Study Reveals HUGE Communication Gap Between Patients and Physicians

October 18, 2010

The Archives of Internal Medicine recently published a study that surprised many physicians who thought they were communicating effectively with patients. A group of Yale researchers study results are very concerning.

Several findings revealed a very significant communication disconnect between patients and physicians.  The gap is alarming.  Here are two examples:

Physician Name — Study found that:

Patient Survey: More than 80% of patients did not know the physician taking care of them.
vs.
Physician Survey: The majority of doctors thought the patients knew their name.

Admission Diagnosis — Study found that:

Patient Survey: About  50% of patients did not know their admission diagnosis.
vs.
Physician Survey: The vast majority of doctors thought the patients had understood their diagnosis.

These results indicate significant works need to be done to narrow the gap between what healthcare professionals say and what patients understand.  This comes through education.

**********************

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. We offer high-impact training, consulting and one-on-one coaching. Contact us today!
http://www.CommunicatingWithPatients.com or 1-800-677-3256

Advertisements

The Cleveland Clinic Improves the Patient Experience … by Improving the Hospital Gown!

October 12, 2010

The hospital gown. They have become a standard joke among comics who talk about being in hospitals.  If patients do not fasten them just right, their derrieres (or other body parts) may be on display for all to see!

The Cleveland Clinic wants to change the hospital gown and they have enlisted the help of a glamorous fashion designer! Fashion icon Diane von Furstenberg created a unisex patient-friendly, comfortable, wraparound apparel that looks good on everyone.

Jeanne Ryan, committee chair, stated, “The original goal had been to improve patients’ hospital experiences. We wanted to provide people with some dignity. They come to the hospital, it’s very stressful and then we ask them to take off their clothes. People said they feel exposed.” The gowns are expected to become available to all patients in the Cleveland Clinic’s Ohio facilities sometime in 2011.

Everything a hospital does creates either a negative or positive “patient experience.”  This initiative certainly enhances the patient experience.  From my work at enhancing the patient experience, I know that these little changes have a big impact. Bravo to the Cleveland Clinic!

**********************

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. We offer high-impact training, consulting and one-on-one coaching. Contact us today!
http://www.CommunicatingWithPatients.com or 1-800-677-3256

MD Anderson Cancer Center Offers Innovative Patient-Professional Communications Program

October 8, 2010

The Interpersonal Communication And Relationship Enhancement (I*CARE) programs are excellent educational tools developed to enhance the communication skills of oncology professionals. The program is part of MD Anderson’s Department of Faculty Development. The program developers strongly believe that “skillful communication is a competency that can be taught and learned.”

The I*CARE program mission: “Most cancer clinicians have not had the opportunity to develop their skills in managing difficult patient encounters such as those where there are strong emotions, stressed families or uncomfortable conversations when transitioning a patient to palliative care or discussing end of life. Oncology providers want to extend their role beyond treating disease to establishing a therapeutic and supportive alliance with the patient and family. Our goal is to assist you in sharpening the skills necessary to manage these challenging encounters.”

I*CARE PROGRAM INITIATIVES

I*CARE Website

The website, http://www.mdanderson.org/icare, contains the MD Anderson Cancer Center’s Video Library of Clinical Communication Skills and is an educational resource for communication skills development. The video library helps with understanding the basic principles of communication and advanced skills such as discussing end-of-life issues and error disclosure by providing specific protocols that can be used and illustrating them with video re-enactments.  Free Continuing Medical Education (CME Ethics credit is available) and Risk Management credits are available to physicians enrolled in The University of Texas Professional Liability Insurance Plan. People may download materials for teaching purposes.

