Communication in the medical field. The consequences of failing to do so.
Unfortunatly, this happens all too often
A book where the authors describes personal experiences and examples of careless doctors.
A limb can be lost, a mistake can always be made. A wrong pill can be given. Why?
Copyright © 2012
Communication plays a major role in every aspect of our lives every day. It goes back to the prehistoric age where grunting was a way to communicate to the multiple ways of the modern world. Whether it is personal as in relationships or professional, such as at work, there is no doubt that communication rules life and how you are perceived. Some careers however, have disastrous consequences if there is a lack of communication. The healthcare field is a major example of this. There is a whole entire network of nurses, assistants, doctors of the numerous branches all working together to save a life or communicate with patients. Communication is important with patients, with each other, and making sure notes and directions are followed through so errors don’t occur.
Good communication skills are a must in the medical field because of the impact that the doctor-patient relationship has on the outcome of the diagnosis. Sadly, there are many cases in which poor skills, such as being too arrogant to listen to a patient’s problem has led to deaths. A great example is when a patient arrives and there are 3 members taking care of said patient. This shows a possible of 3 conversations with any one of the members, but if the team consists of 5 members, the number of conversation increases to 10. Lastly, if there is a team of 10 members, the number jumps all the way up to 45.
It is easy to see how something could be miscommunicated or left out. In a retrospective review of 14,000 in-hospital deaths, communication errors were found to be the leading cause, twice as frequent as errors due to inadequate clinical skill. Further, about 50% of all adverse events detected in a study of primary care physicians were associated with communication difficulties (Coiera). This shows what that even if they do not know how to properly do their job, communication is extremely significant. Another study showed that lack of communication caused a 24% increase in errors from patient-doctor consultations.
Failure to follow up laboratory results, improper recording of information on out-patient charts, and medication dosage mistakes were also important causes of error, some of which have a communication element (Doctors and society). Doctors must communicate perfectly with patients, and their fellow colleagues but it is not just speaking and listening. Sir William Osler once said this concisely, “Listen to the patient, he is telling you the diagnosis”. Doctors often feel pressured by time limits and liabilities but even if something goes wrong, how they initially communicated can play a major difference. An analysis of 114 conversations and the tone of the surgeons and their patients showed that the tone indicated how likely they would be sued concerned vs. dominating. Talking and listening is basic but real communication actually comprehends someone. Doctors should explain key points back that the patient is informing them about. Studies have shown that patients do not remember much from consultation and then are anxious about what to do afterwards which drastically affects their outcome. Doctors who prescribe medicine often do not communicate to patients important details, things such as how long, how many to take, or possible side effects, possibly to save themselves from being incessantly badgered about them or not to worry the possible over reactive patient. The problem is when patients feel intimidated due to a lack of personal connection from their doctor; they do not follow it properly. This then leads to further complications.
Derjung M. Tarn, M.D., Ph.D., of the David Geffen School of Medicine, University of California, participated in an experiment that demonstrated this concept. He and his colleagues assessed communication by doctors prescribing new medications in 185 outpatient visits with 44 physicians in 1999. The patients were called a couple days before their appointments. The visits were then audiotaped and transcribed. The researchers coded the transcripts for the type of communication that occurred, based on five key recommended elements: the name of the medication, the purpose or justification for taking it, the duration of use, adverse effects and the number of tablets or sprays plus the frequency or timing of ingestion (Rivero). The results were a total of 243 new medications were prescribed at the visits including 46 cardiovascular medications; 42 ear, nose and throat preparations; 35 analgesics (pain-relieving drugs); 35 antibiotics; 21 dermatologic creams; 21 psychiatric medications; and 11 pulmonary medications. The doctors communicated an average of 3.1 of the five essential elements, indicating that 62 percent of the necessary information was conveyed. Physicians used the specific name for 74 percent of new prescriptions explained the purpose for 87 percent and discussed adverse effects for 35 percent. Thirty-four percent of the encounters included instructions on how long to take the drug, 55 percent on the number of tablets to take and 58 percent on the frequency or timing of dosing (Rivero).
