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.

Brainstorming early in the research process

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.

Triage Information Card: Given to each patient as they come in

It entails:

• Information about triage
• What their triage level is (a pre-established system now being made transparent)
• Patient tracking number (that will be displayed on the waiting patient tracking monitor)
• Other resource (Insta-Care/Urgent Care/PCP) Information that outlines their function and the conditions they are able to treat.
• **Please note that the hospital logo used on the card is from the Television show “Scrubs” and it has no affiliation with this project.

Waiting Patient Tracking Monitor

• A television monitor mounted in visible locations within the waiting room
• Connected to the receptionist database and automatically updated as she puts in the patient information
• Patient Tracking Numbers are displayed in the order in which the patient will be called back to be seen
• Patient Tracking Numbers are de-identified and are NOT the same as the patient ID number and will not be used again in the hospital setting.
• Monitors can also include information regarding recent ambulatory intakes/number of rooms occupied, which will explain why someone has not been called back even though they are next on the list.

We are open to other ideas that may make these models more flexible, transparent, and implementable… any input is greatly appreciated!

“In 2001, the Institute of Medicine highlighted transparency as an essential component of a high-performing health care system.”

http://www.nap.edu/openbook.php?isbn=0309072808

Do you know of any examples where emergency departments make their patients aware of their priority (triage) level?
Could this understanding aid in the overall understanding of how the ER works, why people are waiting, why others who have arrived later are being seen prior?

For those who have been around since the beginning, you may recall a mention of http://stirrupsandstories.mosaicglobe.com/page/14353.

Communication in healthcare is an infinite abyss of networks of senders and receivers of messages, nonverbal and verbal. In order to simplify life, I hereby elect to focus on improving communication between care-providers and patients (women) in gynecological clinical settings. Again, I invite you all to look at the truly motivating expressions on this website.

These are some ideas…feel free to comment on feasibility, originality, etc!

The patient experience in healthcare communications can be defined as the exchange of ideas, information, thoughts, and feelings. But what if the patient is not well versed on the information (anatomy, verbal expression, etc)? Worse yet, what if the healthcare staff is uninformed??

The battles in sex education have been historical and continue to this date. It seems there is never to be a consensus on who should teach it and what should be taught. Regardless, most would agree that their physician, M.D. should know a thing or two about general reproductive health! After all, more than half of all women in the United States and Canada use some form of contraceptive, there are at least 20 abortions for every 100 live births, and not to mention that ~¼ of all sexually active adults are or will be carriers of STDs and/or STIs (reference CDC; 2002, Mosher et al; 1999, Fisher & Boroditsky; and 2008, Jones et al).

Alas, my research in trying to improve communication in the GYN patient experience has led me to a study that disputes this very ideal. According to J. Steinauer et al. / Contraception 80 (2009) 74–80, up to 50% of all undergraduate medical school curriculum providers did not provide training on counseling patients in family planning, infertility, and pregnancy options…give this article a glance, their findings are illuminating!

1. Patient information Card

This informs the patient their triage level and what the levels symbolize –> gives them a better understanding of why they’re waiting, why the guy  next to them got called in first also he arrived later, and what exactly is considered emergent.

Could this open eyes to the true purpose of the ER and discourage misuse (intended or unintended)???

2. Patient Tracking Board

This is essentially the same concept that you have seen in locations like Verizon Wireless or recently renovated DMVs.  The patient, knowing their tracking number, will see it up on the screen and see that they are 4th on the list to be seen.  This will give them a relative idea of when they will be seen so that they can relax knowing they will be there for a while and not disappointed every time the nurse steps through the door to call the next patient through.  They will also see if persons who were triaged at a more sever level were place ahead of them.  This is ALREADY happening in the ER.  Patients are being ranked and seen as according to the severity of their situation… but currently they have NO IDEA when they will be seen, why others are being seen before them, or how exactly the system works.

Could the knowledge of a relative time frame serve two purposes? 1. reduce anxiety while increasing understanding 2. encourage the use of other (more appropriate) facilities that could possibly see them quicker than waiting for the 10 others on the list ahead?

3. Poster of Triage Information

This is similar to the card… essentially serves the same purpose.

and on a different note

4. Education Syllabus for High School education Adult Roles/ Heath Class

This would be directed toward educating the soon to be adults how the health care system works, how they can receive the health care they will need and in the appropriate locations, how they can help them selves, increase their understanding of OTC medicines and treatments, and make them more knowledgeable and aware of what to do in emergent situations.

Is this where the education needs to begin so that we have a more informed patient who takes responsibility for her/his health and understands the resources out there and how to use them appropriately?  Is this being taught?  And if so… where?

All input greatly appreciated

Did you know that coming up with 66 distinct words is frustrating (one of our words!) and by the time you get done, you just feel blah (also one of our words!)?  Kevin came up with the great idea of taking pictures of the words from book covers and converting each word into looking like the side binding of the book and put them on a bookshelf (the bookshelf part was my idea, I know, genius.  Where else would you put books?) to organize them.  He did a stunning job, and unfortunately…I don’t have that picture file, but he does and I’m sure that in a few days, he’ll post it.

What did we find???

1. Spleen means more than just an organ.  http://www.merriam-webster.com/dictionary/spleen It’s definition 4

2. We felt depressed after doing this.  You would too if your words included the following: misunderstood, upset, perplex, apathy, unapproachable, sever, impede, anxiety, struggle, ineffective, BOTCH, barrier, FAILURE, derelict, aggravation…and so on.

3.  By the time we got done, we felt like we had just come out of the doctor’s office ourselves, truly frazzled…it was as if we each experienced all of these words through the process of finding them.

4. Now, our problem has become alive to us, we’ve given the problem a negative character, but not a hopeless one.  It’s a problem, but it can be fixed.

5. We’ve been able to see our problem from such a completely different perspective as we’ve been able to explore the meaning of some of these words, really, it’s amazing how much they overlap and yet, there are still 66 words out there that are unique and would be completely appropriate to describe the problem.

6. Don’t pick books with weird titles.  When the librarian hands them over to Kevin, he’ll get a weird look.

7. Now that we’ve identified all the most important words, how do we work on them to fix the problem that they are describing?  If there’s a will there’s a way.

Please, we’d love to have some feedback!