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Dianna Booher discusses communication problems in hospitals and healthcare workers

Heaven forbid that you have to go to a hospital for treatment. But if you do, you better be conscious and strong enough to slog through the miscommunication swirling around you—or bring an advocate along to make sure you survive the stress and live through the ordeal.

A recent emergency with my father led him, my mom, and me to the Intensive Care Unit of a local major hospital. Here are a few communication blunders that transpired while there:

(In the Emergency Room while awaiting admission)

Doctor A: We need to do an endoscope immediately to see where you’re bleeding. (leaves the room)

Dad: (Shortly thereafter to nurse who comes into his room) When are they going to do the Endoscope?

Nurse: The doctor says they can’t do that today because you’ve taken Plavix for your heart before you came in this morning. They’ll need to wait until this afternoon or tonight. But we’re sending you to ICU as soon as they have a bed. They’ll tell you more up there.”

(Later in ICU)

Dad: So when am I having the endoscope—this afternoon or tonight?

Nurse in ICU: Who told you that? That’ll be in the morning. We only do those procedures between 7:00 and 10:00 in the morning.

(Next day after the procedure, with the doctor in the waiting room after the procedure)

Doctor B: (to family) Everything went fine. We found the problem and got him repaired. He’ll be fine and probably go home in a couple of days—depending on how he feels and his blood levels.

(Six hours later back in ICU, attending physician talking to patient and family)

Doctor C: Your vitals are looking fine. No more need for transfusions. How are you feeling?
Dad: Great. When can I go home?

Doctor C: That depends on when Doctor B releases you. He has the final say. Probably tomorrow. But he wants to see you in his office on Wednesday. When you get home, call his office directly to make an appointment for Wednesday.

Me: Do you know what caused the problem?

Doctor C: I haven’t seen the report. But typically it’s either a bacteria or cancer. We won’t know until the report comes back.

Me: Doctor B didn’t mention anything like that. And he didn’t mention sending off a report.

Doctor C: They always send off a report. Doctor B will talk with you about it tomorrow when he comes by if he has the report back—or on Wednesday in his office.

(The next morning, Doctor B comes by Dad’s hospital room)

Dad: So from your observation during the procedure, do you think it’s cancer?

Doctor B: No. It’s never cancer in that location.

Dad: When will the report be back?

Doctor B: I didn’t even send off the report. It wasn’t cancerous. No worry there. But you definitely need to take care of yourself until you heal. And I need to see you back in my office in 3 months. We need to repeat this same procedure. You can gradually resume your normal diet over the next few days.

Dad: Not Wednesday?

Doctor B: No. In 3 months.

(An hour later, dismissal nurse comes into Dad’s room)

Nurse: Doctor B is dismissing you as soon as we can get all the tubes out of you. He left a diet for you, and you’re supposed to see him again in a month.

Dad: (He burst out laughing. The nurse shook her head as if he and we, the family, were the confused ones.)

Nurse: I’ll have two prescriptions ready for you when you sign out.

Dad: Can you call those prescriptions in to the pharmacy, so they’ll be ready? Then we’ll just pick them up on the way home from the hospital.

Nurse #1: (big sigh) I don’t have time for that. But I’ll see if I can call a Charge nurse up here to do that.

(Ten minutes later, another nurse walks into the room)

Nurse #2 : You wanted something?

Me: Yes, if you’re the Charge nurse. (She nodded.) Could you call in a couple of prescriptions for us? I have the pharmacy number right here. The other nurse said she didn’t have time.

Nurse #2: I not allowed to do that! I would if I could, but that’s illegal! Only doctors can call in prescriptions. I don’t know why she told you that.

(An hour later when paperwork completed for check-out, Nurse #1 enters Dad’s room)

Nurse #1: Okay, just a few more pieces of paper and you’re ready to go. Here’s your diet.

Dad: (looks over the diet that the doctor didn’t mention leaving) This is a cardio diet—I’ve been on this kind of diet for 25 years. That’s not the problem this visit.

Nurse: Any time you have congestive heart failure, that’s what we treat for. That’s the primary.

