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How Patients Filter Clinician Communication

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How Patients Filter Clinician Communication

By Jock Hoffman, CRICO

Related to: Communication, Primary Care, Nursing, Publications

Patients’ actions, or inactions, are based on their comprehension of the information you convey to them and their assessment of its severity and urgency. Patients who misunderstand or fail to retain critical clinical information are at increased risk for preventable adverse events. As their health care provider, you are at risk of an allegation of miscommunication and its consequences.

Health care communication passes through filters of understanding unique to each patient. Physical and mental health status, age and education, bank balance and insurance coverage, and dozens of other factors modify the intended message into the message received. Clinicians conveying distressing news about a patient’s condition or complex instructions for ongoing treatment must take into account the fact that comprehension will likely be limited—even for patients who credibly indicate they’ve understood every word.

Analysis of more than 64,000 medical professional liability (malpractice) cases from CRICO’s national Comparative Benchmarking System found provider-patient miscommunication in 19 percent of those cases (23 percent for outpatient cases).

 

The Most Common Breakdowns Occur in Five Key Areas of Provider-Patient Communication

% Cases    Communication Breakdown

25%

 

Consent for procedures or treatment, or explanation of alternatives

22%

 

Education regarding hospital treatment, discharge instructions, medications

18%

 

Response to the patient’s concerns

9%

 

Alignment of expectations

6%

 

Comprehension/language barrier

 

Malpractice cases alleging miscommunication expose comprehension/ interpretation gaps across a range of care-related components that providers need to convey. Adopting strategies to close those gaps may help reduce the risk of care-related harm.

 

10 Opportunities to Help Patients
Navigate Health Care Communication

 

  Area Strategies

1

Language/Literacy Risks

Terms for anatomy, biological systems, disease processes, and health care processes necessary to understand their health status and make informed decisions

  • Check patient materials for appropriate reading levels
  • Check to see if your patients actually can hear you and are listening attentively
  • In conversation, use language that reflects the terms and tones that the patient uses when describing complaints or expressing concerns

2

Math/Numeracy Risks

Test results, lab values, dosages, lifelong risks, rates of change, etc. can be unclear to patients with limited math skills.

  • Don’t assume comprehension of probabilities or formulas
  • Put important numbers in context (e.g., ranges) and in writing
  • When possible, use (simple) visual displays to convey complex math

3

Values & Preferences

Myriad socio-economic factors frame a patient’s envisioned future, and how they prioritize health issues. Each patient’s outlook on life is unique.

  • Inquire about what’s most important for today and for tomorrow
  • Frame treatment decisions based on a patient’s willingness and ability to change lifestyle habits for potential health benefits
  • Ask patients directly if they agree with your top concerns or your most crucial recommendations

4

Recommended or Mandated Health Screenings or Preventive Care

The importance, efficacy, and limitations of health screening and preventive care is fluid and confusing—especially when medical history, family history, and genetics are variables.

  • Clarify the difference between prevention and screening
  • Provide aids that patients can use to better understand the value of preventive measures
  • Consider how the tenor of your guidance will impact a patient’s decision to follow screening and preventive care recommendations

5

Signs/Symptoms

Confusing or conflated terminology, cultural or regional variations of terms used to describe health-related signs/symptoms and their duration, frequency, and intensity

6

Testing and Referrals

Follow through on ordered testing or referrals depends on the patient understanding why, what to expect, the time and costs involved, and the degree of urgency.

  • Explain the reason for a test or referral order in a way your patient can, in turn, explain it to the lab, imaging center, or specialist
  • Explain the nature of ordered tests and any preparation requirements
  • Ask the patient the likelihood he or she will make and keep the appointment

7

Results and Diagnoses

Even seemingly straightforward concepts as positive/negative can befuddle ailing and anxious patients. Likewise for diagnoses, which may sound overly troublesome for patients unfamiliar with clinical terms.

  • Tell patients how their results will be communicated and when
  • Ensure that results sent directly to patients provide context and resources to assist interpretation. For results shared in person, confirm the patient understands definitive findings and guide him or her through numerical values.
  • Patients who adequately understand the gravity of their diagnosis are better suited to engage in treatment decisions and regimens

8

Treatment Risks and Benefits

Population-based risk projections and general descriptions of the potential benefits and risks (of either undergoing or foregoing treatment) can be difficult for a patient to personalize.

  • Be specific about both the likelihood and the nature of a given risk or benefit for that patient and any risk mitigating or elevating factors
  • Use the patient’s current health status (if other than ideal) as the baseline for expectations about their post-treatment status
  • Explain the potential impact of delaying a decision to proceed with treatment

9

Alternative or Non-evidence-based Medicine

Questions, expectations, or misinformation regarding outlier treatments or clinical trials

  • Inquire about why and where the patient sought alternative care guidance
  • Explain your process for accessing treatment options
  • Explain any potential dangers of aberrant treatment methods

10

Shared Decision Making

An expectation to make health care decisions can be empowering or burdening, depending on a patient’s comprehension of key factors.

  • Ensure patients that you are not abdicating responsibility for their care
  • Confirm that a patient’s questions have been addressed ahead of any key decisions
  • Ask patients directly if they understand your assessment or agree with your recommendations

 

Of course, not every clinician-patient encounter raises these communication concerns, but providers who are able to gain an understanding of a patient’s information filters are more likely to connect when they do need to convey important instructions or recommendations.

 

Additional Material


October 30, 2018
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