Communication Failures Swamp Hospitals

In another case of proving the stunningly obvious, a new study has found that hospital patients and their physicians have dramatically different recollections of their conversations.  Here’s what was found, why it matters, and what individual patients–not just the notoriously slow-to-act medical establishment–can do about it.

doctor in vast hospital corridorAs reported yesterday by HealthLeaders Media, the study involved 89 patients and 43 physicians at Waterbury Hospital, a teaching center in Connecticut.  Conducting the study were the hospital’s chief primary care resident and the associate director of its primary care program (see our Aug. 3 post on primary care, below).  The prestigious Archives of Internal Medicine published the study report.

Among other findings, the study found:

  • Only 18 percent of patients could name their attending physician, although 67 percent of the physicians said the patients knew their names.
  • A mere 10 percent of patients said the doctors advised them about adverse effects of newly prescribed drugs, although 81 percent of physicians said they did.
  • Most patients (54 percent) said physicians did not discuss the patients’ fears and anxieties, although nearly all physicians claimed to have discussed them.

If you’re reading this blog, these results don’t surprise you.  You also may know that such lapses in communication are associated with worse outcomes of care, less adherence to doctors’ advice and medication orders, more malpractice complaints, and lower patient satisfaction.

But this blog isn’t dedicated to bellyaching.  Here, the idea is that patients themselves can act–in practical, reasonable ways–to improve communication with their physicians.  As Robert Kennedy used to say, citing George Bernard Shaw, “Some people see things as they are and say why.  I dream  things that never were and say why not.”

Three ways for patients and families to improve physician-patient interactions in hospitals are:

  1. If at all possible, have a family member or other friend or advocate present when the main physician comes to the bedside.  If this isn’t possible, ask the doctor to repeat any key information, then write it down as soon as the doctor leaves.  (Our book discusses advocacy in Section 7, “Bringing a Friend with You to the Doctor”).
  2. Be prepared with specific questions, preferably written down in advance.  Examples include: (a) “I’m not sure I have your name and what role you play in my care”; (b) “Can you go over the benefits and risks of this medication?” (c) “Are you interested in my concerns about my health?” (and when the doctor says, “of course,” present your concerns concisely).
  3. Use the nurses.  Ask them any question that’s troubling you.  If they can’t answer it, ask them to note your question in your chart, so the doctor probably will see it.

Take care.

Photo credit:  digital catAttribution.

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One Response to Communication Failures Swamp Hospitals

  1. Tom Ervin says:

    Another cute tale, when my father (94) had a recent bout of anemia, with some dark stool as well.. His GP geriatrist felt Very Sure this was internal bleeding (it is the way to bet) and wanted a prompt colonoscopy. I preferred to go slowly, discontinue his aspirin and try some iron and an improved diet. Doctor said he’d still want to schedule the first visit with the GI doctor.

    Dad says, “Heck, I don’t mind seeing my Eye Doctor!”

    So, the lesson was, the patient often simply misunderstands the doctor, whether in a hospital, or in an office, wherever. Glad I was there.

    The anemia cleared up and we dodged the colonoscopy, for now.

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