Programs

There are many program options, including fellow & faculty forums, interactive workshops, train-the trainer sessions, conferences and the quarterly Achieving Communication Excellence (ACE) lecture series.  One program, “On Being An Oncologist,” features actors William Hurt and Megan Cole who assume the personas of various doctors. Using dialogue gathered by physician focus groups, they share their feelings about the stress of caring for patients with life-threatening illness; the time pressures; the challenge of breaking bad news; the need to keep hope alive; the balancing of sympathy and empathy and keeping personal boundaries, as well as dealing with both the patient’s and their own emotional reactions.  A workbook with reflective exercises can be downloaded for both teaching and learning purposes.  In the Spring of 2011, there will be a new program launched for patients and families to learn how to communicate their needs to their medical team, and specific information on the cultural aspects of communicating with patients. 
One-on-one Coaching

Trainers observe healthcare professionals with patients and feedback is provided.

Research Opportunities

There are many ongoing research projects such as assessing aspects of the patient / oncologist relationship through audio taping clinical encounters and the impact of empathic statements on a patient’s emotional state.
These outstanding initiatives are making a big impact in helping oncology professionals successfully connect with patients on an interpersonal level.

Walter F. Baile, M.D., is the I*CARE Program Director and Cathy Kirkwood,
M.P.H., is the I*CARE Project Director. For more information about I*CARE, visit: http://www.mdanderson.org/icare

************

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. We offer high-impact training, consulting and one-on-one coaching. Contact us today!
http://www.CommunicatingWithPatients.com or 1-800-677-3256

Houston’s St. Joseph Medical Center offers Innovative Method to Communicate with Non-English Speaking Patients

October 7, 2010

St. Joseph Medical Center (http://www.sjmctx.com) recently became Houston’s’ first hospital to use a unique translation system.

A special phone is set up with two handsets, one for the patient and one for the professional.  Based on the language requested, a trained medical interpreter is immediately brought on the line to help the patient and professional communicate.

The phone system is produced by CyraCom (http://www.cyracom.com) and offers interpreters specializing in 150 languages.  The trained interpreters are familiar with medical terminology, which is critical when speaking about healthcare topics.

If the language is not immediately obvious, patients review a card attached to the phone that has questions in their language. They can use this card to select their language.

Every patient room at St. Joseph has one of the phones. The sets are also located in the medical records department, triage and the front desk. There are a total of 400 phones throughout the hospital.

In healthcare, clear and concise communication is critical. This innovative tool helps avoid language-related issues to provide the best care to patients.

************
Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. We offer high-impact training, consulting and one-on-one coaching. Contact us today!
http://www.CommunicatingWithPatients.com or 1-800-677-3256

Medical Students Learn what it is like to be a Resident in a Long-term Care Facility … by becoming a Resident! The Learning by Living© Project

September 29, 2010

Empathy in healthcare is all about understanding what it is like to be “in the shoes of “ a patient / resident.  Medical students at the University of New England College of Osteopathic Medicine learn what it is like to be a resident in a long-term care facility by becoming a resident!

The Learning by Living© Project is the brainchild of Dr. Marilyn R. Gugliucci, Director of Geriatric Education and Research at the College of Osteopathic Medicine.  In this innovative program, medical students are “admitted” into a long-term care facilities to “live the life” of a resident for two weeks.  Each student comes with a diagnosis and appropriate treatments. For example, if the student is admitted in a wheelchair, the student must stay in the wheelchair for every activity, including changing clothes and bathing.

Prior to the development of this project, students learned about long-term care via traditional methods (e.g., lectures and brief visits).  

In 2005, the first medical student was “admitted” into a Maine long-term care facility to live the life of a resident. Each summer since then, Dr Gugliucci has admitted students into long-term care facilities.  The students do not return home at the end of the day; the students live in the facility on a 24/7 basis.

Dr. Gugliucci maintains constant contact with students portraying an adult daughter of the student acting as a resident.  The students carefully document their experiences. The long-term care facilities provide a bed and meals at no cost.

