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