Dr. Jeff Kane: Communication — Healthcare’s orphan

A friend asked her doc’s office for flu and pneumonia immunizations. She got appointments, but only after eight phone calls back and forth. In the process, she discovered that scheduling was now done in an office fifty miles away. With modern communication technology, distance shouldn’t be a problem, but it’s hard not to notice that it’s remarkably more vexing than local contact.

Admittedly, that’s a trivial incident, but it’s not the only bad apple in the barrel. Fact is, the whole barrel’s in bad shape. I’m sorry to say that poor communication pervades the entire healthcare system.

Communication isn’t just about passing data around. Especially in healthcare, where the stakes can be mortally high, it’s important that contact be clear, efficient and compassionate.

A friend showed me a letter she received from her doctor’s office. Obvious boilerplate, it bore her name and address and a seven-digit identifier number. There was no greeting or closing signature, only the names of the office’s four physicians.

“We recently reviewed your medical record,” the letter said, “and noticed that it is now time for a follow up procedure. This is based on the potential for development of serious pathology and the increased risk of cancer…”

My friend said, “A ‘follow up?’ Did they find something wrong last time, so I need a follow up now?” She was clearly frightened. As we spoke, she got angry, too. “Are they trying to scare me? This looks more like it came from IRS auditors than from so-called caregivers.”

And there are other stories…

“Why is it that modern medical science can transplant hearts but can’t manage to fax my test results across town?”

“Why was news of my cancer diagnosis left on my answering machine?”

“I went to the lab for my blood test, but the wrong one was ordered. And where are my X-ray results?”

“Why does my doctor face his laptop more than he faces me?”

It makes us want to ask, “Who’s in charge, anyway?” Responsibility should ultimately fall on physicians, the ones who are most familiar with patients’ personalities, history and needs. The catch, though, is that we docs haven’t been taught communication’s paramount importance, let alone its skills. As a result, many of us are even out of the loop about the quality of patient contact in our own offices.

Communication could be taught to docs-in-training, but the requisite time now goes to memorizing acetyl-coA production and the nature of mitochondrial nucleic acid. That is, we docs are turned out overeducated in subjects most of us will never use and deficient in what’s arguably our most important tool.

In a 1926 graduation speech, renowned Harvard physician Francis Peabody advised, “The secret of the care of the patient is in caring for the patient.” He called, in other words, for communication that’s clear, efficient and compassionate.

Progress in medical education is traditionally glacial, so expect meaningful communication curricula when, as the Russians say, the shrimp learns to whistle. So like it or not, it’s up to patients and their families, as customers, to demand communication commensurate with healthcare’s hi-tech tools. It can’t be legislated, only enacted locally, conversation by conversation.

Jeff Kane is a physician and writer in Nevada City.

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