Put yourself for a moment in your patient’s situation. You are sick enough to have been thrust out of your normal life and admitted to the hospital. You find yourself attached to unfamiliar objects and machines, listening to unfamiliar words, and watching a revolving door of unfamiliar faces stroll in and out of the room to take blood, ask personal questions, touch your body, and monitor equipment. It would be enough to bear if you were well, but you’re not. You are ill and that makes you feel particularly worried and desperate.
Whether the physician succeeds in this scenario largely depends on their communication skills.
“A hospitalist needs to develop an almost immediate relationship with their patients because they are at their most vulnerable,” says Mark Williams, MD, FACP, FHM, professor and chief of the Division of Hospital Medicine at Northwestern University’s Feinberg School of Medicine in Chicago. “It is proven that if a hospitalist can successfully communicate with their patients, the result is much more satisfied patients.”
It is proven that if a hospitalist can successfully communicate with their patients, the result is much more satisfied patients.—Mark Williams, MD, FACP, FHM, professor, chief, Division of Hospital Medicine, Feinberg School of Medicine, Chicago
CAT: The Doctor-Patient Relationship Exam
This is easier said than done, as new research by Dr. Williams and colleagues at Feinberg, Northwestern Memorial Hospital (NMH) in Chicago, and Saint Francis Hospital and Medical Center in Hartford, Conn., has found. As part of the study, which published in the December issue of the Journal of Hospital Medicine, patients who were admitted to NMH between September 2008 and August 2009 and cared for by a hospitalist or hospitalist-led teaching team were interviewed using the Communication Assessment Tool (CAT). The CAT is a 14-item survey designed to measure a patient’s perception of communication with their hospitalist.
The average excellent rating among the 35 hospitalists involved in the study was 59.1% on a scale of 0 to 100 percent. Collectively, the hospitalists scored highest on such items as paying attention to patients (64.1%), talking in terms patients could understand (64.2%), and showing care and concern for patients (63.8%). The hospitalists scored lowest in greeting patients in a way that made them feel comfortable (54.9%), encouraging patients to ask questions (53.2%), and involving patients in decisions as much as they wanted (52.9%).
“There are a lot of factors working against hospitalists. Hospitalists are first meeting their patients when they are at their weakest, they sometimes don’t know the patient’s history, and, of course, there are all the demands on hospitalists’ time,” says Darlene Ferranti, research coordinator at the Feinberg School of Medicine.
What is particularly fascinating about the research is 13% of the patients eligible for the study could not participate because they weren’t able to identify their hospitalist by name or photo, Ferranti says. “If your patient doesn’t know who you are, how can they recall the information you are sharing with them?” she asks.
The study wasn’t designed to test patient communication techniques and their effectiveness, Dr. Williams explains. “We think future research needs to focus on interventions to improve doctor-patient communication,” he says.
However, the study did demonstrate that the CAT survey can be a valuable tool for HM groups interested in learning how their physicians are doing from the patient’s perspective, Dr. Williams notes. Perhaps more importantly, it can also help hospitalists target those communication areas in need of improvement, Ferranti says. For example, each hospitalist in the study was given a report of their individual scores and where they fell in the chart compared to the group as a whole.