Communication with patients is a problem. How do we fix it?

In my practice of facilitating cancer support groups, all I do is listen to patients and their families. Consequently, I hear much about the nature of their care. They generally speak favorably about its technical aspects, and indeed these are often awesome. But when they complain, it’s uniformly — and I mean one hundred percent — about communication.

One man has been trying to get an appointment with a pulmonologist for several weeks now. The required referral from his primary care doctor was sent long ago, by fax and also by snail mail, yet the specialist’s office claims it wasn’t received. When the man phoned to check on progress, he told me, the receptionist barked, “No. Didn’t I tell you I’d call you when we got it?” So he hasn’t secured a referral yet, only a dose of antagonism.

You might think that the ability to, say, transplant hearts might also mean we can transfer a record across town, but apparently we’re not as advanced in that area. I hear other, similar stories, too. For example, some medical offices’ phone recordings are poorly designed or corrupted.

One frustrated patient asked me to phone his oncologist to see for myself. When I did, I was left stupified; there seemed no way to reach a human or even leave a message. Some nurses and assistants fail to introduce themselves to patients, which increases the patients’ feelings of disorientation and vulnerability. One nurse, about to take a wheelchair-bound patient’s vital signs, asked the patient’s wife, “What brings him in?”

Having heard such tales for decades, I could go on. The mass of non-communication and miscommunication is disheartening, especially given our technological capabilities, but what bothers me as much is the fact that more often than not, physicians are unaware that their phone system is a mess, that staff members might actually be abusing patients, or that their medical record flow is a train wreck.

I see only two remedial alternatives. One is for doctors to become patients. A sick internist friend who found himself at the other end of the stethoscope told me, “I can’t believe the system is this screwed up.” The other alternative, doctor, is for you to take a few minutes and note how your staff behaves with patients, and call your office number to see how long it takes to reach you, if you can reach you at all.

If we’re to truly reform health care, we can’t limit improvements to finances. We need to renovate how human beings in this system relate to one another.

Jeff Kane is a physician and is the author of Healing Healthcare: How Doctors and Patients Can Heal Our Sick System.

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