The program has a 100% success rate!  Follow-up data reveal that students practice medicine differently because of their experience of living in a long-term care facility.  According to Dr. Gugliucci, students gain the following by having this experience:

  • Importance of physical touch, voice inflection, and word cadence when working with patients.
  • Enhancement of communication by being at eye level with the patient, whether they are in a bed, a wheelchair, or on a treatment table.
  • Communication with authenticity and sincerity, emphasizing the importance of being comfortable sharing with patients.
  • Connection with and treating the person rather than the diseases or frailties of the patient.

Currently, the University of New England College of Osteopathic Medicine is the only medical school in the country admitting students into long-term care facilities for extended periods to live the life of a resident. The plan is make this a nationwide project. The project is also applicable to nurses and other health profession students.

The Learning by Living© Project is being filmed for a documentary, due out in June 2011.

For more information about the Learning by Living© Project, please contact Dr. Marilyn R. Gugliucci at mgugliucci@une.edu

************

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. We offer high-impact training, consulting and one-on-one coaching. Contact us today!
http://www.CommunicatingWithPatients.com or 1-800-677-3256

 

Patient Advocates Help Healthcare Professionals

August 31, 2010

 

In 2004, Trisha Torrey discovered a golf-ball sized lump on her torso.  There was no  pain associated with the lump.  Trisha contacted her doctor and ultimately several tests were performed.  The tests revealed a devastating diagnosis, a rare form of lymphoma that is nearly always fatal.  She was told to begin chemotherapy immediately.

Trisha felt something was not right.  She did all her Internet research and discovered that she had no other significant symptoms associated with this type of lymphoma.  It just did not add up.

Through a friend, she found a new doctor for a second opinion.  Then came the shocking (but happy!) news.  Trisha did not have cancer!  She would have gone through chemotherapy for nothing!  (Chemotherapeutic agents are toxic. It would have been devastating to go through this treatment and not actually need it!)

For Trisha, this was a life altering time for many reasons.  From that moment, she became a patient advocate to help others through the healthcare maze. Today, Trisha is the About.com expert on the topic of patient empowerment.  She recently posed a question to her readers, “What Should Medical Students Learn?”  These are some the responses that you will find helpful:

  •  Do not “give/write orders.” Medicine is not a military command. The patient makes the final decisions. You are there to offer expertise on diagnosis and treatment options. Take the time to make certain that patients understand clearly what options are available to them and the pros/cons/costs of all the options.
  • If you want patients who have money / insurance, you will have to accommodate some aspects of customer service in the medical care regimen. Treat patients, not disease.
  • Treat every patient with dignity and respect, imagining that each patient was your own loved one: parent, grandparent, child, brother, sister, or spouse.
  • For some patients, gender matters, especially with intimate procedures and exams. Some women would prefer female caregivers, some men would prefer male caregivers. Medical staff should not assume just because a patient doesn’t discuss their preferences, that everything is just fine.
  • Never forget that your world, the world of the hospital, is not the real world. It’s not where most of us live. Explain things. Talk. Communicate. Don’t assume too much about what patients already know, want to know, or value personally. Ask.

 Trisha’s first book, You Bet Your Life! The Ten Mistakes Every Patient Makes, was published in 2010. You can contact Trisha through her personal website:  www.EveryPatientsAdvocate.com

********************************

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. We offer high-impact training, consulting and one-on-one coaching. Contact us today!
http://www.CommunicatingWithPatients.com or 1-800-677-3256

My Mother’s Recent Hospitalization Experiences: The Good, the Bad and the Ugly!

November 18, 2009

About a month ago, my mother was crossing the street with her friend. Just as she stepped on the sidewalk she started feeling faint and began to feel sick.  An ambulance was immediately contacted and my mother was taken to the ER.  My mother’s friend accompanied her to the hospital — she called us from the hospital and told us to come right over.

My brother and I entered the hospital’s ER to find my Mom awake and alert. An ER nurse told us that my mother’s EKG was abnormal and that she had a condition known as Atrial Fibrillation and would need to take the medication, Coumadin.

