Communication in Medicine: making yourself understood
In this month’s blog, Joel considers the troubles that we can all face when trying to communicate with other medical professionals. Do you know your ALS from your ALS? (yes, they are different). How would you communicate in an emergency? Do you know the common pitfalls in medical communication?
Clear communication between medical professionals is vital. It’s probably one of the few skills which requires all 5 or 6 years of medical school to really get to grips with. It’s a skill that is assessed in medical school OSCEs, and is certainly something that is rigorously tested from day one as a junior doctor. Every day is spent ‘handing over’, presenting patients on ward rounds, making telephone calls to refer patients, writing emails, or composing discharge summaries. Communication between different healthcare professionals needs to be accurate, concise, and engaging!
How much teaching does the average medical student receive on communication? Medical schools now teach communication skills for patient consultations as a core part of the curriculum. Hopefully, exposure to real life clinical practice during clinical placements also gives pointers on how to present clinical cases to consultants and GPs. It can be easy to focus on these areas as big topics for exams (and that’s what our OSCE guides and courses try to help with too!).
However, life as a junior doctor is more complex than that, and medical school teaching can sometimes miss out on the difficult aspects of intra- and inter-professional communication. The subtleties of communication within your firms, between medical teams, and with other healthcare professionals are numerous. Medical communication is built upon well-established foundations of specialist terminology, acronyms and euphemisms. Non-medics need only watch an episode of ER or Grey’s Anatomy to get the idea – it is easy to completely loose the thread of a conversation unless you know your medical jargon.
Observe the communication techniques used by colleagues and supervisors. You’ll find an array of different tactics and shortcuts. Take abbreviations, for example. These are numerous in medicine, and arguably with good reason; medical terms are frequently long winded, and abbreviations and acronyms provide ‘shortcuts’ that save time. But, there are potential pitfalls. The same TLAs (three letter acronyms) can represent different terms. ‘RSI’ can mean something different to an anaesthetist compared to a general practitioner (rapid sequence induction vs repetitive strain injury), SBP might mean something different to a gastroenterologist (spontaneous bacterial peritonitis) than a nurse (systolic blood pressure), and ALS could allude to a degenerative neurological condition or the method for resuscitating a patient in cardiac arrest.
Sometimes, even the same medical term can represent different concepts to different people. Whilst working on implementing a new induction programme for new foundation year 1 doctors a few years ago, I was explaining to the consultant running induction that it was vital that junior doctors learn how the ‘multidisciplinary team’ works. He had looked confused, asking me whether I really thought that it was that important for FY1 doctors to know about MDT meetings. It became apparent that we were talking about different concepts. I was referring to the therapists and allied health professionals who are essential to helping patients rehabilitate and return home safely from hospital (and who junior doctors talk to on a daily basis). The consultant, as a cardiothoracic surgeon, had a different concept of a multidisciplinary team – involving cardiologists, surgeons, radiologists and much discussion about coronary arteries and valves.
How about the way in which things are said in the medical world? I remember clearly being chastised in my final year of medical school when I presented a patient to one of my cardiology consultants. I thought I had presented a perfect summary of the patient, with a thorough description of her presenting complaint, her multiple issues and her numerous blood test abnormalities. “But Joel, you haven’t told me how unwell you think the patient is!”. My consultant had wanted me to start my presentation with an honest comment on the patient’s condition. He had wanted me to convey at an early timepoint that this patient had multi-organ failure and a very poor prognosis. A fair comment, and one that I have taken with me ever since.
Medical communication can also stray too far into the colloquial. Whilst most medics avoid inappropriate or controversial language (despite the media’s perception), there can be a tendency for doctors to use euphuisms when in crisis situations. At a recent training day on Human Factors in Transfusion, we were presented with a real life post-partum haemorrhage case study. During the case, the anaesthetist involved in the case had called the transfusion laboratory and stated simply “send me everything”. The blood transfusion laboratory staff member didn’t really know what was meant by that statement – the urgency of the request was clear, but the precise meaning was not. It seems, in retrospect, they should have just asked for the next ‘pack’ in the major haemorrhage protocol.
Are euphemisms conducive to accurate communication? Probably not. Airline pilots, although prone to using their own jargon and abbreviations when talking amongst one another, are well known for precise, clear, and concise communication in times of crisis. In medicine, euphemisms and colloquial language are used to give perspective on a situation, but it must be remembered that in emergencies and during critical procedures, clear and simple language is much more useful.
Ultimately it takes months, even years, of practice as a junior doctor to be able to provide accurate and concise medical communication whilst simultaneously being able to impart your own perspective on the problem. Being aware of the potential pitfalls is an important first step, and the only way to get better is to practice! Take opportunities as a medical student to practice: presenting patients on a ward round or handing over to an on-call doctor – you might not get it right to start off with, but you’ll learn something each time you do it.
Top tips for communicating with other medical professionals:
- Try to avoid using acronyms and abbreviations unless you know that the term is well known and widely used – will the person that you’re talking to know it?
- Give your own thoughts and perspectives on a case when you’re presenting or handing over – as a junior doctor you will be helping to form management plans for your patients and in order to do so you need to practice forming diagnoses and assessing the severity of situations
- Keep communication clear and simple during emergency situations. Things will get done more quickly and the rest of the team will be grateful for your clarity!
- Take every opportunity you can to practice presenting, referring, handing over and writing patients summaries. Practice is the only way to get better.