Thursday, July 9, 2015

Doctors Are From Another Planet

By Sid Roberts, MD
Lufkin Radiation Oncologist

Editor’s Note: This blog post was originally published July 7 at the Lufkin Daily News and on Dr. Roberts’ blog.

Jupiter and Venus aligned recently in what was called a Bethlehem Star event. The next time the two planets appear this close together will be in 2023. The rarity of planetary conversions reminded me of the 1993 bestseller from PhD counselor Dr. John Gray, titled Men Are from Mars, Women Are from Venus. If you haven’t read it, apparently there are more than 50 million copies floating around.

The basic premise of the book is that men and women are naturally different in the way they think and communicate. We all know that an underlying lack of communication in a relationship keeps that relationship from maturing or even kills it. The success of the book is rooted in the knowledge it imparts (in very humorous ways) about how our spouses think and, therefore, how we need to relate to one another.

Communication among doctors is equally important, but what may die in this physician-physician communication desert is you, the patient.

Everyone knows the phrase from the 1967 Paul Newman movie, Cool Hand Luke, “What we have here is a failure to communicate.” A scholarly article in the Journal of the American Medical Association in 2007 noted that direct communication between inpatient physicians and primary care physicians happened in fewer than one in five hospitalizations. It is just as bad inside our hospitals.

Physicians are notorious for expecting others to communicate for them. Part of that is time crunch, but mostly it is laziness. It is easier to write an order for a nurse to contact another physician to see a patient rather than to make the call yourself. Although, with cumbersome electronic medical records and CPOE — computerized physician order entry — it is getting easier again just to pick up the phone and call.

Consulting physicians are busy, too, and getting one on the phone can be a challenge. But if I am asking another physician see my patient, I’m the one who knows best why I am making that request and what I want from that consultant. I shouldn’t delegate critical communication to others. That gets back to one of my golden rules: Take the time and do what’s right.

What’s more, patients are demanding better communication among their health care team members and rating hospitals and physicians on whether or not they measure up. A 2011 National Academy of Medicine discussion paper noted, “Consistent and effective communication between patient and clinician has been associated in studies not only with improved patient satisfaction and safety, but also ultimately with better health outcomes, and often with lower costs.” In addition: “Breakdowns of communication, or disregard for patient understanding, context, and preferences, have been cited as contributors to health care disparities and other counterproductive variations in health care utilization rates.” In other words, when we don’t communicate, extra tests may get done and patients can get hurt.

However, communication is a two-way street. You, the patient, need to know at a minimum your own medical and surgical history, what medications you are taking (and what doses), and what you are allergic to. Medical records are not perfect, and as with any electronic media, if garbage goes in, garbage comes out. If you don’t give your physician or the hospital accurate and complete information, that’s just garbage in. Can’t remember everything? Write it all down and bring in a copy.

Communication is a skill, and skill development requires practice. Yes, some physicians (and patients) need more practice than others. Let’s work together to align our communication stars and usher in a new era of patient safety, better outcomes, lower costs, and greater satisfaction.

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