[Info] Doctors Need More Training in Communication

[RobinN]

A new study shows that when it comes to communicating important information to other doctors, first year residents apparently fail to communicate effectively the most important information about their patients.

Even more disturbing is that doctors don’t realize they aren’t communicating effectively, and rate their own abilities far greater than what researchers found.

Suggesting needed changes in medical school training, the study points to the problems in a common medical practice in training, the “hand off.”

As shifts change in a hospital, outgoing physicians must hand off important information to their replacements in a brief meeting.

The research highlights the importance of educating doctors about successful communication skills during hand-offs.

“When resident hours are shortened, you have more hand-offs,” said Vineet Arora, MD, assistant professor of medicine at the University of Chicago Medical Center. “You could have concerns about either a tired physician who knows the patient or a well-rested physician that may not know the patient. The tradeoff is between fatigue and familiarity.”

Conducted through a unique collaboration between physicians and psychologists at the University of Chicago, the study observed hand-off communication between pediatric interns — first-year residents — at Comer Children’s Hospital at the University of Chicago. Interns at the end of an overnight shift would spend a total of 10-15 minutes sharing information about hospitalized patients with the resident relieving them in a designated hand-off room.

Both the outgoing and incoming interns were then asked by researchers about what they thought was the most important information conveyed during the hand-off about each patient. Surprisingly, what the outgoing intern identified as the most important information was not successfully communicated to the incoming intern 60 percent of the time. The rationale for certain medical decisions – such as why a patient is on a particular drug or why the primary care physician should be contacted – was also not understood by the receiving intern in a majority of cases.

But despite these miscommunications, interns on both sides of the hand-off consistently rated the quality of their communication as very high. Boaz Keysar, PhD, a professor of psychology at the University of Chicago and co- author of the paper, said that this disconnect between perceived and actual success of communication is common in other settings.

“You would imagine the kind of miscommunication we discover elsewhere actually might be reduced when the stakes are high in a clinical setting, because it matters so much,” Keysar said. “But the opposite is true, which I think is counter-intuitive and important to know.”

The results were even more striking given the optimal hand-off conditions for interns at Comer Children’s Hospital. In each hand-off, a conversation takes place in a designated room under supervision by more experienced physicians. In previous research, Arora found that many hospitals and programs have much less organized hand-off procedures – if they occur at all.

In illustrating the communication breakdowns that plague even best-case hand-off conditions, Arora and Keysar hope to inform medical centers and schools of the need for better education about hand-offs.

The study found that “anticipatory guidance” — offering to-do items or if-then advice — was a more effective way of communicating information between interns than passing on knowledge items in bulk. Currently, Arora and colleagues are working on a simulation exercise for fourth-year medical students to train more effective hand-off communication skills.

Such training, they hope, will be more effective than relying upon computer programs and electronic medical records to facilitate hand-off communication. A verbal exchange of information remains important so that young doctors can make quick, informed decisions about patients, Arora said.

“IT solutions cannot substitute for a successful communication act,” Arora said. “We aren’t at the point where computers are going to do that for us.”

“Technology solutions can help so that you have the information that you need when you need it, but to look at that information and be able to make a judgment about what to do, that is what the hand-off conversation is for.”

The research was published in the March issue of Pediatrics.

Source: University of Chicago Medical Center

http://psychcentral.com/news/2010/03...ion/12074.html

[drarvindr]

Resident doctor's perspective ( Indian resident doctor , i'll grant you , who has lousier work conditions than an american pizza delivery guy):
"Luckily" for me i work 24X7 "on call" - so no hand off for me since there's no one to hand off to! ( the effect on my personal life , whatever's left of it , is no laughing matter , though.). Earning a bounteous $435 per month working for the slave-masters (read hospital admin).Apparently you can't bitch about working insanely long hours in this country since - you chose the profession and it's noble and the doctor patient ratio is some where near 1:30000. Currently posting from hospital library. Anyhoo , the article does make a valid point , although i'm more worried working in a hospital that has one nurse on night shift per 40 patients and living in hospital quarters that look like Abu Gharib.
Cheers,
Arvind

[stilldancing_98]

I stay with my epileptologist just for that reason. I have been with that Dr. for 14 years just because of his sense of sense of humor, his compassion, we have argued, laughed, I told him one time not to long ago that "I hate epilepsy!. I'm sick of it". And he came back with " Oh I love it! it has paid my way." Then I gave him the evil eye and we had a good laugh. But I have left good dr.s just because there was no respect from the beginning. It's a hard job. My doctor has over 1000 patients. But he tells me , you have to stay positive.

[survivor]

When we go to a doctor, we go with lots of hopes and want to get solutions ready for us. What I have seen all these years is that, they (doctors) are really not prepared for replying to our queries specially if I talk of my old doctor. Dr. arvind he was a retired neurosurgeon from PGI Chandigarh, but I still cant get it that on earth PGI could have a doctor like him! Myself being a doc (although vety.), I do understand what the doctor goes through but the doctor is there to help and HE SHOULD HELP, whether this prob or that. Hope the things improve!