A few hours later, my mother was admitted to the hospital.  The physician on the unit determined the underlying medical issue, dehydration.  We thought my mother was drinking enough fluids — obviously not.  My mother was in the hospital for four days.  Upon proper hydration, she was feeling fine and looking forward to returning home.

These are my observations regarding my mother’s recent hospitalization.  I base the observations on my PIE Model of Patient Communication.
P  Psychosocial (providing emotional support)
I  Interviewing (getting information)
E  Educating (giving information)

Psychosocial Dimension

Everyone was very friendly and kind.  I found the healthcare professionals to be very caring and treated my mother quite well.  However, what I did not find was any direct empathic responses.  I was waiting for someone to make a statement such as, “I know this must be difficult for you.”  Every medical center and practice always mention that empathy is an important component of their work.  In reality, empathy is rarely displayed.  This is due to the fact that healthcare professionals are not educated on how to convey empathy.

Interviewing Dimension

The questioning techniques employed were sufficient to gather information from my mother and I.  There was the usual issue of asking too many closed questions in succession and not allowing the patient sufficient time to discuss their medical issues.

The biggest issue was closing the interview with this question, “Do you have any questions?”  That is a closed question.  To encourage patients to ask questions, we should rephrase the question as an open question, “What questions do you have?”

Educational Dimension

Brace yourself and fasten your seat belt!  This was by far the weakest area.  Upon discharge, the unit nurse reviewed the discharge instructions, which were disjointed at best.  There were so many issues, I almost did not know where to begin my evaluation.  These are the problem areas and suggestions for improvement:

Excessive use of medical jargon:  The discharge instructions used the terms presyncope and mixed hyperlipidemia.  I am in the healthcare field and know what the terms mean, but what if I wasn’t in the field and didn’t know what the words meant?  Use patient-friendly language.

Ultimate diagnosis not mentioned. My mother initially fainted, but was ultimately diagnosed with dehydration by the attending physician.  Dehydration was never mentioned in the discharge report. This is a perfect of example of how poor handoffs lead to medical errors. At the time of discharge, I asked about the dehydration and how much fluid my mother should consume.  The nurse said, “About 3-4 glasses a day, I guess.” (Having a solid healthcare background, I researched the topic and developed a daily fluid intake plan for my mother.)
Vague comments. The discharge form states, “Will order Influenza vaccine.” Was it ever administered to my mother?  I called the hospital and was first sent to the Medical Records Department — they had no idea.  The Medical Records Department sent me to the unit, who also had no idea.  The unit nurse did say this, “Your Mom most likely did get the flu shot.  We usually give it to people 50 or over.”  Why didn’t the report state, “Patient was given a flu shot?”

No educational materials / resources.  In spite of the fact my mother was diagnosed with dehydration, no information was provided.  A brochure, website or organization to contact would have been helpful.

Overall, the healthcare professionals who took care of my mother were kind and skilled at their jobs.  There were some issues with the interviewing questions and empathic responding, however the biggest concern was the poor patient education component.  If patients do not comprehend their medical situation, they are at risk.

I signed the form for my mother (I have Power of Attorney).  By signing the form, I indicated I understand the discharge papers.  I actually did understand them — I have been in healthcare over 20 years.  My biggest concern is that most people will sign the form stating they understand, but they really do not.

Hospitals need to do a better job at educating patients.

********************************

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  To book one of his high-content credit-hour-approved keynote speeches or training programs, visit or call: http://www.CommunicatingWithPatients.com / 1-800-677-3256

How to Remember Names of People: Six Top Tips

October 19, 2009

NameTag

How to Remember Names of People: Six Top Tips

When I was in graduate school, I volunteered at a crisis hotline center. All volunteers had to go through an intensive three-month training.  The first day of training, all 45 volunteers formed a circle.  The group leader asked one person to say their first name and favorite food.  The second person had to say their name and favorite food, but also repeat the first person’s name and favorite food.  This went on throughout the entire circle!  I was in the middle — I had to recall about twenty people’s names and favorite foods.  I correctly recalled every person and favorite food because I was very motivated to learn their names.  If we work at it – we can remember names.  It is not an innate gift that only certain people possess. Here are some tips to help you!

