Communication Problems in Medicine


A sweet grandmother telephoned the hospital. She timidly asked, “Is it possible to speak to someone who can tell me how a patient is doing?”

The operator said, “I’ll be glad to help, dear. What’s the name and room number of the patient?”

The grandmother in her weak, tremulous voice said, Norma Findlay, Room 302.”

The operator replied, “Let me put you on hold while I check with the nurse’s station for that room.”

After a few minutes, the operator returned to the phone and said, “I have good news. Her nurse just told me that Norma is doing well. Her blood pressure is fine; her blood work just came back normal and her Physician, Dr. Cohen, has scheduled her to be discharged tomorrow.”

The grandmother said, “Thank you. That’s wonderful. I was so worried. God bless you for the good news.”

The operator replied, “You’re more than welcome. Is Norma your daughter?”

The grandmother said, “No, I’m Norma Findlay in Room 302. No one tells me anything.”

As the above possibly apocryphal funny story (the names vary) found on the Web illustrates, communication in hospitals between medical personnel and patients is not always what one would hope it would be. In addition to all the other dangers encountered after passing through the portals of a hospital, “Current research indicates that ineffective communication among health care professionals is one of the leading causes of medical errors and patient harm.”[1],[2],[3]From the first of the cited studies, “Although 83% of the errors that ultimately occurred were mistakes in treatment or diagnosis, 2 of 3 were set in motion by errors in communication. Fully 80% of the errors that initiated cascades involved informational or personal miscommunication.”

 In another study published in Annals of Family Medicine, vol. 2, no. four, July/August 2004, “Patient reports of preventable problems and harms in primary health care,” used interviews of adults from various geographic locales in Virginia and Ohio. The study found out 221 incidents out of 38 narratives that primarily involved breakdowns of the clinician patient relationship. “The incidents were linked to 170 reported harms, 70% of which were psychological, including anger, frustration, belittlement, and loss of relationship and trust in one’s clinician.”
  
The dangers of medical errors, one of which occurs from problems in interpersonal communication, have been known for many years. Only recently has the the mainstream media realized this, recently running stories on the third leading cause of death or injury in this country after cancer and heart disease coming from the medical establishment itself. Reports about medical errors have been published for the medical professionals for decades. Sixteen years ago, a major report in a book form by the Institute of Medicine Committee On Quality of Healthcare in America reported that, “Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That’s more than die from motor vehicle accidents, breast cancer, or AIDS–three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems.”
Despite the urgency noted in 2000, it does not seem to this blogger that many improvements have been made in the healthcare system. Studies, editorials, reports and analysis continue to be published in the medical literature. On February 17, 2016, Jess White, in a posting on a Web site reporting on a study by patient safety expert CRICO Strategies wrote, “Communication is important in providing top quality patient care. Any breakdowns in communication can lead to serious problems, such as patient complications or deaths.” Here is a list of common communication problems identified by CRICO:
  • miscommunication about the patient’s condition
  • poor documentation and failure to read the patient’s medical record.
  • inadequate informed consent
  • unsympathetic response to a patient’s complaint   inadequate education (such as about medications)
  • incomplete follow-up instructions
  • no or wrong information given to patient
  • miscommunication due to language barrier.
There is a wealth of information in the CRICO reports, which are available for download free through a website at Harvard.edu. A 2015 report on malpractice cases gives a summary by type of treatment:
Communication failure is involved in:
  • 38 percent of all general medicine cases  
  • 34 percent of all obstetrics cases
  • 32% of all nursing cases
  • 26% of all surgery cases
COM’s attack obstetrics cases MUNICATION FAILURES WITHIN SELECTED SERVICES
This is scary stuff. Many of these problems seem endemic in hospitals (have you experienced any of them?). Medical publications describe ways to minimize such concerns. For example, some hospitals try to cut down on misinformation by using something called the I-PASS system during shift changes in patient care.  I-PASS is a mnemonic system that tries to make certain important information at the time of patient handoffs is properly communicated. I-PASS stands for Illness severity, Patient summary, Action lists, Situation awareness and contingency planning and Synthesis by receiver. It does seem obvious that if the problem was at all close to solution it might not remain such a common source medical studies.
Should you be so unfortunate as to land in a hospital you might ask if they use a mnemonic such as I-PASS to improve communication among staff.


[1]Woolf SH, Kuzel AJ, Dovey SM, et al. A string of mistakes: The importance of cascade analysis in
describing, counting, and preventing medical errors. Ann Fam Med 2004; 2: 317-326.
[2] Lingard LS, Espin S, Whyte G, et al. Communication failures in the operating room: An observational
classification of recurrent types and effects. Qual Saf Health Care 2004; 13: 330-33
[3] Leonard M, Graham S, Bonacum D. The human factor: The critical importance of effective teamwork
and communication in providing safe care. Qual Saf Health Care 2004; 13: 85-90.

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