Improving telephone communication with patients

Physician on telephone with patientTelephone communications with physicians, pharmacists, medical staff, and patients can result in miscommunication and lead to treatment and prescription errors. Anna Reisman, MD, and Karen Brown, MD, point out in their Journal of General Internal Medicine article that telephone communication may be error-prone because of technical issues and an absence of visual cues.

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How coaching a patient can improve care

In my years of seeing patients, I know that sometimes they can still surprise me. I can see that they want to quit smoking, or they want to lose weight—sometimes with a feeling of desperation—but they feel powerless to achieve their goals. As their physician, I want to see them get healthy so that they can prevent infections, diabetes, and all the other effects that are so difficult for patients to manage. For each patient, how can I find the key that will unlock the solution to their good health?

Case study:

A patient in her mid-20s was generally healthy, very bright, and thinking about applying to law school. However, for reasons she didn’t understand, she had developed a crippling fear of speaking in front of people. During presentations in front of her colleagues, she was frozen when she stood to talk and she thought, “It’s because I had surgery on my face, and everyone sees me as disfigured. They don’t even hear what I’m saying.” The trauma escalated, and she felt frozen when she even thought about speaking in public. Suddenly she worried that perhaps more was going on. Maybe the surgery had caused a neurological impairment? Maybe she’d developed a tumor?

Her doctor listened and said, “First, let’s do a workup to see if there’s anything neurologically wrong.” He performed an exam and determined that there was no problem. Then he used the technique of appreciative inquiry, which focuses on the patient’s positive experiences. “Tell me about a time in the past,” the doctor said, “in which you spoke in front of people and felt good about it.” After a pause she revealed that she had been able to speak successfully in front of people in high school and college. In fact, she had been valedictorian in high school and had graduated from a rigorous college program magna cum laude. During their conversation, she admitted that her friends and family didn’t seem bothered by her facial scars.

The physician said, “You’re intelligent, and I know you can overcome this fear. I would like you to look inside yourself and start focusing on your many strengths. What do you think about doing that?” Then together they decided that she would work with a wellness coach to help her find specific ways to focus on her strengths and overcome her fears.

The coach—who was trained to relate to patients using empathy, appreciative inquiry, motivational interviewing, and more—quickly developed a trusting relationship with the patient to learn about her struggles and her hopes for her life. With the coach’s encouragement, the patient developed goals and decided how to approach new opportunities to speak in front of a group. With small steps, the patient made progress and developed a newfound confidence whenever she had a presentation.

A few months later, she visited the physician for a follow-up appointment. Her demeanor and confidence were so changed that the physician remarked, “You’re a new person!” because the difference was so profound. As they talked, she revealed that after focusing on her strengths and trying new approaches to public speaking, she developed the courage to give a huge presentation at work and was extremely well received. Then she said, “My facial scars? I think I was using them as an excuse to explain why I wasn’t speaking as well as I wanted. People don’t really care about that at all.”

Lessons learned

What does this illustrate? To me, it shows that it’s our job as physicians to find out what will work for each patient.

Before I related to my patients in this way, I was frustrated with those who just wouldn’t follow through to get better. I thought, “Well, they’re just not responsible people. There’s nothing I can do about that.” I didn’t realize that my patients were failing themselves because I hadn’t taken the time to make that caring connection with them.

Once I am able to tap into a patient’s emotional life, I can help the patient discover the barriers that prevent him or her from quitting smoking, losing weight, taking medication properly, or exercising. And once we see the problem clearly, we can work on overcoming the barriers together. Working with a trained coach helps my patients work through the nitty-gritty of the tasks. And when my patients come back to see me, I cheer their progress and use my technique of appreciative inquiry to keep them on the road to good health.

To learn more about physician coaching and earn CME, attend a weekend workshop in Seattle for the Coach Approach: Transforming Health Care through Patient Engagement. Training takes place September 8-10 and November 6-8.

Managing opioid discrepancies with your patient

managing opioidsAs a clinician, you are aware of the many complications that arise from a patient’s opioid misuse, and you know about the regulatory scrutiny on providers who prescribe opioids. You are not only ultimately responsible for patient safety, but you are also responsible for how you respond and react in the face of challenging scenarios.

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Can we improve the accuracy of orders given to radiologists?

radiologist with head scanCase study

A 49-year-old male patient arrived at the ER with a chief complaint of dizziness and vertigo with nausea and vomiting. The treating physician ordered a noncontrast head CT scan, indicating a history of “headache” for the radiologist to review.

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Finding the words to help a traumatized colleague

iStock_000003517620Large-blogFor many in health care, experiencing a patient’s death is an extremely stressful experience. Some are able to process the experience in a short period of time and resume caring for patients. For others, the experience can be significantly worse—leading to high stress that doesn’t resolve, a repeated reliving of the experience, and a change in the way they function as caregivers. Continue reading

Ensuring effective handoffs

Verbal handoff of patient chartMiscommunication contributes to as much as 80 percent of medical errors, much of it occurring when care is transferred from one health care provider to another.1 In fact, in a 2006 survey of residents at Massachusetts General Hospital, 58.3 percent revealed that at least one patient was harmed in the course of their most recent rotation because of a problem with the handoffs. Even more troubling, 12.3 percent said that major harm occurred.2
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Improving how physicians and patients talk about medical tests

Physician talking to patient about medical testKnow Your Choices—Ask Your Doctor is a campaign sponsored by the Washington State Medical Association to promote better physician-patient relationships when discussing treatment options, expected outcomes, and quality-of-life choices. One of the campaign’s three initiatives, Choosing Wisely, a national program created by the ABIM Foundation and Consumer Reports, encourages patients and physicians to talk about the risks and benefits of medical tests and treatments. Continue reading

How can I convince my patient to get healthy?

Physician convincing patient to get healthyPhysicians arrive at medical school excited and hopeful. They come out of medical school exhausted, in great debt, mentally beaten down, and cynical. In our new practices, we quickly become overloaded, and our mission is just to get through the day—seeing patient after patient—without making any mistakes. We want patients to get better, but where is the time? Shouldn’t we expect patients to take our advice and follow through so they can get better? Why aren’t they listening to us? Continue reading

The most important part of the electronic health record

Physician and patient discussing the EHRAt my clinic, we are using an integrated electronic health record, and many of us have achieved meaningful usage targets. While this success has been building, however, a critical element of documentation in the EHR has been given less attention than it deserves: discussion of clinical decision-making rationale. Continue reading