What to say when the wrong thing was said

This week on #hcldr we welcome special guest host – Sarah Greene @ResearchMatters. Sarah is an active participant in the #hcldr community and has some amazing insights into a variety of healthcare issues. She has chosen a fascinating topic for this week’s discussion – communication errors in healthcare.

Blog post by Sarah Greene

Good intentions notwithstanding, communication is notoriously hard in healthcare. Visits might be rushed, healthcare jargon may be mystifying, and practitioners may not recognize when they’ve said or done the wrong thing. While we’re all familiar with classical adverse events such as wrong site surgery or medication dosing errors, there is a more insidious phenomenon of adverse communication events in medical care, both real and perceived. The range of adverse communication events is broad a may include patient complaints, conveyance of incorrect or incomplete information, or the manner in which a provider communicates (“bedside manner”).

An extensive body of research has explored the complexity of communication in a healthcare setting, and what happens when something goes wrong. Gallagher and Levinson have looked at concepts such as disclosure of medical errors, and the effect of apologies in the medical care context. Among their studies include a body of inquiry about the impact of apology. Bismark and colleagues published a significant discovery that among Australian physicians, 3% accounted for 49% of the patient complaints. This research team is now studying whether a pattern of past complaints can predict a future event.

Spurred by this work, others have looked at more specific instances of communication failures in the healthcare context. I was fortunate to be part of a research team in which we studied the impact of communication breakdowns in cancer care. Perhaps not surprisingly, we discerned that communication breakdowns have the potential to induce significant emotional and psychological harm, exacerbating an already challenging time for a person dealing with cancer. Moreover, sometimes the communication “error” is perceived, and the healthcare provider may not even recognize that something went wrong. Consider the example of a woman receiving a phone call from a radiologist at 4:30 on a Friday afternoon in which she’s told that a breast lump looks suspicious and that the woman needs to follow up with her doctor on Monday. The radiologist fulfilled his role of conveying information to a patient, but may not appreciate the anxiety and emotional wallop this could have. One can readily see how the patient on the receiving end of this phone call would not only be shocked, but also forced into a holding pattern of anxiety and despair from this news that effectively upends her life.  Another scenario we encountered in our work was the surgeon telling a patient, “We got it all,” where the patient assumed she was cancer free, and perceived she didn’t need adjuvant treatments (chemo, radiation). From the surgeon’s standpoint, this may be technically correct, but the patient did not grasp the fuller picture of cancer treatment, and was distressed to learn that she then needed six weeks of radiation.

Even as we find a light on these communication problems and care, patients dealing with diagnosis and treatment are ill-equipped to deal with them in real time or after the fact. We found that the patients simply wanted to focus on getting well, and even when a significant communication breakdown occurred, few were inclined to pursue action at the time of the event.  However, we also found that these affected patients were keen to ensure that what happened to them did not happen to other patients, and offered many possible solutions and opportunities for improvement. Nor did they want to be perceived as “difficult.” One cancer patient we interviewed described her oncologist as her “lifeline.”

So how do we address these communication challenges in a way that preserves the doctor-patient relationship.  What about within the health care team itself?  Does a provider want to be called on the carpet for a cold and uncaring communication incident?  Moreover, whose responsibility is it to tactfully identify communication errors on the health care team?

Join the #hcldr weekly tweetchat Tuesday September 27th at 8:30pm ET (for your local time click here), when will explore these communication intricacies together:

  • T1 Beyond classical adverse events like wrong-site surgery or incorrect medication dose, adverse communication events can also occur in healthcare. What types of troubling or harmful communication issues have you experienced that affected your care?
  • T2 Perceptions vary. Patients may perceive something as a problem, whereas the healthcare team just sees business as usual. How can patients help clinicians understand that perceived problems are as important as actual problems?
  • T3 What steps can help (quickly) establish rapport between health care practitioners and patients so that if communication goes off-track, each is better equipped to address the problem or perceived problem?
  • T4  If nurses or other care team members observe poor communication between a physician and patient, what is their obligation–how should they attempt to address the situation?

More about special guest Sarah Greene

Sarah Greene, MPH, is the Executive Director of the Health Care Systems Research Network, a voluntary coalition of researchers embedded in care delivery systems. Sarah’s 25-year career in health care research includes PCORI, where she was an Associate Director for Methods and Infrastructure, Director of Strategy at Group Health Cooperative, and a faculty member at Group Health Research Institute. Her research has included patient-centered communication, health literacy, quality of cancer care, and approaches to optimizing multi-institutional collaborations. Sarah is a champion of consumer/patient engagement and has served as the Chair of the Washington Health Alliance’s Consumer Engagement Committee since 2008. An accomplished writer and speaker, Sarah has presented to the National Academy of Medicine, American College of Cardiology, International Society of Pharmacoeconomics Research, and numerous other organizations. She has authored more than 60 manuscripts, many focused on development and implementation of multicenter research, and she created ResearchToolkit.org, which aggregates publicly available resources related to conduct of health research studies. She received both her MPH, and a BA in Psychology and Italian from Indiana University.

References

“Speak Up! Addressing the Paradox Plaguing Patient-Centered Care”, Mazor, Smith, Fish and Gallagher, Annals of Internal Medicine, 3 May 2016, http://annals.org/article.aspx?articleid=2490535, accessed 23 September 2016

“Identification of doctors at risk of recurrent complaints: a national study of healthcare complaints in Australia”, Bismark, Spittal, Gurrin, Ward and Studdert, BMJ Quality and Safety, 10 April 2013, http://qualitysafety.bmj.com/content/early/2013/02/22/bmjqs-2012-001691.short, accessed 23 September 2016

“Toward Patient-Centered Cancer Care: Patient Perceptions of Problematic Events, Impact and Response”, Mazor, Gallagher et al, Journal of Clinical Oncology, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383179/, accessed 23 September 2016

Image Credit

Scrabble Tiles and Scrapbooking Letters 3 – Barbara Mazz https://flic.kr/p/83xbsF

 

 

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