[marlena23]

I always joke with my doctors..."can I get all of you in a room together so you can have a meeting about me." If only it was that easy. It's hard enough to get a doctor to listen to what you have to say let alone get them to share information. I found that its easy to use my PCP as the go to guy. He knew me before the epilepsy and has helped me through this whole process. I tell my other docs to send him reports and I sign a release so my other doctors can contact him for questions. This is extremely helpful when collecting records.

[jyearta]

I went to a new neur. on the 11th of Aug. of this year.

He seem to listen to me. He told of this email system they have (gave me all the info. on how to go about it) It sounded great.

As I was leaving my visit with him, he said he would sent copies of my visit to my FP, so that all would be on the same Page. It sounded Great also.

I have Email him (on this systm) asking for him to PLEASE fax something in for depression. I gave him all the inf.

I went twice to the Phar. - NO fax for medic.

In one email to me (I wouldn't go into all) he told me to go to my FP and ask for CSC test. I called made appt. with FP, - his office said they needed a order for this and could I ask for a fax from my neur. to them. OK --That makes sense.

I email asking for fax that my FP requesting order.

I go to my FP 2 days alter- for CBC test--NO FAX---the nurse said she would fax him ( I didn't take that in with me , thinking there would be a fax.) I told her to look on the paperwork from my neur., regarding my 1st visit with him. that she would find it on the paperwork (you guess it) didn't have the fax.

I came home and I DID EMail my neur. asking why are their faxes not reaching my phar. or my dr. office, did I provide the wrong info. WHAT

I DID get a email back from THIS neur. - telling me that his office always do what they say they will do. AND that I had better watch my tone, TONE MY TONE - I'm the one looking on the internet so that I can tell him what my boby is needing. (still looking)

Just the day before I called this neur. about fax not reaching my phar. his office manager, told me that they set their faxes up auto. - it will try sending several times. AND thAT they forgot to check the machine, until I CALLED ONLY to find the fax had not gone through. 5 days later.

They showed me all this equipment and procedures they have to ensure the patient, that you will be able to communicate to one another and therefore take away any stress. How don't this just great.

How mind you, I am NOT prefect, and do not claim to be.

Now looking for new Neur. - one without an EGO.

[epileric]

I found this to make lots of good sense

Your Role in Avoiding Medical Errors 101

[Elsie]

Took a list along of all the supplements my husband was taking, you'd have thought he was taking poison for all the comments. And they were nothing unusual.

I have to share this: almost 40 years ago I went into labor. Regular doctor was on his weekend off and doctor taking his patients delivered my baby. Of course, I'm in labor and don't even think to tell him my problems, just get this baby out!

Well less than 24 hours after giving birth, I have full-blown t/c and when I came to, said something about that being scary. Dr. says he was scared too. I say, you haven't given me my medicine for this, he says I didn't ask for it, didn't tell him about it. Ah, it's in my chart, isn't it?

I guess he never read it. Just came & delivered my baby, like I was just any old female he never saw before.

Hmmmph!

[Endless]

I agree with much of what the article in Eric's link said. I did go and get a second opinion on my MRIs, and the reading on my MRI's was slightly different that the original opinion. New one was more detailed, more informative, caught something the first one didn't. Better.

There are many centers of excellence around the U.S. that will do remote (not on-site) second opinions. You send your file and/or images. Here's an example at Johns Hopkins. It's expensive if you don't have insurance. My insurance would pay for it if I took advantage of it.

[Krista2882]

On the topic of hand-offs, this is actually related to nurses. My mom had a bleeding brain aneurysm in June. She was in ICU for 2 weeks, had surgery, then was in the step-down unit for 5 days. Then in a rehabilitation hospital for 5 weeks. I was horrified when I saw the mis-communication at that place between the nurses. The nurses would change shifts every day at 7 and anyway, just one example- my mom was given a sleeping pill one night. The next evening me and my dad went to see her and we couldn't wake her up. It was really scary. She eventually woke up after shaking her and yelling at her for a few minutes, and then she just wanted to go back to sleep. We found out she was given a sleeping pill the night before. She's very sensitive to medication, so we told the nurse to make sure she didn't get another sleeping pill. The nurse said she would pass it on to the night nurse. We went to see my mom the next day, and she was just as bad as the night before. It turns out the night nurse gave her another sleeping pill! It wasn't communicated by the day nurse. She was also on Oxycontin, and I did my own research and found that it's dangerous to mix sleeping pills with Oxycontin. So we said "that's it." And my dad got ahold of her doctor the next day and he made a note in her chart not to give her sleeping pills. But that was just one time we caught a mis-communication between the day and night nurses. We had to watch them like a hawk.

[stilldancing_98]

When I have been in the hospital, I make them tell me every me med I am taking when,what it is what is does and the nurses get mad. But I think I am civil.I am writing more down so I can't be fooled.Push it over and over to make sure she feels comfortal.Some times ( and it hard to sleep) and also if I can ask,what sleeping pill some of the pills are just plain bad for you.Good luck, Teresa

[Nakamova]

Just yesterday I was in the ER with shoulder issues, and I had to correct the doctor as he was typing in my info (he typed in the wrong shoulder). If I hadn't been paying attention and reading over his shoulder, it would have gone into the system incorrectly. Not a big deal in the scheme of things, but shows how a lot can still come down to human error and inattention.