The book Between One and Many, The art and Science of public speaking describes essentially what it is a doctor must do. It states that the process of listening is hearing, understanding, remembering, interpreting, evaluation, and then responding. This is what must occur. "This study demonstrates spotty physician counseling about new medication prescriptions," the authors write. "Although physicians educated patients more about psychiatric and analgesic medications, the overall quality of communication was poor even for these medication types and could contribute to patient misunderstandings about how and why to take their new medications. Physicians conveyed full medication dosing directions for less than 60 percent of all medications and informed patients about the duration of intake and adverse effects or adverse events only approximately one-third of the time." Medication errors are the most common type of miscommunication, harming at least 1.5 million people every year (Institute of Medicine of the National Academies).
This costs 3.5 billion dollars in damage and life. The committee that wrote the report had found that errors are common at every stage, from the prescription and administration of a drug to monitoring of the patient's response. Studies indicate that 400,000 preventable drug-related injuries occur each year in hospitals. Another 800,000 occur in long-term care settings, and roughly 530,000 occur just among Medicare recipients in outpatient clinics. (Institute of Medicine of the National Academies). This is due in part to a lack of proper communication skills.
Doctors need to work affectedly with patients to underline all important details so the medicine is successfully administered. Patients must also take awareness into their own hands and not be afraid to speak up as pharmacy screw ups can happen and the patient may end up with the wrong medicine because they look the same or sound the same. Writing charts properly also is an important form of communication to others. They provide all information to an incoming doctor or provide crucial tidbits of details in an emergency. In the event something wrong happens, which is a daily possibility when overseeing people’s lives, operating on them and such… records will be of utmost importance during trials, medical board hearings where a communicated detail could lead to the loss of a license or a fatal mistake.
Two of the most important places that communication must be relied properly in the medical field are during surgery and in the Emergency room. It is a matter of life or death, within even seconds depending on how efficient everything is. This is where the vital communication of paramedics comes into play. The paramedics alert the hospital with the stats of the patient so then they can be triaged (sorted) according to their situation. The 3 states are red, yellow, green, meaning emergent (life threating, heart attack, stroke, things needing immediate attention) urgent (not life threating but still needing fast attention) and non-urgent (patient can wait as long as needed). This is a very valuable system because the hospital can get everything prepared and ready to maximize the survival of a patient. An announcement will usually be made such as “adult trauma eta 5 minutes” or “level one trauma alert” so if needed, the ER, the O.R and all surgeons are available as soon as possible.
The second most important place where excellent communication skills are required is in the operating room. Lack of communication here can cause irreparable damage. A few examples are when a surgeon cuts, or takes out the wrong part of you. One study indicated that study concluded that there are 1,300 to 2,700 wrong-site procedures annually in the United States. In 2007, surgeons at Rhode Island Hospital operated on the wrong side of patient’s heads 3 different types. In one case, surgeons amputated the wrong leg of a patient and in 2002; British doctors removed the wrong kidney from a patient. Then, in July of 2007, doctors again in Rhode Island drilled into the wrong side of an 86 year old's head. A commission has set guidelines to improve communication such as verifying the surgery, the patient and the films. Patients can also take matters in their hands by speaking with your surgeon to make sure everything is correct.
Another tip is not to let the nurse or staff marks the site, tell the surgeons to use a marker to mark the site. It is imperative that patients also develop good communication skills so the wrong side operating mistake does not occur. Lastly technology is making it easier for the whole interconnected system of health care to transmit information quickly when most needed. Communication is vital here because not every doctor that is always needed is on call or easily able to be found in large hospitals. One hospital (Huntington hospital in Los Angeles) has taken the initiative by using an iPhone device that uses a voice over internet protocol rather that less convenient ways such as shouting orders across a busy ER. It also provides voice, text, and alarm services.
In conclusion, the entire health care system relies on communication. It can be the difference between life and death, prescribing the correct medication “Pharmaceutical companies must utilize near-perfect levels of communication in order to fully relay to their audience the importance of their medications, as well as the usage and physiological effects their drugs contain.”(Craven). Communication is important with patients, with each other, and making sure notes and directions are followed through so errors don’t occur.
Have you ever been the victim of miscommunication medical wise?
Have you ever been the victim of miscommunication medical wise?
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