned and apply it to my practice — I hope to work every day to improve my communication with all of my ill and hospitalized patients.
Most of all, my experience has reminded me that although medicine is the application of science to the treatment of ailments suffered by human organisms, it is the human that really matters. Our patients are people — they are often alone, frightened, emotionally exhausted and suffering. We must all engage them in a way that best facilitates their understanding of their situation and focus equally on both treating a disease and treating a frightened person lying in the bed before us.
Kevin R. Campbell is a cardiac electrophysiologist who blogs at his self-titled site, Dr. Kevin R. Campbell, MD.