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Communication Counts


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.

“If you want to improve your career, you need to improve your communication with patients,” says Dr. Williams, who notes that hospitalists often don’t know the areas in which they are weak and strong. “It’s a career killer if you have multiple patient complaints against you.”

Risk Reduction

Being an effective communicator can also reduce one’s risk of being sued for malpractice, says Mitchell Wilson, MD, FHM, chief medical officer of Atlanta-based Eagle Hospital Physicians, which manages hospitalist practices for clients in the Southeast and Mid-Atlantic regions of the U.S. Dr. Wilson’s company believes communication is so important that starting with the very first interview of a hospitalist candidate, it considers the candidate’s ability to communicate by taking note of such things as accents, how they present information, and body language, Dr. Wilson says.

“Communication is one of the top three competencies that are essential to hospitalists,” he says.

Certain aspects of hospitalist work make communication exceedingly important, Dr. Wilson says. Hospitalists are coordinators of a patient’s care; they are caring for patients who are out of their comfort zone; many times the patient is in an extreme health situation; and hospitalized patients are of all different ages and backgrounds.

“If a hospitalist is a poor communicator, I would encourage them to seek additional training,” Dr. Wilson says. TH

Lisa Ryan is a freelance writer based in New Jersey.

Techniques to Improve Doctor-Patient Relationships

When it comes to communicating with patients, hospitalists can learn much from their colleagues in the ED. Common courtesies like knocking on the door, introducing yourself to your patient and family members, being respectful and honest, and listening to what the patient has to say can go a long way to building a relationship with a patient, Dr. Williams says.

“Hospitalists should also be mindful of sitting down and addressing the patient at eye level, and giving information in intervals, so as not to overload the patient,” says Dr. Wilson, who also endorses the “teach-back” method.

Rather than assuming their patients understand what they are being told, hospitalists should use “teach-back” and ask the patient to recount what was just discussed in order to confirm their comprehension, Dr. Wilson explains. It also helps to use plain language, show pictures or diagrams, speak at a moderate to slow pace, and repeat instructions.

Hospitalists should remember that, above all, patients want to be treated with dignity. They want their physicians to ask about the concerns they have and be available to answer questions that arise, Dr. Williams says.

“Thirty to 40 people walk into a patient’s hospital room every day. It’s like a revolving door where names and faces jumble together,” he says. “If at all possible, hospitalists should visit their patients twice a day to cement their role.”

Hospitalists should let their patients know at the outset if there are time constraints. If questions can’t be adequately answered during that visit, schedule a more convenient time.

“When leaving a patient’s room, hospitalists should always thank the patient for trusting them with their care,” Dr. Wilson says.—LR

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