Dad: So did the doctor leave me a diet for the current problem? He told me to resume my normal diet and you said he left me a diet. He isn’t my cardiologist so I don’t know why he would be leaving me a cardio diet. We haven’t even discussed my heart issues.

Nurse #1: (another big eye roll and sigh) Well, I’ll have to get in touch with his answering service and see if they can find him. He’s left the hospital already.

Dad: Never mind. Just let me sign and get out of here.

Diagnosis on Hospital Communication Problems

• Each department works in a vacuum, without knowledge of other departments’ hours, practices, procedures, or policies.
• Staff turnover leads to poorly informed employees.
• Workers leave unclear and incomplete notes in patient records. Consequently, shift changes and multiple doctors involved in one case often breed havoc.
• Workers simply answer questions other workers or their patients ask them—without understanding the bigger picture (why that person is asking the question and how they plan to use the information gathered).
• Doctors and nurses do not bridge the communication chasm easily.
• When there’s a miscommunication, many hospital workers adopt an arrogant attitude, assuming the problem lies with the patient.
• Workers do not listen carefully to each other or to patients.
• Workers speak and write with vague, general words.

Prescription for the Cure of Communication Mishaps

– Listen carefully to patients and their advocates. Do not assume that because patients are unknowledgeable in a medical field, they are incapable of communicating in a logical fashion.
– Keep clear records. Use a proper, repeatable format for notes.
– Use appropriate interviewing techniques—how to question and process answers from other medical experts and from patients.
– Separate fact from opinion.
– Be specific and precise, not vague and general when speaking or writing.
– Avoid speculating on issues outside your area of expertise.
– Provide job-aids so that workers are informed about the primary practices, services, schedules, and hours of operation of other departments.
– Deal with the retention issue (Admittedly, this problem stretches beyond the walls of any one hospital system, involving several industries and the government.)

As CEO of Booher Consultants and a keynote speaker, Dianna Booher works with organizations to address specific communication challenges and increase their productivity and effectiveness in writing skills, presentation skills, interpersonal communication, and client communication. An expert in executive communication, she is the author of 46 books, published in 23 languages. Her latest books include Creating Personal Presence: Look, Talk, Think, and Act Like a Leader and Communicate with Confidence, Revised and Expanded Edition. National media such as Good Morning America, USA Today, the Wall Street Journal, Investor’s Business Daily, Bloomberg, Forbes.com, CNN International, NPR, Success, and Entrepreneur have interviewed her for opinions on critical workplace communication issues. Clients include 22 of the top Fortune 50 companies. www.booher.com 1-800-342-6621

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20 thoughts on “Communication Skills: A Diagnosis and Prescription for Hospitals and Healthcare Workers”

    1. Thanks, Sandy. I would like to say my experience last month was an isolated one. Unfortunately, it was not.

    1. True, Fran, the elderly do need “common” or nontechnical language about their medical condition or procedures. But so do the rest of us. Another thing about commmunicating with the elderly: Many have a hearing impairment as they grow older (as is the case with my mom). I continued to ask (or signal) each nurse, doctor, or technician who came into the room to speak a little louder. Most did so graciously; others looked irritated and continued to mumble in low tones. Totally unacceptable.

    1. Thanks, Carmen. Glad you found this prescription on target. Now, …. getting it into the right hands is the next challenge.

    1. You are correct in making application of this “prescription” to running all businesses. Poor internal communication always shows up to the customer as poor service.

  1. What a great post! And wonderful for you and your dad that you could handle that kind of arrogance and incompetence with such grace. AND come up with a great blog post about the importance of clear communication in a hospital that could really be applied to any business!

    Ugh – seems like it is pretty amazing that more people don’t just die by accident in hospitals.

    1. So right, Susan. And those accidents are a key reason that insurance premiums are going through the roof–not to mention the death of the victims and the grief suffered by families!