Repeat the name immediately.  When I first meet someone, I immediately repeat their name.  If they say their name is Carol, I will say, “Hello Carol. Nice to meet you.”  Repeating the name serves two purposes — helps you recall the name, plus people love hearing their names!

Use an association strategy.  When I first met a lady named April, I recalled her upbeat personality — she was like rays of sunshine.  I thought to myself, “April is the month when spring is beginning — we see more sunshine.” The person with the sunshine personality is April!

Write the person’s name on their forehead (not literally!).  Franklin Roosevelt amazed his staff by remembering the names of nearly everyone he met. He used to imagine seeing their name written across the person’s forehead.  Imagine writing their name in big bright letters on their forehead.  To make it stick, keep this image in your mind between 5 – 10 seconds.

Comment on the name.  At a recent meeting I met a man named Hank.  I immediately told him my brother’s name is Hank.  That created a link in my mind.  Last year, I met a lady at a meeting named Georgia.  I told her about my many trips to the state of Georgia. Commenting about the name further reinforces the name in your mind.

Use the name throughout the conversation.  For example, during your chat say, “So tell me, Peter, what do you find are the most significant trends this year?”  Use the name during the conversation without overdoing it.

Say the person’s name at the end of the conversation.  Once again, this helps reinforce the name.  For example, say, “I enjoyed our conversation, Mary. I will email you the requested information.”

After the conversation is completed, write the person’s name on a piece of paper — this helps cement the name in your mind.

What if you see a person at a meeting that you have met, but do not recall their name?  First of all, do not say, “I am really bad with names.  I forgot your name, what is it?”  The comment is very weak and creates a poor impression.  This is how to handle the situation with finesse.  First, ask someone else at the event if they know the person’s name.  If that does not work, approach the person and mention where you previously met.  For example, say, “I recall meeting you at last year’s symposium. I’m John Smith. Will you please tell me your name again?” The person may have forgotten your name too, and will be thankful that you stated your name.

One of the most fundamental elements of who we are is our name.  It is important that we recall names. Practice these skills and you will remember names!

********************************

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  To book one of his high-content credit-hour-approved keynote speeches or training programs, visit or call: http://www.CommunicatingWithPatients.com / 1-800-677-3256

When Patients Want Antibiotics They Don’t Need: Offer Explanations, not Prescriptions

August 31, 2009

AntibioticsNotForColds

A patient with an upper respiratory infection comes to see you.  After performing a history and physical, you determine the patient has a viral infection.  You are concerned the patient will insist on a prescription for antibiotics.  Below are the steps to handle this patient concern.
 
Show Empathy
 
Think about how sick you felt with a respiratory illness.  They can be a miserable experience.  Here is an example of a statement you can say to a patient, “I understand you are not feeling well.  I want to assure you that I want to help you.”
 
Explain Difference between Viruses and Bacteria
 
For patients, viruses and bacteria are all “bugs.”  They do not perceive a great deal of difference between these organisms.  We need to explain to them the difference and then discuss how antibiotics are effective for bacteria, but not viruses, such as the virus causing the common cold.
 
You can mention to patients, “Most adults, on average, get two to three colds a year; and children can have eight to twelve colds a year. Most colds last about one week. But it’s not unusual for symptoms to continue for as long as two to three weeks.”
 
Describe Dangers of Antibiotics
 
Side Effects. Mention how antibiotics can be have unpleasant side effects. Say, “I do not want to give you a drug that will not help and possibly make you feel even sicker.” Describe potential antibiotic side effects including: upset stomach, diarrhea, rashes, and (rarely) serious allergic reactions (even with antibiotics that they may have used safely in the past).
 
