April 26, 2018
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Improved Communication Equals Improved Care

By By Dr. Jonathan Wood, Eastern Maine Medical Center

Being admitted to the hospital can be scary and traumatic for patients and their families.

Being critically ill, needing invasive procedures or having a hospitalized child all accentuate these feelings. Medical jargon is often difficult to understand, the issues discussed often carry great importance, and there are often unanswered questions. What’s more, caretakers often seem to be overworked or in a hurry.

And then money is invariably an issue: missed work, inadequate insurance, childcare needs, day-to-day living away from home, etc.  More stress.

In the end, many people report a sense of “loss of control”.  What can be done? Arrgghhhh!

While I cannot offer a fix for the sometimes-beleaguered state of modern medicine, I will suggest one central thing that can help with all the above:  improved communication.  And much of it is within your control.

Here are some suggestions:

Ask questions.

  1. Who are you? Insist that people introduce themselves and explain their role in your care.  Where do they fit in the lists above?
  2. Why are we doing this? Insist on understanding why tests are being done and what is going to happen with the information.
  3. May I speak with my doctor? Ideally there is one doctor orchestrating all of your care.  Ideally there is excellent communication between doctors and amongst all the participants in the care team. Insist on a team and a good leader.

Learn the system — who are all these people?

Hospitals depend upon a complex system of personnel that is often very confusing and very difficult to understand.  Examples:

  1. Primary care doctors, such as internists, family practitioners, or pediatricians.
  2. Inpatient specialists such as hospitalists or intensivists.
  3. Specialists such as surgeons, psychiatrists or OB-Gyns.
  4. Sub-specialists such as cardiologists, neurologists or orthopedic surgeons.
  5. Mid-level providers such as a nurse practitioner or physician assistant
  6. Nurses, including bedside nurses, charge nurses, and nurse managers.
  7. Ancillary personnel  such as respiratory therapists, physical therapists, occupational therapists, nutritionists, social workers, and care managers.
  8. Trainees including medical residents, nursing students and medical students.

Tell your caretakers your worries – don’t be afraid to tell people what concerns you or what would make you more comfortable.  Nothing is off limits!

Believe in the system.  Much of believing is understanding.  Work to understand the system (see above) and increased confidence will follow.

Don’t worry about offending. Doctors are people — you can talk to them like you talk to anyone.  Sometimes people feel intimidated, but it is important to move beyond this.  Be yourself.  Remember: you are the consumer.  Be polite and expect the same in return.

Leave your biases at home

  1. Gender. The days of female nurses and male doctors are long over.  Do not make assumptions based on gender and treat all your caretakers with respect.  Insist on the same in return.
  2. Teaching hospitals. Much of the best care in the US is delivered in teaching hospitals.  No one is experimenting on you.  On the contrary, these are often very concerned, very smart, and often less busy students or residents who can be very helpful in you quest for quality health care.  Take advantage of the opportunity!
  3. Culture differences. Maine attracts caregivers from all cultures.  These people are invariably well trained and very caring.  Treat them with respect and expect the same in reverse.  If accents are difficult to understand, be frank, polite, and patient.

Know what is expected of you and your family when you are discharged.

  1. Ask questions
  2. Get to know your “care manager” or “discharge planner”.
  3. Be sure you understand your medications and doses, especially any changes from when you arrived.
  4. Ask to have instructions repeated as many times as it take to understand.
  5. Know who you need to see after leaving, and where and when.

While these suggestions won’t make being hospitalized fun, they may take some of the unnecessary fear and anxiety out of the process.

In the end, remember…communication is the key!

Dr. Wood is a pediatric critical care specialist and medical director of Eastern Maine Medical Center’s pediatric intensive care unit.

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