I began this project looking into communication methods in patient-physician relationships. By researching language barriers, the effect of interpreters in hospital settings and non-verbal communication methods, I decided to focus on the inability of patients and physicians to communicate in real time. While investigating this area of communication, it became apparent that many physicians graduate medical school without being taught how to deliver bad news to a patient.
It is important for a physician to recognize that all bad news will have adverse consequences for both patients and families and it is critical to change patient expectations while delivering difficult news. Abraham Flexner shaped the current medical curriculum of the United States in 1910 by acknowledging that there was a “public interest” in the changing world. Our society has changed significantly since 1910 and public interest also continues to evolve. By adapting the teaching methods of medical schools in the United States today by teaching physicians how to deliver bad news, both patients and physicians will benefit.
There are three main constraints affecting the implementation of an alternative communication curriculum method. Medical students face four years of tight schedules with neither space nor time to spare; current curriculum content is focused highly on rote learning of textbook-style information; and many curriculums do not focus on today’s social needs and the public interest of society.
Elisabeth Kübler-Ross, MD, brought the five stages of grief to the public’s attention. It is important for physicians to acknowledge that patients will not all go through the cycles of grief in the same order and some may never accept their change in lifestyle due to bad news. Family members are also likely to be at completely different mental states than the patients and will feel frustrated because the patients may deny everything that is happening to them.
According to the Press Ganey, as much as 50% of substandard care is related directly to physicians’ communication with patients. However, the bottom line is that the changes in communication methods are not that intimidating. They require going back to basics with interpersonal skills.
Providing future physicians with strategies to use, with no definite rules, they will have guidance in their relationships with patients, specifically when delivering difficult news. Developing a curriculum with a variety of components – interdisciplinary courses, simulations, reflections, mentoring, testimonials and recognizing teachable moments – will promote better communication in patient-physician relationships. Through continuous student and faculty evaluations of interventions and recognizing the changing public interest, the impact on student self-confidence and their behaviors through curriculum intervention will create a more empathetic physician.
Creating a generation of physicians who care and are interested in improved communication with their patients will create a more empathetic patient environment. By providing a communication curriculum method that any medical school could use to adapt to their own medical curriculum, physicians will take communication seriously both as students and in practice.
Education will always needs to be adapted and revised, especially in such a shifting world. But, hopefully, through improved reflection and understanding, communication strategies will be taken more seriously and increased empathy will result.
Here’s a big summary of my research from the past fall:
The following poster shows my initial research into the language barrier present in healthcare regarding patients with limited-English-speaking abilities.
The gears have been cranking for a while now and it seems like the right thing to do is sum up where the current ideas and the intent came from.
Here is where my thinking process and research has taken me to this point in time:
The inability of patients and physicians to communicate verbally during real-time interaction can negatively impact the patient experience. Though patients may receive perfectly fine medical care, if they do not feel heard or adequately involved they may end up feeling lost and uncared for. By providing a widespread, or easily understood, non-verbal method to facilitate communication between both the physician and patient in an effort to promote safety and trust, all patients within the hospital setting can feel heard and become empowered to be further involved in their own medical treatment.
Originally, my interest was in the language barrier that so many individuals in the United States tackle while making their way through the healthcare system. In the past ten years, the number of individuals living in the U.S. with limited knowledge of English, or no capability of speaking the English language at all, has increased immensely. They enter our hospitals on a daily basis, but sit in fear and frustration because no one understands them and the system set in place to help them does not always work. I researched extensively into the use and availability of translators and interpreters on a national and local level here in Utah.
It soon became apparent to me that there were many more communication barriers being faced by individuals in the hospital setting: little children unable to relate their feelings and ideas, intubated but coherent individuals trying to relate their experiences to their doctors, people stressed out by the medical terminology that has no meaning to them, limited-English-speaking individuals, as well as deaf, blind and mute patients. Now, how do we provide a way to facilitate communication between physicians and all of these different people in a real-time manner? How do we ease the stress that comes along with a communication and/or language barrier?
The inability of patients and physicians to communicate verbally during real-time interaction can negatively impact the patient experience. Many patients find it difficult to understand their physicians and the patient-physician relationship is negatively affected. The use of specific medical terminology can hinder the patient’s understanding as well as issues like age, education, limited English proficiency and other handicaps.
Although certain translation issues can be bypassed with an interpreter, there are not always enough of them in hospital and clinic settings. Even if interpreter availability is sufficient, it is not always practical to use this limited resource for specific patient-physician interactions. Instead, using non-verbal communication methods may help facilitate real-time communication between the patient and physician. Though patients may receive perfectly fine medical care, if the patient does not feel heard or involved, the inability to communicate may negatively impact their overall experience.
The inability to communicate happens on an individual level and will not affect all patients who enter the hospital or clinic setting. It also can affect any part of the hospital because the communication barrier can arise without notice with any type of patient. If the real-time communication barrier is not handled efficiently it can slow down the entire process of the patient experience and require contact with more people. Frustration can also arise on both sides, which can ultimately affect the diagnosis, treatment and prevention of further medical issues.
By providing a widespread, or easily understood, non-verbal method to facilitate communication between both parties and promote safety and trust, all patients within the hospital setting can feel heard and be more involved in their own medical treatment. Effective communication promotes patient involvement and empowerment within the healthcare system. Because communication barriers can arise without any notification, having an effective means of quickly facilitating translation and understanding between the patient and physician can make the patient experience much more productive and meaningful.
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- Peter Jones on Communication Strategy: From the Classroom to the Clinic
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