  2. As an ICU nurse I can perhaps give a little insight from the other side of the hospital gown:
    You seem disturbed that the ER said immediately on the endoscpe and the ICU said differently. Just so you know, an ER Dr’s job is to treat emergent conditions, stabilize the patient and move them on to an appropriate level of care. They coordinate the admission with the admitting Dr. The admitting Dr. is the attending physician and he then gets to call all the shots. He calls in the consults and coordinates with all the other MD’s from that point. No Dr can or should tell another Dr how or when to practice their type of medicine. It is up to them. Now back to your situation. The endo guy apparently didn’t agree that the situation was emergent enough to do it reguardless of medications so it was put off until the AM which is the preferred time for that proceedure b/c that’s when his staff of nurses are there at the hospital. They know how to set his patients up and get his equipment ready. As an ICU RN I can tell you that had it truly needed it, he would have been called in and I would be his assistant at the bedside even though I don’t know anything about doing the procedure so he would have to tell me everything he wanted me to do.

    As for the when to schedule a follow-up I can’t speak to that situation in particular but often MD’s read other physician’s progress notes which have a Plan Of Care, POC, section and maybe the endo guy mentioned Wednesday follow-up or often they talk over the phone during the initial consultation and talk over a general POC. Also things change over night. If everything was looking good the endo guy might have changed his mind. Who knows.

    As for the last concern. As an ICU nurse I can assure you I know nothing about calling in prescriptions. Pt’s aren’t often discharged from ICU unless it’s to the morgue. There are hoops to jump through due to HIPAA that I can’t concern myself with because I’m dealing with life and death, and don’t have time to sit on the phone for 30 minutes talking to a pharmacy and trying to figure out all the paperwork that has to be filled out just so you don’t have to wait at a pharmacy. We usually deal in continuous drip infusions that require our attention (That’s why we only have 1 or 2 patients). I hate to say it because we’re supposed to be all customer service and crap but the fact is, It’s not my job. Would you like me to be on the phone calling in prescriptions while your blood pressure drops due to the IV I’m not attending to? How about I let you continue to cough on that ventilator because I can’t get in there to suction the secretions out of your tube.

    As for your recommendations most are already in use. Most hospitals use SBAR format. Standardized handoff communication is mandated by JCAHO for accredidation.
    Dr’s already separate fact from opinion. They call it objective/subjective. Dr’s and nurses often speak outside of our areas of expertise b/c pts’ and their families keep prodding us for information so we give a general answer that hopefully satisfies them because they keep demanding it.

    1. Wade, thanks for expressing your opinion. It sounds like you have a very tough and stressful position. Let me clarify a few facts in our situation: 1) My dad eventually got moved out of ICU to a regular floor. We never asked an ICU nurse to call in a prescription. We asked the discharging nurse if she could call in a prescription. When she said that she didn’t have time, but that the charge nurse could do so. If she had said “no,” we would have dropped the issue. My point in the blog was that the nurse was unknowledgeable about what the law was–and what a charge nurse could and couldn’t do. 2) We never kept demanding any doctor or nurse to give an opinion about a medical question. Instead, in the absense of simple answers to simple questions such as these: “Do you know when we can expect test results to be back?” “Which doctor will discuss test results with us?” “Which doctor am I suppose to see for a follow-up?” “Doctor X said to follow up with him in a month. You said I was supposed to be in his office on Wednesday; which is correct?” “Am I suppose to be on a restricted diet? The doctor said to resume my normal diet, and you said the doctor left a diet for me. Which is correct?” we kept getting conflict answers. The blog also made a point about the impatience and arrogance of a one particular nurse and one particular doctor–as if it were the patient and family who were all confused rather than the conflicting information they were being given.

  3. What a comedy of errors! However, in this case, it wasn’t very funny since it was your dad’s health that was at stake.

    I can see where mistakes like this can be very frustrating for the patient. These things happen in so many businesses. It’s a good thing there are organizational communications experts like you to help with issues like these!

    1. Yes, Gina, looking back it was comedic–just not at that time. And you’re right again when you point out that these kinds of snafus surface repeatedly in businesses of all kinds. The tragic thing is that poor internal communication eventually shows up to the customer as poor service.

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