The Importance of Patient Communication
While covering the inpatient service a few weekends ago, a nurse called to inform me that a patient's mother wanted to talk before her daughter was discharged.
When I asked if there was a specific question or concern, she replied, "Mom doesn't understand what happened in the procedure yesterday and she wants someone to explain it to her."
I told the nurse I would be down shortly, and after printing a few diagrams of the patient's pre- and post-surgical anatomy where an expired stent was found, I went down to the unit. I reviewed the patient's prior surgeries and discussed her upcoming palliation.
We talked about the pulmonary artery stenting procedure that her daughter had undergone the day prior, and discussed additional transcatheter procedures she could be expected to undergo in the future. The mother thanked me and asked that the nurse bring in her discharge paperwork.
As I reflected on this encounter, I thought about the many different permutations of this same situation that I have faced during my relatively short medical career. I have seen the dazed look on parents' and patients' faces when they interact with physicians.
I have often thought to myself, "This person doesn't understand a word that is being said." On occasion, I have gone back to the family to answer their unspoken questions – the ones they asked with their eyes only. I have tried to say things differently and remember that I am often giving really terrible news to an audience who may be distracted, shocked or overwhelmed.
Many medical school curricula now include standardized patient interactions to aid students in developing history-taking and physical examination skills. These encounters also provide invaluable opportunities for students to receive feedback on their bedside manner and communication.
While many young physicians struggle with converting medical speak into layman's terms, physicians at all levels can benefit from similar instruction. In fact, it is often the astute, highly-skilled physician who has been practicing his or her craft for many years who finds it difficult to translate into regular English words and concepts, which have become his or her normal way of speaking.
The mother in my most recent encounter spoke up. She was brave enough to admit that she did not understand and thought it was important that she demand an answer before leaving the hospital. However, many families are not as courageous and some are not as outspoken. Many of them do not consider it important enough to refuse to leave the encounter without understanding the medical jargon we use.
We must do better.
The average American reads between a seventh- to eight-grade level. This reading level may be even lower when they are receiving bad news. It is important for us to ensure that we speak to them in a way that they can understand.
One of my favorite attendings uses multiple analogies when speaking to parents and patients about their diagnoses. He uses the concept of a car running without gas to describe vasovagal syncope, and draws each patient a heart diagram that looks like a house with windows and doors for the chambers and valves. He teaches parents about their child's pre- and post-surgical anatomy and makes sure that as the patient gets older, they too can talk about their diagnoses.
Medical literacy is our responsibility. It takes us many years to master medical jargon – and we must not expect families to achieve the same following a 30-minute visit. It takes repeated review, often providing information in increments so as not to overwhelm them.
When we fail to communicate effectively with our patients and fail to deliver information in a way they can understand, we drive them to search for this information from other (often inaccurate) sources, such as the internet.
Let's take the time to teach patients about their diagnoses. Let's take the time to teach them why our recommendations are important. And most of all, let's take the time to notice when they do not understand and need us to break things down even further.
Improved communication can positively impact patient retention, compliance and overall health outcomes. Let's partner with our patients to help them live long, healthy lives, and let's talk to them about it every step of the way.
This article was authored by Renelle George, MD, pediatric cardiology Fellow in Training (FIT) at Rainbow Babies and Children's Hospital in Cleveland, OH.