Communication

Nothing is more vital to improving patient safety tan effective communication. This skill is developed by learning to actively listen to verbal and non-verbal cues. Communication between a patient and physician is just as important as it is among providers and staff. Reducing communication errors and ineffective “hand-offs” of important medical information is crucial to lower risk and improve patient safety.

According to an article in the Annals of Family Medicine 2/3 of errors in a physician’s office were initiated by communication errors.  These included:

• Breakdown in communication with patients
• Breakdown in communication with colleagues
• Breakdown in communication with patient requests
• Breakdown in communication with messages.

In addition other areas of concern involve inaccessibility of medical records and inadequate “tickler” or reminder systems.  (Woolf, SH 2004 Jul-Aug; 2(4):317-26)

The opportunity to communicate effectively is available from the first contact with the patient (phone call or in person) to the discharge from care.  Each step is vital to continuity of care.

Avoid Breakdowns in Communication with:

• Patients
  These suggestions pertain to physician and staff alike
  • Greet the patient as soon as feasible
  • Make eye contact (maintain as much as possible)
  • Introduce yourself
  • Ask patient how he/she would like to be addressed
  • Offer a handshake (project a caring attitude)
  • Sit down (if feasible)
  • Lean toward the patient
  • Listen to the patient, give them a full minute before interruption
  • Ask questions one at a time
  • Allow patient to respond
  • Don’t interrupt, be courteous
  • Avoid crossing your arms or legs
  • Avoid sighing, rolling your eyes or yawning
  • Use non-medical jargon and terms
  • Paraphrase important points and restate if necessary
  • Be an active listener – be sensitive to what the patient isn’t saying
  • Leave time for questions

• Colleagues
  • If possible speak with consultants or referring physicians to assure mutual understanding at plan or request
  • Inform patient about the reason for the consultation
  • Respond to consult in a timely manner and correspond results to referring physician
  • Referring physician should define the type of consult
  • Consultant should respond to type requested
  • Do not consult another physician unless primary physician concurs
  • Track consults to assure completion
    • It is recommended that referring physician receive notification if patient was a “no show”
  • Don’t criticize other physician’s care

• Patient requests
  • Patients have a right to access their records
  • Patients have a right to have their records amended if approved by provider
  • Physicians are not required to release the original record (unless under court order)
  • Patients can request consultation
  • Patients can request a chaperone or family member be present
  • If the physician feels the above requests are not going to be honored, explain the reason to the patient and DOCUMENT IN THE CHART!

• Patient messages
  • Document all telephone communication including lab and orders
  • Telephone triage is a liability landmine
    • Develop processes to assure proper documentation and follow-up
  • Document all after-hours calls and advice
  • Document all medication orders in chart
  • Never leave private confidential information on an answering machine or voicemail
    • Request patient contact the office for details

There is a direct correlation between physician communication and malpractice claims. Remember the communication techniques are a learned skill, what is said is just as important as how it is said. How we communicate impacts our relationship with our patients and their perception of care.  Remember, you can only make a first impression once!