“What We’ve Got Here Is A Failure To Communicate“

“The more elaborate our means of communication, the less we communicate.”

J B Priestley
Image Credit: Cool Hand Luke, Warner Brothers, Seven Arts

One of the most critical aspects of providing quality patient care is effective communication between caregivers and patients. Unfortunately, poor communication can often lead to adverse outcomes for patients. There are many ways that poor communication can affect patient care. First, if caregivers and patients cannot communicate effectively, it can lead to misdiagnoses or delays in treatment. Additionally, poor communication can also lead to medication errors, as well as a breakdown in the doctor-patient relationship. Ultimately, poor communication can seriously impact the quality of care that patients receive.

It is disturbing to me that we are here in 2023 and have access to some of the most sophisticated technology available, and yet there has been a steady increase in the number of “Cool Hand Luke” moments in healthcare over the past year. I’ve written earlier about the recent number of MRI accidents that have occurred. Most communication problems at organizations are caused by ineffective policies and procedures, language issues, poor communication skills, high workloads, EHR issues, and ineffective communication systems.

Medical safety experts at CRICO Strategies investigated 23,000 medical malpractice lawsuits and found more than 7,000 of those lawsuits could be attributed to communication failures. Those communication failures resulted in $1.7 billion in malpractice costs and almost 2,000 preventable deaths. A study conducted by the Joint Commission found 80% of serious medical errors were the result of miscommunication between caregivers during patient handovers. According to the Journal of Healthcare Management, U.S. hospitals lose an average of $12 billion annually because of inefficient communication among healthcare providers.

Let me illustrate an example of the current situation through a personal experience from a family member’s inpatient care journey. The section headings that follow are my characterizations, but the information in each section is what occurred. The patient, in this case, was under the care of an oncologist for an advanced cancer diagnosis with metastasis to the bone and their primary care physician.

The “Drive-By” Medical Specialist Consult – where a specialist is called in to evaluate additional symptoms or conditions requiring treatment. In this case, each comprised a five-minute or less visit to the patient’s bedside, a chart review, and a follow on medication or other procedure order. Here’s the list for this case over two weeks:

  • GI consult for inability to swallow and maintain nourishment following chemotherapy and radiation treatment resulting in an order for tube placement.
  • Neurologist consult for swallowing and speech difficulty resulting in a CT scan order and a medication order for high-dose corticosteroids.
  • Cardiologist consult to evaluate cardiac rhythm problems resulting in orders for ECG and subsequent pacemaker insertion.
  • Urology Consult to evaluate a urinary tract infection resulting in orders for antibiotics and IV fluids.

“Who’s On First” – No clear responsibility for the overall review of these orders and interventions to monitor effectiveness and make changes if required. In this instance, and only after repeated requests by the family did the patient’s primary care physician intervene and demand a full case review with all disciplines present – which took nearly one month.

“If you don’t know the secret password, we can’t talk with you” – Beginning with the original diagnosis, the family understood that this would require complex, multi-disciplinary care with many moving parts. To make things easier for the immediate family members, we contracted with an organization (that I’ve covered before in a previous post) to handle those tasks and coordinate activities for us. Despite having the necessary signed paperwork authorizing all healthcare providers to communicate with them, take their calls, and act on their requests, we encountered continued roadblocks to allow that to happen under the excuse of HIPAA concerns.

We’re not alone in experiencing these information-blocking issues. Here’s patient advocate Grace Cordovado’s LinkedIn video on her recent problems. (Thank you, Grace, for all you do) And here’s an image of Jan Oldenburg’s reply to Grace’s post about her difficulties in helping patient Casey Quinlan (aka Mighty Casey) to transition to hospice care. (Thank you, Jan, for your tremendous efforts)

Image Credit: Jan Oldenburg, LinkedIn
Image Credit: Jan Oldenburg Twitter Timeline, 3/38/23

“I was only following orders” – Patient developed a GI infection because the tube was not being flushed regularly. When questioned by the family, the charge nurse said there were “no standing orders” in the patient’s chart to maintain the patency of the tube. Really?

Image credit: Giphy

We need to fix this NOW. So here’s my plea:

As a first step, I suggest that hospitals, health plans, and physicians stop blaming patients and/or their designated representatives for everything that’s wrong with health care today. Maybe then we can make some progress at collaboratively building on all that’s right with health care. If hospitals, health plans, and physicians expect patients to change their behavior, they must change how they think about, communicate and relate to patients (aka people). They have to become genuinely patient-centered and more engaging to patients…from the patient’s perspective.

“We’ve always done things this way” is not an excuse for continuing these policies.

We need stronger Interoperability regulations with teeth in them. Over $38 Billion in HITECH funding was spent, and what have we got? Nothing worth talking about – just frustration on all sides.

Sign up for The Society of Participatory Medicine and ask your physicians to sign the manifesto. The Society seeks to bring together all healthcare stakeholders (patients, caregivers, healthcare professionals, payers, and others) to encourage collaboration, communication, and cooperation to foster provider/patient engagement, patient empowerment, and education.

Image Credit: Society for Participatory Medicine

The healthcare industry, over the last 100 years, has done a great job of socializing people to assume the passive sick role when we seek care. In that role, we are not expected to challenge physicians or question their decisions…in fact, many patients fear being labeled as difficult when they take on such behaviors.

Poor communication is a failing of the health system, not of patients. A good health system engages fairly and respectfully with everyone who seeks care. It recognizes that its patients and plan enrollees come with a range of previous experiences with the health care system, as well as different literacy levels, language fluency, and cultural norms. It is the responsibility of system managers and front-line providers to ensure that good communication techniques guide everything from examination room interactions to provider training.

Leave a Reply