STRONG WORKING RELATIONSHIPS WITH PATIENTS PROTECT HEALTHCARE PRACTITIONERS

The following information was released by the Ohio State Medical Association (OSMA):

Provided by The Doctors CompanyOSMA's exclusive partner for medical liability insurance.

Daniel Kent Cassavar, MD, MBA, FACC, Medical Director, The Doctors Company and TDC Group

Recently, a new patient arrived expressing dissatisfaction with a cardiologist who had told them that there are only two causes of atrial fibrillation. This other cardiologist reportedly said: You either have sleep apnea, or you drink too much.

I acknowledged those two causes but also listed others, such as valvular disease, thyroid issues, and electrolyte abnormalities. My patient said the other cardiologist had been adamantand had told the patient that if they didnt like hearing an unpleasant truth, then they could leave.

Good Communication Can Save Lives, Sanity, and Resources

New research published in theAnnals of Internal Medicinehas shown thatpoor communication contributes to 24 percent of patient safety incidents, and it is the sole identified cause in 13 percent of incidents. Similar findings permeate The Doctors Companysclosed claims studies(and the bulk of risk management literature). For example, in The Doctors Companys study of closed claims against cardiologist members, one-third of allegations were related to diagnosis, andcontributing factors related to communicationfeatured prominently.

Fortunately, effective physician-patient communication has the power toimprove patient adherence and patient outcomes. It reduces both the odds that something will go badly for a patient andthe odds that the patient will allege malpracticeif it does.

Patient-Centered Terminology Builds Rapport

In the U.S. overall, just12 percent of our patients are highly health literate. Many people nod along to be polite or may be afraid to ask for clarification, so lets remember that cultivating a strong working relationship with a patient begins with simply establishing a sense of give and take.

For a model, we might look to our personal relationships. I have friends who can change a timing belt on an engine or chainsaw a tree, and I dont always speak their lingoevery activity has its specialized knowledge. To a patient, I might explain atrial fibrillation in terms of the more familiar atrium. Ill note that an atrium is where you receive things. Your heart has two atria, which are the receiving chambers. And so on.

Hopefully, in each clinical encounter, were trying to understand the patients level of health literacy to meet them where they are with patient-centered terminology. Its easy for me as a cardiologist, or for you in your specialty, to wow the patient with brilliant medspeak, which is what the American Medical Association (AMA) calls those long Latinate phrases from the patients perspective. But medspeak isnt very helpful, even if Ive said something brilliant, when the patient doesnt understand it.

We know that poor patient satisfaction connects to alower rate of adherence and a higher likelihood of alleging malpractice. On the other hand, research confirms that a strong interpersonal relationship between physician and patient can exertpowerful protective effects.

The High Wire and the Safety Net

Rapport is a safety net. It is woven from threads of both interpersonal connection and patient understanding, so that in case of a known complication, the patient can say to themselves, Well, he did explain it to me. I did understand there were risks. But without understanding, there's no rapportand no safety net.

Communication With Structured Tools

In our daily practice, structured communication tools can help us, like the balancing poles that tightrope walkers hold to keep their bearings. They can remind us of our commitment to patient safety and our imperative to protect ourselves and our practices from preventable liability exposure. I found the AMA article onRESPECT: Rapport, Explain, Show, Practice, Empathy, Collaboration, and Technologyvery helpful.

RRapport:Nonverbal cues like eye contact and overall demeanor can demonstrate present-minded attention.

EExplain:Give patients opportunities tofully explain their symptomsin the context of their life outside of healthcare. This can aid accurate diagnosis.

SShow:Consider providing access to educational materials, trustworthy websites, or support groups.

PPractice:Anyone can choose one aspect of communication to practice improving.

EEmpathy:Some patients are embarrassed to disclose symptoms; othersdont want to admitthat they havent adhered to their treatment plan. Empathy invites more accurate information from the patient.

CCollaboration:Patients are more likely to follow your recommendations in a collaborative atmosphere.

TTechnology:Be selective with communication channels, and stick with patient-centered terminology in written communication.

What Gets in the Way?

If a clinicians working relationship with a patient can help shield the patient from poor outcomes and the practitioner from liability, why arent all of us getting to know our patients better? What is getting in our way?

Answers includestaffing shortages, production pressure, time pressure, lack of education in bedside mannerand lack of willingness to ask for help.

It Takes a Team to Promote One-on-One Focus

One morning, I was in the cardiac catheterization lab for a case that should have taken three minutes. However, the patients unusual anatomy had us trying one catheter after another, then changing sites from the wrist to the groin, and then calling in a colleague. To make a long story short, a three-minute procedure took an hour and a half.

Meanwhile, my office staff members were relaying requests for a call back from the ER,a patients primary care physician wanted to talk to me, and so on. I gave a status update: Please ask my partner to pick these up. I will get back to you as soon as Im done. My partner could handle those communications, no problem, but my front office was unaware I needed assistance.

Now weve come full circle: In order to maintain my personal focus on the patient in front of me, I need excellent collegial collaboration.

Sit Down, Connect, Focus

When residents rotate with us and they have questions about rapport with patients, I tell them to sit down, connect, and make the patient the most important thing at the momentbecause they are. If things go badly, I tell them, you're going to want to say, I gave it my all here, even though it didnt go well.

We cant control all outcomes, but we can know that we showed up and were mentally present to help the patient. We can know that we engaged in a true conversation.