Resistance. In addition, explain how overuse use of antibiotics can result in resistance to them.  For example, you can say, “Using unnecessary antibiotics can cause some bacteria to become resistant to the antibiotic. This increases your chances of having bacterial infections later that can’t be treated by antibiotics. This is called ‘antibiotic resistance.’”
 
Potential Patient Issues
 
Concern over Green or Yellow Mucus. A patient may state they are having green or yellow mucus and fearful that means their illness is serious.  We need to combine empathy with our explanation. You can state, “I could understand your fear.  We used to think that green or yellow mucus indicated a bacterial infection. However, today, we know this is not true. A viral infection can cause green or yellow mucus.”
 
Previous (Unnecessary) Antibiotic Prescription. Explain to patients that if they were given antibiotics in the past for colds that antibiotics often get credit that your body’s own immune system really deserves. Review issues of antibiotic side effects and resistance.  Also, mention newer knowledge of antibiotics.
 
Emphasize the use of self-care measures (such as fluids) and nonprescription medications.
 
It is important to remember, patient satisfaction is generally linked to communicating effectively not writing prescriptions.
 
The CDC has an excellent brochure for patients, “Cold or Flu. Antibiotics Don’t Work for You.”  Here is the link:
http://www.cdc.gov/GetSmart/campaign-materials/print-materials/Brochure-general-color.pdf

********

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  To book one of his high-content credit-hour-approved keynote speeches or training programs, visit or call: http://www.CommunicatingWithPatients.com or call 1-800-677-3256

New “Readability Toolkit” Helps Develop Understandable Patients Forms and Educational Materials

July 9, 2009

PatientFormsClipboard

The Group Health Center for Health Studies recently created an excellent report, the “Readability Toolkit.”  The Toolkit is designed to show research teams how to create consent forms and other participant materials in plain language.  Overall, the Toolkit has excellent information to create patient-friendly forms and educational literature.

The Toolkit contains these sections:

What You Should Know Before Using this Toolkit – Background information on health literacy, plain language, and why both are important in the research context.

The Principles of Plain Language – An explanation of the components of plain language, as well as concrete strategies that support plain language writing.

How to Determine Reading Level – Information and advice about using readability formulas to rate the approximate reading level of your materials.

Quick Reference Guide for Improving Readability – An at-a-glance summary of plain language principles and strategies, plus other formatting, editing, and proofreading tips.

Editing Checklist for Participant Materials – A companion to the Quick Reference Guide that guides users through a systematic process to improve readability, identify unclear concepts, and eliminate proofreading errors.

Resources for Informed Consent Documents – Readability advice and resources specifically for consent forms, including a list of common pitfalls, links to helpful consent templates and guidelines, and a selection of easy-to-read template language for common consent topics, such as randomization and voluntary participation.

Resources for HIPAA Authorization Documents – Links to helpful HIPAA templates and guidelines, along with a brief selection of easy-to-read HIPAA language.

Alternative wording suggestions – A list of plain language alternatives for hundreds of words typically used in medical and research settings and links to online resources that define medical and research jargon.

Examples of improved readability– Before and after “snapshots” of plain language revisions to original text taken from actual participant materials.

Examples of improved formatting – Techniques for improving readability through
formatting changes are illustrated with three before and after examples: an advance letter, a consent form, and a study information sheet. While the focus is on improved formatting, all three examples also illustrate other plain language techniques.

Repository of readability resources and references – A clearinghouse of Web-based resources focused on health literacy, readability, plain language, and informed consent, plus a short bibliography of articles related to literacy and readability in health research.

Download the complimentary Toolkit here:  http://www.centerforhealthstudies.org/capabilities/readability/ghchs_readability_toolkit.pdf

********

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  To book one of his high-content credit-hour-approved keynote speeches or training programs, visit or call: http://www.CommunicatingWithPatients.com or call 1-800-677-3256