Friends,
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| Patient Communication |
The biggest hurdle in accepting communication skills as an integral part and parcel of patient management is the thought process that considers communication as just simple niceties and basic courtesies in handling patients. There is no doubt that we need to be courteous and well behaved with the patient and their family but that is not the end of it. Communication in healthcare is a lot more than that. Communication in healthcare is not just about niceties, it is about the serious communication that happens between the healthcare professionals and the patients, where the patient has a set of information about his health and disease that needs to be collected in a systematic manner and a set of information that the healthcare professionals including doctors, nurses and other caretakers that they need to share with the patient in a manner that the patient understands it and is able to apply it to recover from the illness and regain health.
Patient care is teamwork.
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| Sharing the Treatment Plan |
A lot of information about the patient’s medical condition is shared amongst the team members managing the patient. The team includes consultants, residents, nurses, technicians and other paramedics. This exchange of information is also a part of the clinical communication. A major chunk of the errors in patient care are the result of communication failure amongst the healthcare professionals. Careful, accurate, systematic, and timely exchange of information is the basis of quality healthcare. So, in nutshell, clinical communication is an exchange of health related information either with the patients and their family or with the fellow healthcare professionals and is not just about niceties.
Communication with a patient is not the regular communication between two healthy individuals. This is the communication between a trained and qualified healthcare professional and a person (patient), who is not feeling well, who is in need of help, and who is seeking your attention, care and advice. In such a situation, communication can not be a simple exchange of conversation. It has to be a mindful effort from the healthcare professional to proactively connect with the patient, understand his/her health needs and meet them in the best possible manner.
There are a lot of communication opportunities with the patients and their families like collecting patient history, informing and explaining about the diagnosis, discussing about the options available to treat an illness and the pros and cons of each treatment modalities. Each of this communication requires understanding of quick ways of building rapport, getting all important health related information in the shortest span of available time, winning patients’ trust to reach a mutually acceptable treatment plan and answering patient’s queries in a manner to create patient satisfaction. There is a huge knowledge differential between the treating doctor and the patient. The treating doctor is expected to acknowledge this gap and make sure to design the communication in a manner that is understandable to the patient. This requires the knowledge and understanding of principles of communication and effective tools to communication. Clinical communication is learning and practicing all about it.
Patients may have unrealistic expectations from the treating doctor or the treatment modality. It is helpful to be aware of these expectations and how to help them accept realistic expectations. All this needs understanding of the fact, how the human mind does not accept anything less than the best and how to fine tune it to match with the reality. This is the negotiation and persuasion aspect of communication and is required in everyday handling of patients.
At multiple times the communication with the patient is very sensitive in nature and requires real experience in terms of handling challenging situations like asking personal sensitive information, taking sexual history, communicating with suicidal patients, communicating with rape and abuse victims, informing about treatment failure or medical error, handling aggressive patient, or breaking bad news like serious diagnosis, or announcing death. Managing these communications require training and experience and these are part and parcel of healthcare communication. Understanding, learning, practicing and demonstrating these skills need training.
In an average stay of 3 to 4 days, a patient’s information exchanges 50 to 60 hands. A lot of errors in patient care are the result of internal communication failure. When two or multiple healthcare professionals with different educational, professional, and experience backgrounds work together, there is a risk of miscommunication or missed communication. Unless you have standardized ways of communicating to bring uniformity and minimize the impact of individual difference in communicating, lapses are bound to happen. Most of these lapses in the care of patients, leading to fatal consequences are the result of communication failure amongst the healthcare professionals. Clinical communication is all about learning and practicing communication protocols to prevent these errors, and ensure continuity of care, patients’ safety and quality health outcomes.
Communication needs of patients have changed drastically over the last couple of decades. Today, they wish to know their disease and actively participate in choosing treatment options considering their suitability as well. They don’t want to be a mute spectator of their treatment planning and management. It is time that we respect patients’ autonomy and give it due importance without compromising the clinical goals. Involving the patient in decision making, answering their queries, addressing their concerns and acknowledging their experiences is the basis of modern medicine practices. Now the patient is an important team member in healthcare delivery. Engaging them in planning and management of their health condition is a definite way to create patient satisfaction and would also enhance professional satisfaction of the care providers. After all, the purpose of all our actions is creating happiness and satisfaction.
Considering these facts in the background, it is time we realize the importance of clinical communication in providing quality healthcare including continuity of care, patient safety and patient satisfaction and take these skills seriously!
Dr. Indu Arneja is Founder Director of Indian Institute of Healthcare Communication, A pioneer in the field of Healthcare Communication in India
She has conducted around 1500 Clinical Communication programs for doctors, nurses and other healthcare professionals in more than 100 hospitals and medical colleges across the country.
She is an external assessor for NQAS, Ministry of Health and Family Welfare and NABH (IRCA), QCI, India. Is a core group member of Advisory Board on Health and Mental Health for Nation Human Rights Commission.
She is also a visiting faculty to some of the very prestigious organization like IIM Ahmedabad, Delhi Judicial Academy, Maulana Azad Medical College, Delhi University, IGNOU and PHFI. She has over 30 years of experience in the field of health and training.
She is a regular invitee at National and International Conferences. Recently, she was invited to attend Annual Summit on "Patient Experience and Empathy" by Cleveland Clinic, Ohio, USA, 2019. She has been awarded scholarship to attend a prestigious communication course ‘ENRICH’ organized by Academy of Healthcare Communication at Pittsburgh, USA in 2019.
She regularly conducts webinars for national and international audiences. She has conducted multiple webinars for Anschutz Medical Campus, Colorado, US. She has a YouTube channel in her name Dr. Indu Arneja and has an on-going series under the titles - "Heart to Heart talk with Dr. Indu Arneja" and "Master Stroke with Dr. Indu Arneja".
arnejaindu@gmail.com
www.iihcglobal.com
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Very insightful and comprehensive treatment of this important subject.
ReplyDeleteAll the more important when compliance protocols have increased paperwork for the attending nurses and if the nurse to patient ratio is adverse, then they don't have the bandwidth to cope with the sheer physical routines...thereby leading to lesser time to engage with the patient or the family member accompanying the patient.
Also, as rightly pointed out, when doctors of different specialities are called to weigh in on a patient's health, in case of secondary issues, it is good to have a well experienced GP, review the list of medicines in its entirety and take a balanced view. This could perhaps help in preventing over-medication.
Great article!
Very insightful and comprehensive treatment of this important subject.
ReplyDeleteAll the more important when compliance protocols have increased paperwork for the attending nurses and if the nurse to patient ratio is adverse, then they don't have the bandwidth to cope with the sheer physical routines...thereby leading to lesser time to engage with the patient or the family member accompanying the patient.
Also, as rightly pointed out, when doctors of different specialities are called to weigh in on a patient's health, in case of secondary issues, it is good to have a well experienced GP, review the list of medicines in its entirety and take a balanced view. This could perhaps help in preventing over-medication.
Great article!