Communication is Key: Let's Give it More Effort

Communication is an art, a skill, an all-around tricky thing and vital to effective patient care. As nurses, we’ve all received some measure of training in how to communicate with patients and their families. I don’t know for sure, but I’ll assume that medical schools also devote at least a small portion of their curricula to arming doctors-to-be with effective communication techniques. Yet, failures abound.

A recent article in JAMA reported the results of a study that investigated whether or not doctors informed patients with terminal illnesses of their life expectancy. It was reported that, even when told, some patients either didn’t understand or chose to hear what they wanted to hear. So, the doctor knows that the patient doesn't understand or seems to be turning a deaf ear to the reality of his condition (the doctor did report these observations) and the doctor is going to leave it at that?

Receiving shocking news does have a way of turning off the senses initially, but I have my doubts that, for the long-term, there are many patients who are so much in denial that they entirely shut out information that is so important. I think what we have here (a la Cool Hand Luke) is a failure to communicate, and that the failure falls more onto the shoulders of health care workers than onto those of the patient.

A few years ago a friend was having a colonoscopy. Because of the anesthesia the procedure required, she asked me to be available to drive her home from the hospital. My friend, 41-years-old at the time, was six weeks post-op following a double mastectomy and just ready to resume her job as a teacher when abdominal pain prompted the scheduling of the diagnostic test.

Following the completion of the procedure I was waiting in a small office with my friend when her doctor appeared. After a few pleasantries he sat on a stool, rolled up to her knee-to-knee, took her hands in his, looked straight into her eyes and told her he had bad news. He had found a large tumor at the very top of her colon. At the moment those words left his mouth my friend visibly shut down. Her eyes actually glazed over into a fixed stare and it seemed she didn’t hear a single thing the doctor said to her after that. My observation was confirmed when, later in the afternoon, she couldn’t recall any part of her post-procedure conversation with the doctor.

It's possible that some of her memory failure was related to the anesthesia but I think the shock of the news was responsible for most of it. Either way, what would’ve happened if I hadn’t been a nurse and able to recount to my friend the doctor’s words? If the person sitting alongside the patient is a family member, the news would be as emotionally traumatic to that person as to the patient, so then what would we have? Not just one, but two people who aren’t hearing and absorbing what is said to them.

In every similar situation, it is incumbent upon the doctor or the nurse to make sure someone understands what is going on. It is always a good idea to ask the patient or the person accompanying the patient to repeat what has been said to them. We also need to put ourselves into the patient’s place and imagine ourselves with no knowledge of medical terminology. Medical terms roll so easily off our tongues but don’t translate so clearly into the ears of our patients. We need to remember that.

The friend I mention here (now seven years post-op and healthy) later had the opportunity to accompany a friend who was facing an emotional surgery to a pre-op doctor appointment. She asked questions of the doctor and made notes. Sure enough, her friend didn’t remember a lot of what the doctor said, so my friend recapped the conversation and handed over the notes for future reference.

My friend is involved in supporting other cancer survivors and says that it is common that patients don’t hear anything after, "You have cancer." I know time is always at a premium but taking just a little more time to clarify a patient’s situation would likely save even more time on down the road and would be an immediate comfort to the patient.

Although cancer figures significantly into my examples here, I hope it is evident that excellent communication carries over into all areas of patient care. Explain, explain, explain and never assume that you are the world champion of clarity. Ask your patient what he heard you say. You might be surprised to learn that there is a big gap between what you said and what the patient thought you said.