Saturday, June 27, 2015

Physician-physician communication

Poor communication between doctors and patients, and between doctors and nurses, is discussed relatively frequently. But what about confusion between the teams of doctors who share patients in the hospital or clinic? 
I have seen this happen numerous times during my nascent medical career. Understandably, it is infuriating to patients and their families. It can also prove dangerous.
Miscommunication between a patient’s physicians is a major contributor to treatment and diagnostic mistakes. And too often, doctors who care for a patient in the hospital fail to communicate at discharge with the patient’s primary care provider, sowing confusion about what happened in the hospital and the plan moving forward.
A few months after the patient with liver failure passed away, I was caring for a middle-aged woman with metastatic cancer who was in the hospital for pain that had rapidly worsened. Images of her bones showed numerous fractures, and tumors had mangled her skeleton. As part of the medicine team, I worked with four groups of caregivers to figure out how best to treat her bone problems and minimize her pain.
As I approached her bedside one morning, she glared at me. Her pained grimace had turned to anger.
“Three different people came into my room this morning before you did, and all of them told me different things!” she sputtered. Each had recommended a different sort of procedure, she said, and it didn’t appear that any of them had discussed the options with each other – or the patient’s main doctors – beforehand.
After that, her nurse and I worked together to minimize visitors to her room so her primary physicians could synthesize the other teams’ suggestions into one cohesive plan. That greatly decreased her frustration and confusion, which allowed us to better evaluate her treatment preferences and needs.
As doctors, we place much emphasis on working with our patients to choose the right combination of interventions, and rightfully so. Yet I have seen that despite best intentions, patients and loved ones sometimes hear conflicting messages from caregivers about these plans.
In truth, medical care often entails myriad moving parts, which means the plan for diagnostics or treatment may change. Yet sometimes the way to avoid mixed messages is as simple as fostering a discussion between all members of the care team. Although medical knowledge is important, simply communicating amongst ourselves is a critical part of serving our patients – and one that is too often forgotten.
Courtesy of Doximity

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