Communication in healthcare
Communication is a means of exchange of information, as also a method of sharing ideas. However, in health care, poor communication is a bane. Let's see how.
"The single greatest tragedy in health & science. right now, is the inability to communicate well”.
Communication is a means of exchange of information, as also a method of sharing of ideas. Fundamentally it has three components - Speaking, Listening and Non-verbal communication (use of posture, hands, eyes & gestures). We use words, vocabulary, emotion, enunciation, dialect, our knowledge of the subject to speak and our ears and brain to listen. We tend to ignore the role of non-verbal part of communication, despite research that emphasises its role and value. Whilst University of Pennsylvania’s research gives 70% of weightage to body language, the more commonly followed 7-38-55 rule gives it 55% weightage.
Communication follows a 7C formula - Complete, Correct, Concrete, Clear, Concise, Considerate and Courteous.
However, in health care, poor communication is a bane as 65% of all sentinel events (JCACO 1995-2004) were related to poor or no communication and most complaints about doctors are related to communication errors. Research also indicates that as we progress from being medical students to senior consultants, our technical proficiencies certainly get enhanced but, in many cases, our ability to communicate well with our patients declines. 75% of wrong site, surgeries (Haynes etal, 2009), 60% of medication errors (Reader etal, 2006), 72% of neonatal deaths in obstetric cases (Leonard etal, 2004) & 30% of all malpractice suits in the United States (US) (2009-13) were a result of communication errors/deficiencies.
Health care is a complex field wherein communicating well is as great a necessity as learning the technicalities of the practice of medicine and surgery. Poor communication between colleagues, peers and juniors, amongst doctors, doctor-nurse, doctor-patient and lack of communication and documentation during patient handovers are quite common and potentially harmful.
The quality of information recorded and conveyed, time given to listen to the patient; (77% time doctors interrupt the patient’s initial statement and interrupt the patient once every 18 seconds (Beckerman & Frankel), improper communication using medical jargon like COPD, AMI, CHF and TNM-- words which the layman can't understand, create a gap that causes distress and mishaps.
Whilst communication is (wrongly) attributed purely as an art, there is a science to it. Art is most important part of "how" in communication but science is key in the "when, where & whom” part of communication. Tools like SBAR for structured communication in healthcare can help. SBAR stands for Situation, Background, Assessment & Recommendation. Even the United Airlines CUUS – Concerned, Uncomfortable, Unsafe, Scared - mode can be used in health care settings to good effect.
Teaching communication to medical and nursing students in the undergraduate curriculum, use of educational tools like Teach Back, check lists (Pilot Gawande, Pronovost, WHO Safe Surgery), Electronic Medical Records, Computer Generated Prescriptions, Patient Engagement Tools & good practice example, like Making Care Better (by Weill Cornell Medical Collage & NY Columbia College of Physicians & Surgeons (2014) can do wonders.
The time has come to pay heed to the saying of two "greats" - George Bernard Shaw who said "The biggest problem with communication is the illusion it has taken place" and Peter Drucker who said "The most important thing in communication is to hear what isn't being said”.
Let's make health care safe.
This article has been authored by Dr Narottam Puri – Principal Advisor, QCI; ex-Chairman, NABH; Medical Advisor, Fortis Healthcare; and Advisor (Health Services), FICCI.