Falling of Deaf Ears - The Communication Barrier in Healthcare
There seems to be a rather common communication barrier in Medicine/Healthcare.
Day in and day out, I see patients who express a common pattern of frustration -- a lack of communication between them and their healthcare practitioner. This may be a Primary Care Physician, it my be a Specialist or Surgeon, it could be their last Nurse while in hospital, or it could be their last Physical Therapist or Chiropractor. Being an out-of-network provider, by the time the get into my door, most have been through the system and are seeking something different. I am by no means the only physical therapist in Las Vegas practicing in a small, boutique practice and seeing patients one-on-one, let alone across the country, but our style is certainly not the majority.
The common complaint is that the patient does not feel their voice was heard. They do not feel like what they were conveying was listened to, understood, or they many not have even had the opportunity to ask their questions or voice their concerns. Many patients state that their wait for the appointment was long, sometimes multiple hours depending on the office, and their actual time with the Provider is a matter of minutes. Others complain that they didn't get to actually see their Provider but instead saw their support staff or extenders. While these extenders may be great and provide the same high quality of care, perception once again rules.
With the continued trend of ever declining insurance reimbursements, many offices are seeing a higher & higher volume of patients and the Practitioners may simply have less time to spend with each patient. As Physical Therapists we have a unique position in that our patients are generally with us for an entire hour or half hour. We start by listening, by asking for their take on what their issues are, what their goals are, and what they feel is going to work for them. We can often alleviate a lot of anxiety and misunderstanding just by answering their questions and explaining what we are doing and how we can help them.
Far too often clinicians discount the value of the patient's take on what they think is going to work. Sure, you do occasionally get the patient that answers "I don't know, you're the one that went to school for this" -- touche -- but most have some idea of what they perceive as beneficial. Often times, they are right. Put another way, as an individual we often say "Well no one knows my body the way I do, because it's my body and I am conscious of it every day." Okay. So why is different for our patients? Would the same stance not apply to them?
Communication is key, and is coupled with Education. What you say, how you say it, and what the patient's perceptions are can make all the difference in the world. A patient who understands the plan, what you are attempting to accomplish, and why it can benefit them is far more likely to buy into the treatment plan and be compliant with their home program.
If we as Healthcare practitioners are going to effectively and efficiently help anyone, it would seem that the first thing we would do is listen to what the patient or client's problems are and what they are wanting to overcome or get back to doing. It is a bit ironic, given the first step in any clinical appointment is the history taking interview. It seems that this would be the first place where the patient would get to voice their needs.
Additionally, setting Patient Goals are an important part of treatment planning, and will ultimately help the clinician to establish Treatment Goals, both of which should be reflected in programming. If the goals of the patient do not align with the goals of the clinician, there may be resistance from the patient. Likewise, if the goals of the patient simply are unrealistic then certainly a conversation needs to be had on why the clinician feels their goals are not realistic. Take our average mid-40s office worker who tears their ACL and has to undergo reconstruction surgery. If the patient feels they are recovering too slowly based on the fact at Adrian Peterson returned to playing so quickly after he had his reconstruction surgery -- we may have some unrealistic expectations.
As Healthcare Practitioners, the last thing we want is for our patients to feel like their voice is falling on deaf ears. I find that looking back on past experiences, it seems that there are some offices who have found a way to make it work. One Orthopedic Surgeon had a Patient Care Coordinator who basically was the go-to person that could answer the patients questions and provide a direct line of communication. Other offices utilize a nurse or MA for this role, and in most cases these offices had a rather low rate of patient complaints. Again, the Practitioner may have provided great care and done everything they should have and more, but if the patient feels they were not heard or they do not understand why they are scheduled for a certain procedure or why certain test was not ordered, their account of the visit may not be as positive as it should be.
At the end of the day our goal is to help as many people as we can, as much as we can, and to the best of our ability. Mindset of the Practitioner is also another key variable. Clinicians who are overworked, stressed out, and frustrated themselves will often find the encounter with the patients clouded by it as well. Even when trying not to let it show, if the Practitioner is thinking about the other 3 exam rooms that have patients waiting to see them, they will not be present with the patient currently in front of them. Being present, in the moment, and aware of the encounter occurring at that time will often yield a much more fulfilling experience for both the patient and the Practitioner.
The business side of healthcare will most likely always exist, and it is understandable that there has to be balance as it is after all a business. Hopefully we can continually work to listen to our patients, provided them a level of services greater than what they expect, and have a business that is rewarded for quality more than volume. Either way, it begins and ends with communication.
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Thank you for stopping by the Athletes Physiotherapy Blog! Kristopher Bosch founded Athletes Physiotherapy in Las Vegas, NV. He is a Father, physical therapist, athletic trainer, pilates teacher, & perpetual student!
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