Communication The Big C - Crozer-Keystone Health System - PA

Communication - The "Big C"  December 2010

How you communicate with your patients really does have an affect on patient care. Continuity of care and quality of care are dependent on what you say, how you say it, what you hear, and how you respond. Many medical errors, including misidentification of patients, are the direct result of a miscommunication or omission of communication.

Communication is a two way street. Talking with patients without really listening to their complaints, concerns, or questions can lead to a wrong diagnosis or plan of care. The exchange of information between patients and physicians is critical to the relationship. If the patient provides inaccurate or incomplete information then quality patient care can be compromised as the physician is working with misinformation. It is important to flush out the discussion so there is unison in what is being said. For example, it is really important for questions to be framed so that it can be answered specifically. For example, “how many drinks do you consume in a day?” will allow for a concrete answer as opposed to someone stating they don’t drink a lot when they may have five drinks a day. 

On the reverse side, if the physician provides vague, confusing, conflicting, or technical information/directions beyond the patient’s capacity to understand then quality patient care may be compromised, as the patient will not accurately follow up with instructions or care. For example, to tell a patient to take a drug twice a day does not provide enough clarity as to specifically when to take the medication -breakfast, lunch, dinner, or bedtime. Often patients are labeled as noncompliant because they did not take their medications appropriately when in reality there was a miscommunication as to the need for the medication, when to take the medication, or the consequences of not taking the given medication.    

Mutual trust and respect is the foundation for a patient/physician relationship. The patient needs to understand his/her responsibility with respect to communicating and articulating his/her concerns. Many patients are anxious and/or intimidated by physicians or healthcare professionals. They may be reluctant to ask questions or clarify assumptions. Low literacy also plays a role. With this in mind, you must:

  • Take the lead to provide a sound communication framework. The key is to provide simple, concrete questions and/or directions. Ensure the patient understands and ask him/her to recap or do a return demonstration. They more they understand not only the instructions, but the reason behind the instructions (i.e., why they are taking a given medication) the more likely they will be compliant and possibly reducing medication errors or returns to the ED.  
  • Reinforce the patient’s sense of control.  Ensure they are involved in making decisions regarding their care. They more they “buy into” their treatment plan the more likely they will be compliant. Additionally, the more a patient understands the scope of their illness the more realistic their expectations are.
  • Actively listen. Sit down and maintain eye contact with patients. Your observations may be just as critical as what the patient is telling you. Your individual attention demonstrates respect of their time and issues. One physician reported when he took the patient chart into the room and documented there, his patients reported being more satisfied with this care because they felt he spent more time with them.
  • Take responsibility for special communication challenges such as language barrier or communication disabilities. Remember, it is the patient, barring competency issues that you have the duty to communicate with. 
  • When there is an undesired outcome, regardless of the reason or severity, the patient needs to be informed of the situation and plan of action. At the time of the event, it may not be clear as to why or what happened, but it cannot go unrecognized. This includes both the known and expected complications. Disclosure of any event is part of the continuum of a dialogue that starts with informed consent.   

Some of these are the very issues that have resulted in a strained patient/physician relationship or subsequently initiated a lawsuit.

When patients perceive poor communication or sense there is the lack of communication, they believe the physician is “hiding something” or ignoring them, and they may seek litigation as a way to get answers. For additional information regarding communication call risk management.

Communication - The "Big C"  Questions and Answers December 2010

Communication - The "Big C" Questions December 2010 

Communication - The " Big C" Answers December 2010

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