Good Patient Communication Matters, So Why is it So Hard?
Improving physician communication skills is an increasingly hot topic, as the Wall Street Journal recently noted, because of a confluence of factors, including the rise of the empowered patient, malpractice suit trends, and changes in reimbursement that tie payment to metrics like patient satisfaction. However, as diagnostic imaging specialists well know, good communication takes time and effort that is largely unrewarded. On top of this, even the most well-written and thoughtful radiology reports can be misread (or not read at all) by the ordering physicians. Never mind what may happen when patients are able to read their reports directly through personal health records linked to their electronic medical records. The hilarious John Cleese did a brilliant take on what doctors sometimes sound like in a short YouTube video.
So what can be done to improve communication when the information you are communicating is inherently complex, like the function of the brain or an imaging report? One of the biggest is to stop expecting, as “Dr. Cleese” does in the video, that your audience is following along. Expect the opposite, that a certain number of ordering physicians either didn’t read or didn’t understand you correctly, and that these physicians are either too busy, too embarrassed or both to say so. The same goes for patients. Make yourself truly available as a resource on the patient’s care team. A few years ago, Lawrence E. Ginsberg, MD, from the Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, in Houston, wrote in Radiology about the term “as clinically indicated” in radiology reports and its role in overutilization of imaging. He noted that “if radiologists want to be accepted as clinical colleagues and not merely as film readers, we must be more involved. To me, this means that the patient is my patient, too, and I am his or her doctor.” The vast majority of malpractice suits include some type of communication breakdown, and if you are pulled into court in such a case, juries are unlikely to accept the argument that it was the sole responsibility of the ordering physician to make sure he or she received and fully understood the imaging report. Equally important is to make sure that as payment reform moves forward, standards are created that reward specialists for the type of communication they engage in. Considering how often medical mistakes are due to poor communication, imaging providers that have systems in place to avoid communication breakdowns should be rewarded for this. If you are actively consulting with other physicians and even speaking directly to patients and/or their family and caregivers, you are offering a much more valuable service than the provider who simply sends off reports and trusts that they will be received and acted on correctly. You should be rewarded for this.