In his third post for
Progress Notes, Dr. Selinger explains that good communication -- which is the key to a high functioning health care system -- extends far beyond just doctor and patient and must be maintained across all touch points in the health care system.
By H. Andrew Selinger, M.D.
When I get sick, I want to know what’s wrong, how I can get better and all the details in between. If I need to get tests, why? What medicine do I need to take? If I don’t need to take medicine, why not? How long until I get better and what can I expect along the way? In sickness, education is just as important as treatment. Education and dialogue reduce stress and promote healing.
Likewise, when a patient comes to me for an employer/Medicaid/Medicare
-encouraged “wellness examination,” I want them to know what tests they need and, just as important, what tests they don’t need. My job is to tell my patients what problems I identify and what they need to do to successfully address them. Nowadays, we use “teach back” and motivational interviewing to be sure our patients understand our instructions and to alert us when they are ready to make a behavior change.
But doctor-patient communication is just one small aspect of the communication necessary to make health care high quality care. There are countless points of contact a patient can have with the health care system, and unfortunately, each operates in its own independent silo and they often do not communicate well with one another. Not only does good communication reduce patient anxiety, enhance patient well-being and reduce frustration and confusion, but it also avoids mistakes and saves lives.
In a time of increasing focus on improving outcomes while lowering costs
, every health care provider should be committed to improving communication between the many different touch points of the health care system and enhancing the personal communication between patients, health care professionals, and non-medical caregivers and family members. But first, we must all be keenly aware of each of the points with which we must communicate.
Beyond doctor-patient communication, the medical staff office has a responsibility to communicate with the patient as well. A patient’s responsibility is to tell health care providers everything about their personal health history, family history, lifestyle, habits and any concerns and questions they have. The medical office staff's responsibility is to collect and update this information so your health care providers can access this whenever and from wherever they need it.
Another touch point in our health care system is specialists. Unfortunately they are not expected to send reports to other specialists involved in a patient’s care. All information is supposed to funnel to the primary care clinician and then be available to other specialists at the primary care “hub.” When this doesn’t happen, it’s a recipe for missed information. Until everyone can exchange data electronically, it often falls on the shoulders of the patient to keep his or her medical information straight, and that's simply not a reasonable expectation.
Primary care doctors and specialists need to share information so everyone has a list of current medications, up-to-date test results and medical findings. This helps to avoid taking duplicate medications, medication interactions and incomplete sharing of test results.
This is the reason for the creation of the patient-centered medical home
(PCMH). My medical office staff is now a primary care “team.”
They formally accept the responsibility to serve as the “hub” for all patients’ health care information. It’s our job to make sure that we reach out and collect that information whenever it is generated from wherever it is generated. It is also the job of every medical team to coordinate its patients’ care, however complex their needs may be, in a timely and efficient manner. Navigating the health care system on behalf of our patients is one of the most important jobs that we do.
The nurses, therapists, counselors, pharmacists, medical assistants and all the other health care professionals that make up the PCMH team are often my eyes and ears in the field. In my patients’ homes, at the nursing home, in the hospital, at the pharmacy and even in my own office, my colleagues’ participation in patient care undoubtedly improves patient outcomes. If it takes a village to raise a child, it takes a team to take care of a patient.
Still, landing in a hospital or skilled nursing facility is often for some patients. Transitions in and out of these facilities and back home and back to the doctor’s office are the Achilles heel of the health care system. When transitions are handled correctly, we complete the circle from health to sickness and back to health again. But when done poorly, patients suffer, relapse, return to the hospital and cost the health care system unnecessary billions annually.
Communication often extends beyond the patient, too. For many patients, it’s crucial to include non-medical caregivers and family in the information loop. Elderly patients with visual or hearing impairment, those with language or cultural barriers, and those suffering from dementia all need help managing their health care needs. Involving, educating and responding to caregivers and family members can go a long way toward promoting health and wellness and avoiding or delaying hospital admissions or readmissions and eventual nursing home placement.
Good communication extends far beyond doctor and patient. It includes so many touch points in the health care system and often patients’ families, loved ones and other caregivers. Communication that is compassionate, patient and respectful both between the patient and all of these touch points and among all health care professionals is the linchpin of highly functioning health care and optimum patient health.
H. Andrew Selinger, M.D., is a family physician and an associate professor at Quinnipiac University's Frank H. Netter MD School of Medicine and University of Connecticut School of Medicine.
Also on communication