For the physician, she says, “there are so many things to communicate and because it is often very complicated, the relationship and the trust have to be built quickly, and information has to be transferred very quickly. Poor communication will lead to potentially not being able to build that alliance with the patient during that short period of time of their hospital experience.”
Hospitalists must be on the lookout for how the constraints of time affect the way they practice and relate to their patients because every nuance of behavior or tone of voice can make a difference to how a patient perceives his or her doctor.
For example, in a study conducted at Harvard University in 2002, investigators used audiotapes of 57 surgeons, 36 of whom had had two or more malpractice claims filed against them.9 Patients were asked to listen to two 20-second clips of audio between these surgeons and two patients. Those surgeons who were judged by the tone of their voices as “high dominance” and “low concern/anxiety” correlated with those who had had previous malpractice claims.
Because there is no continuity of relationship to help steady what might be an emotional response when things go wrong in the patient’s treatment or when patients and families are upset by circumstances, hospitalists may be subjected to blame, resentment, fear, and displaced anger concerning their communications with patients and families.
“Especially if you’re harried in an incredible time crunch, if you don’t [communicate] with patients and patient families [about] what is going on [in their care], those relationships very quickly can turn antagonistic,” says Dr. Trowbridge. “And then the very thing most of us like about medicine—relationships with patients and families—becomes something that people tend to avoid.”
Dr. Trowbridge says that this can become somewhat of a vicious cycle whereby a certain extent of inadvertently “avoiding the patient and family may lead to further communication faults.” On the flip side, using good communication can be a circular process but in a positive way: A good communicator may experience better well-being, which in turn, leads to better communication skills.2,5 Also, on a practical level, the data are clear that bad communication puts you at risk for malpractice litigation.9,10
Communication with Colleagues
“People that don’t have very good communication skills tend not to be successful,” says Dr. Vidyarthi, who practices with the hospitalist group at UCSF and is also an assistant professor there. Her definition of success is closely linked to the quality of relationships; that is, “being well liked by the nurses, building working relationships with … the nurses,” as well as others, including the hospital administrator. “Hospitalists are almost always … doing quality work or performance improvement,” she explained. “They’re on committees. That is the nature of what we do. … Not learning what those [communication skills] are and [not] being able to communicate at [effective] levels would … be a detriment to one’s personal job advancement, but absolutely to one’s job satisfaction as well.”
Collegiality, in fact, is one component cited as a “powerful engine of socialization” in organizational structures more likely to foster the lifelong learning and commitment that are inherent to medical professionalism.1,3-5,11,12
Many of the components of effective communication with colleagues parallel those that are best used with patients. “Communication is what holds that team together,” says Dr. Vidyarthi, whose interests include information transfer and communication as a form for team-building. “In academic medicine, poor communication can impact the teaching environment, the experience of the students and the residents, and that team cohesion. And that can lead to poor patient care, it can definitely lead to a poor educational experience, and it is not enjoyable, so job satisfaction suffers.”