Communication issues

Introduction

The consequences of poor communication in the delivery of health care can be dire, to say the least. Ultimately, poor communication can lead to unwarranted injury and death. A study assessing 10 years of malpractice lawsuits found that breakdowns in communication were one of the top three most prevalent factors contributing to malpractice lawsuits. The impact of miscommunication on patient safety is likely to be an even bigger issue when one considers that these statistics are solely based on actual lawsuits filed. Thus communication practices should be duly scrutinized as they relate to the ethical edict of “do no harm.” In the American Academy of Physician Assistants (AAPA) guidelines for the ethical conduct of the physician assistant (PA) profession, nonmaleficence is one of the four bioethical principles. Nonmaleficence means to do no harm or to not impose an unnecessary or unacceptable burden upon the patient. Conscious and deliberate communication within the delivery of medical care is essential to minimize costly errors. There are many benefits to effective patient-centered communication. For one thing, patient-centered communication improves patient satisfaction and safety and contributes to improved health outcomes. For another, successful communication can help to overcome health care disparities by removing biases from the conversation. When communication is successful, it can also positively affect provider job satisfaction. The potential that the right communication has to improve health outcomes, reduce medical errors, and even improve provider job satisfaction makes it a crucial point of discussion. This chapter focuses on five areas of communication in health care. These areas are patient-centered communication, health literacy and cultural competency, interprofessional communication, information technology (IT), and professionalism.

Patient-centered communication

Research has shown that no matter how knowledgeable a clinician might be, if the clinician is not able to engage in good communication with a patient, the clinician may be of no help at all. ^, A patient-centered approach to delivery of care improves communication and is an effective means to improve health outcomes and patient satisfaction. Patient-centered care starts with patient-centered communication. Patient-centered communication involves creating a sustainable health care provider–patient relationship. A sustainable relationship explores the patients’ perspective, expresses emotional experiences, demonstrates empathy, and engages in shared task-finding and shared decision making. Patients who are able to negotiate the best plans of care with their clinician have been shown to have had better success at achieving healthy lifestyle changes and adhering to treatment plans. Appropriate communication skills are also critical in managing emotionally charged situations, such as trauma and end-of-life situations.

How does the clinician know how well communication with the patient is going? Effective patient–provider communication is measured by the patient’s ability to follow through with medical recommendations, to self-manage chronic medical conditions, and to adopt preventive health behaviors. Effective communication also hinges on subjective feedback about the patient and provider’s feelings of the communication exchange. How one perceives the patient–provider relationship influences the experienced quality of communication. Therefore strengthening interpersonal relationship skills is an important component of care.

There are two major communication obstacles in health care delivery that are problematic to communication. These are communication breakdowns and common communication barriers. Breakdowns and barriers in communication hinder effective and collaborative communication. Identifying where these obstacles occur in patient-centered care and communication will help promote successful encounters.