Jupiter and Venus aligned recently
in what was called a Bethlehem Star event. The next time the two planets appear
this close together will be in 2023. The rarity of planetary conversions reminded
me of the 1993 bestseller from PhD counselor Dr. John Gray, titled Men Are from
Mars, Women Are from Venus. If you haven’t read it, apparently there are more
than 50 million copies floating around.
The basic premise of the book is
that men and women are naturally different in the way they think and communicate.
We all know that an underlying lack of communication in a relationship keeps that
relationship from maturing or even kills it. The success of the book is rooted
in the knowledge it imparts (in very humorous ways) about how our spouses think
and, therefore, how we need to relate to one another.
Communication among doctors is equally
important, but what may die in this physician-physician communication desert is
you, the patient.
Everyone knows the phrase from the
1967 Paul Newman movie, Cool Hand Luke, “What we have here is a failure to
communicate.” A scholarly article in the Journal of the American Medical
Association in 2007 noted that direct communication between inpatient
physicians and primary care physicians happened in less than 1 in 5 hospitalizations.
It is just as bad inside our hospitals.
Physicians are notorious for
expecting others to communicate for them. Part of that is time crunch, but mostly
it is laziness. It is easier to write an order for a nurse to contact another
physician to see a patient rather than to make the call yourself. Although,
with cumbersome electronic medical records and CPOE – computerized physician
order entry – it is getting easier again just to pick up the phone and call.
Consulting physicians are busy,
too, and getting one on the phone can be a challenge. But if I am asking
another physician see my patient, I’m the one who knows best why I am making
that request and what I want from that consultant. I shouldn’t delegate
critical communication to others. That gets back to one of my golden rules:
take the time and do what’s right.
What’s more, patients are
demanding better communication among their healthcare team, and rating
hospitals and physicians on whether or not they measure up. A 2011 National
Academy of Medicine discussion paper noted, “Consistent and effective
communication between patient and clinician has been associated in studies not
only with improved patient satisfaction and safety, but also ultimately with
better health outcomes, and often with lower costs.” In addition, “Breakdowns
of communication, or disregard for patient understanding, context, and
preferences, have been cited as contributors to health care disparities and
other counterproductive variations in health care utilization rates.” In other
words, when we don’t communicate, extra tests may get done and patients can get
hurt.
However, communication is a two
way street. You, the patient, need to know at a minimum your own medical and
surgical history, what medications you are taking (and what doses), and what
you are allergic to. Medical records are not perfect, and as with any
electronic media, if garbage goes in, garbage comes out. If you don’t give your
physician or the hospital accurate and complete information, that’s just
garbage in. Can’t remember everything? Write it all down and bring in a copy.
Communication is a skill, and skill development requires
practice. Yes, some physicians (and patients) need more practice than others. Let’s
work together to align our communication stars and usher in a new era of patient
safety, better outcomes, lower costs, and greater satisfaction.
