Communication is the core of many health care problems


Despite all the challenges that we, and every other nation, faces with their health care systems, it’s worth remembering that in the broader picture we really have progressed in leaps and bounds over the last several decades. How easy is it to forget that only 100 years ago the average life expectancy was in the 20s to 40s in most parts of the world (just as it was for nearly all of human history). The simplest of infections could easily kill you, there were no vaccines, and the most natural act of childbirth was a highly dangerous and precarious process for any mother to go through.

Today, we take for granted that all of our health care interactions will be safe and successful, and that’s also a testament to how high we’ve set our standards. In the modern and technologically advanced system that we work in, with cutting edge medications and treatments, the other side of the coin is that it’s also easily forgotten that health care is still very much about human beings and real people.

If there’s one common thread that links everyone who has ever needed medical attention, from those first cavemen to our current generation, it’s just that. Hippocrates, the father of medicine, said over two millennia ago: “It is more important to know what sort of person has a disease than to know what sort of disease a person has.”

It was true then, and it’s just as true today. Another one of my favorite quotes from Hippocrates is that physicians should, “Cure sometimes, treat often, comfort always.” This is something that no physician should ever forget as they go about their daily routine and what can seem like “busy work.” Every interaction is sacred, and the trust placed in us and our decisions is humbling. Communication, empathy and compassion with patients and their families is paramount, and the most important part of what we do. Racking your brains out, ordering a battery of tests, and coming to a potential diagnosis means little if that information isn’t properly communicated.

As a physician who has worked in several different hospitals up and down the east coast, and also internationally — from major academic institutions to more rural outposts — this has been universal no matter what the patient’s background, demographic, educational level or social class. We as physicians need to maintain the highest standards when it comes to communicating clearly the diagnosis, treatment options, and prognosis to our patients.

By the same token, as we look to improve quality and outcomes in health care, and administrators bang their heads together to try to figure out how to do this, communication is actually at the core of many of the problems we face. Not just with patients, but between health care professionals too. The fragmentation in our system is undoubtedly made ten times worse by inadequate communication among physicians, nurses, case managers and all manner of other professionals at the front lines of medicine. In hospitals, this applies particularly to medically complicated patients who are seeing several different specialists during their stay, aren’t given crystal clear instructions on discharge, and don’t get the quick follow-up they need. The downstream effects of this are what cause excessive testing, readmissions and even unrealistic expectations. Needless to say, the effect on health care costs is enormous.

Years ago, Bill Clinton’s campaign strategist James Carville coined the phrase, “It’s the economy, stupid,” to simplify the reality of what drives election results. To apply the same quote to health care, so that we don’t lose the forest for the trees as we search for overly complicated solutions to often not so complicated questions.

Instead of looking towards expensive answers involving things such as more administrators, costly information technology, new apps, and mountains of bureaucracy, just remember that with lots of health care: It’s about communication, stupid.

Suneel Dhand is an internal medicine physician and author of three books, including Thomas Jefferson: Lessons from a Secret Buddha. He is the founder and director, HealthITImprove, and blogs at his self-titled site, Suneel Dhand.

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