Guest post by Calvin L. Chou, co-author with Laura Cooley of Communication Rx: Transforming Healthcare Through Relationship-Centered Communication.
As a practicing internist at an academic medical center, I spend most of my time in the outpatient setting, and I spend a couple of months supervising trainees in the hospital. A short while ago while starting my ward attending stint I met Mr. Bailey, a 68 year-old veteran who had undergone a Whipple procedure, one of the most complex procedures that surgeons can do, to remove a pancreatic mass. Complications placed Mr. Bailey in the ICU for a prolonged stay due to infections and respiratory failure. His wife was constantly by his side. Previously, they had developed deep trust with the surgeon who had diagnosed his mass and who had followed up with him for more than 5 years. Their first question when I met them for the first time: “Do you know Dr. James? She is so fantastic.”
Message #1: Families can become very aligned with health care professionals who they trust.
Though my intern was doing a very good job taking care of the patient’s daily medical and logistic needs, he had not met Dr. James, who had been away for a couple of weeks. In that time, Mr. Bailey had transferred out of the ICU, and we were preparing for a careful and safe discharge for him (in part because his wife was doing such a terrific job looking after him). But then Dr. James returned to town, and, alarmed that we were considering discharge, started ordering a whole bunch of tests.
After a call with Dr. James, my intern was distraught.
“She kept asking me question after question, interrogating me. She wouldn’t let me finish. Once I’d finally got all the information out there, she kind of said nothing and basically hung up on me. She was being so passive-aggressive. And she wants to talk to you.”
Does this sound familiar?
You can imagine that what I most wanted to do was to defend my intern. You can’t treat him that way! He’s doing a great job! And we’re the primary team – don’t order tests without consulting us!
Message #2: Although we may have done everything right, there are always differences of perspective, and strong emotions can arise.
In these cases, skillful communication – and recognizing but checking our own emotions – can really help.
I made certain to use the fundamental skills that apply to every conversation in healthcare. First, I made sure to elicit the list of what was on Dr. James’s mind. These included her worry about Mr. Bailey’s respiratory status, his ability to function at home, and our shared deep respect for his wife’s strength and skills to care for him. Second, I responded to any emotional cues I noted. Finally, I made certain to use short, easily understandable chunks of information, avoiding a long download that could increase resistance. In this case, without prompting, Dr. James also remarked on my intern’s great thoroughness and attentiveness to detail, obviating my underlying feelings of defensiveness and righteousness.
I’m not trying to imply that we can always navigate challenging conversations so easily. But I know that when I can methodically use the fundamental skills, my worst fears are rarely realized, and the result is usually positive and builds relationships.
Calvin Chou, MD, PhD, is Professor of Clinical Medicine at the University of California San Francisco and staff physician at the Veterans Administration Medical Center in San Francisco. As Vice President for External Education for the Academy of Communication in Healthcare, he is nationally recognized for his education and research to enhance communication between patients and physicians.