Page 5 - Mecklenburg_Medicine_July-August-2019

President’s Letter
Communication
By Elizabeth B. Moran, MD
“The single greatest problem in communication is the illusion that it
has taken place.” distracted from the very beginning due to baseline anxiety over
T— George Bernard Shaw
his famous quote by the Irish playwright seems to ring
truer today than it did at the peak of Shaw’s career. It is they may only be able to express “issues” as their problem,
hard to think of important interactions between people
that are more crucially linked to good communication
than those in health care. In the clinic setting, this starts with the
first staff member-patient interaction and continues in increments
throughout the flow of the visit, peaking in the exam room. There,
the physician or care provider synthesizes the information he or
she has gathered into a plan that is intended to start the patient on a
road to a solution. If communication is on point, this is an extremely
satisfying interaction for
While most people both parties. However,
believe communication due to the complex nature
of health care — the
needs to change, few hodgepodge of electronic
see it as their role. messages, centralized
scheduling, time pressure,
Confused and frustrated, inconsistent interfaces
people feel powerless between EMRs, insurance
authorizations and
to change. approvals — it frequently
goes off the rails. If the
patient does not follow
the plan, what often happens is the plan-maker/communicator
is frustrated, while remaining confident in his or her ability to
communicate. The patient remains equally confused, believing only
that nothing was gained.
According to a study at the University of Kansas School of
Medicine in Kansas City, patients’ reports of their understanding of
the post-discharge information and instructions they received was
significantly less than what their doctors perceived. For example,
while physicians thought 89 percent of their patients understood the
potential side effects of medications, only 57 percent of patients said
they understood.
Anyone who has spent any time in an office or practice setting
knows the feeling of communication mismatch all too well. Who
among us has not entered a patient room feeling (based on the
information we quickly review ahead of time) that we already
have an idea what is going on, only to find a completely different
scenario? Or, alternatively, we also might have absolutely no
information available? For example, I not infrequently have faced
a new patient with the chief complaint of “issues.” I think much
of this is related to the modern input fatigue in society. Generally,
we (patients and physicians alike) are constantly inundated with
“messages” and communication seeking attention. Think about
it from this perspective: Patients likely are overwhelmed and
the problems they are having, frustrations over scheduling, driving
to an unfamiliar place, navigating parking and signage, check-in
and medical intake forms on top of not feeling well. Consequently,
or are disorganized enough by that time that the physician
misunderstands entirely. Physicians also have been inundated
with electronic and human messages seeking attention of varying
importance all day and are somewhat overloaded at baseline.
Ideally, physicians would be able to invest the time and effort to
dissect all of this, but in reality, it is all too unlikely, given time and
volume pressures, that we can ever understand messages in exactly
the way the communicators meant to be understood.
Also supported by literature is how a physician communicates
information to patients is as important as the information being
communicated. Patients who understand their doctors are more likely
to acknowledge health problems, understand treatment options, modify
behavior accordingly and follow medication schedules. In fact, research
has shown that effective patient-physician communication can improve
patients’ health as quantifiably as many drugs.
While most people believe communication needs to change, few
see it as their role. Confused and frustrated, people feel powerless to
change. This is further exacerbated by a constant demand for better,
and more, communication without explanation of what, how or why.
This is an uphill battle in the current landscape due to our many
pressures and limited time.
Here are a few actionable suggestions. Remember, in the midst of all
of the distractions, stress and chaos, the core goals of an office encounter
with a patient are things that can’t be done by a computer. Slow down
a bit when entering the room, greet the patient as a friend, take time to
listen fully to the complaint in their own words and be candid about the
condition. Emphasize the benefits of following your prescriptions at
least as much as you stress the negative consequences of not doing so.
Give positive feedback for their efforts, even if incomplete. Accentuate
the positive where appropriate and treat setbacks in the course of
their treatment as bumps in the road that you can work on overcoming
together. Be understanding of patients and they likely will be more
understanding of you.
These are truisms every physician learned in medical school, but
in the reality of daily medical practice, especially with the increasing
and often unnecessary burdens put on physicians, they tend to fall by
the wayside. Make it your goal to renew your commitment to them
for a week and gauge the results. The benefits of maximizing mutual
patient-physician trust and respect is the best possible anti-stress
strategy, because it brings us back to what attracted us to clinical
medicine in the first place.
Mecklenburg Medicine • July/August 2019 | 5