Physician Communication & Patient Safety: What’s The Connection?

As physicians go about their extremely hectic days trying to balance patient care and an ever-increasing administrative workload, it can be easy to forget that individual patients have unique needs, expectations, and their own healthcare “story.” It may seem like the next chronic wound we see is something we have seen many times before, but for the patients, even those who may be living with multiple wounds, there is no “typical” wound. And while we all may set goals for spending as much one-on-one time with patients as possible, our time to speak with them may come down to a precious few minutes. Those fleeting minutes are very often the most important part of that individual patient’s day. Patients may have been waiting hours, days, and weeks to see us, and they may be expecting a lot of information and guidance to be given in that brief amount of time. It is absolutely crucial that doctors settle into a communication “zone” that provides the attention that all patients deserve with a level of communication that empowers them to be active in their wound care and helps to keep them safe from complications such as infections and falls.

Being a poor communicator should rank right along with medical errors and near misses when it comes to traits that physicians never want to be identified by. This article will discuss the types of negative feedback typically shared among patients who “give voice” to their concerns related to physician communication and
offer basic suggestions on how to avoid communications challenges.

“My physician was
too rushed.”

A common gripe for sure. Yes, seemingly all doctors are rushed, and healthcare is a frantic environment by its very nature. However, no doctor should ever give away his or her hurriedness through body language or tone of voice. Displaying a calming presence and assuring the patient that you have all the time in the world (even when you don’t) is the noble aspiration. It is often said that the greatest gift you can give to anyone is the purity of your attention. That sentiment is most true for the doctor who is caring for patients. 

What to do: Ask patients if they have any questions, and answer them. Also, give them an outlet to provide follow-up questions. Consider appointing someone from the office staff to be a point-person for patients to call with questions that can be relayed to the physician(s). 

“My healthcare clinicians do not speak with each other.”

This phenomenon is endemic. Think about how confusing it must be for patients who get different (maybe conflicting) information from their clinicians — sometimes during the same visit. Examples can include variations in discharge instructions, follow-up appointment dates, or, scariest of all, conflicting diagnoses and prognoses. 

What to do: Have collaborative conversations when possible. Review all documentation and ensure there are no inconsistencies.

“My doctor acted dismissively.”

There should be no such thing as a bad question or thought when it comes to patients, even if it is that patient who comes off as “Dr. Google” and cites misguided information as evidence. This should be considered part of the job for any clinician.
After all, it is probably in everybody’s best interests for the patient to have an extreme assumption about their health condition as opposed to someone who is nonadherent. All patients have a right to ask questions and it is the clinician’s job to act professionally, calm, and understanding at all times.

What to do: Recognize a teaching moment when you see one and educate the patient appropriately. If a patient truly is noncompliant, consider implementing a patient “contract” that states the physician will refer the patient elsewhere if they are not following the care plan appropriately. 

“My doctor didn’t
explain things fully.”

In the healthcare “bubble,” it can be all too easy to assume that our patients are completely health-literate and understanding of all the technical jargon that is part of our everyday language. Knowing the appropriate wording to use according to one’s education level, however, is something that can usually be learned for those clinicians who are paying attention to certain cues and demographics. Many seasoned physicians use highly complex medical terminology instead of having a conversation with the patient. 

What to do: Ask the patient to explain, in their own words, the information provided to them about their care and, if they are unable to accurately do so, continue to educate them.  

“The doctor didn’t
seem to care.”

This is just about the worst thing that any patient can ever perceive after an interaction with a physician. The issue is not so much questioning the reality of a physician’s dedication, but how he or she comes across when communicating with patients. The first thing that any doctor must do to ensure that this is never a lasting impression that any patient has is
simply to make prioritize listening more when it is really time to do so. That’s always the very first step in portraying empathy and compassion in any discussion. Of course, providing verbal education is important, but physicians should be able to recognize when to pick the right moments for listening to and speaking to the patient. 

What to do: Ask the patient, “Did I answer all of your questions?” before they are discharged. 

Summary

Any healthcare setting is going to be an emotionally charged environment. Remember, effective communication lies at the core of all good medical care. That doctor-patient moments that we have together is a point in the day that no regulator, administrator, or computer should interfere with. n

Suneel Dhand is a board-certified internal medicine physician based in Boston, MA. He grew up just outside London before moving to the United States after completing medical school. He can be followed on Facebook and Twitter @SuneelDhand