Newsletter
How Patients Filter Clinician Communication
Oct 30, 2018
Patients’ actions, or inactions, are based on their comprehension of the information you convey to them and their assessment of its severity and urgency. Patients who misunderstand or fail to retain critical clinical information are at increased risk for preventable adverse events. As their health care provider, you are at risk of an allegation of miscommunication and its consequences.
Health care communication passes through filters of understanding unique to each patient. Physical and mental health status, age and education, bank balance and insurance coverage, and dozens of other factors modify the intended message into the message received. Clinicians conveying distressing news about a patient’s condition or complex instructions for ongoing treatment must take into account the fact that comprehension will likely be limited—even for patients who credibly indicate they’ve understood every word.
Analysis of more than 64,000 medical professional liability (malpractice) cases from CRICO’s national Comparative Benchmarking System found provider-patient miscommunication in 19 percent of those cases (23 percent for outpatient cases).
The Most Common Breakdowns Occur in Five Key Areas of Provider-Patient Communication
| % Cases | Communication Breakdown | |
|---|---|---|
| 25% | Consent for procedures or treatment, or explanation of alternatives | |
| 22% | Education regarding hospital treatment, discharge instructions, medications | |
| 18% | Response to the patient’s concerns | |
| 9% | Alignment of expectations | |
| 6% | Comprehension/language barrier |
Malpractice cases alleging miscommunication expose comprehension/ interpretation gaps across a range of care-related components that providers need to convey. Adopting strategies to close those gaps may help reduce the risk of care-related harm.
10 Opportunities to Help Patients
Navigate Health Care Communication
| Area | Strategies | |
|---|---|---|
| 1 | Language/Literacy Risks Terms for anatomy, biological systems, disease processes, and health care processes necessary to understand their health status and make informed decisions |
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| 2 | Math/Numeracy Risks Test results, lab values, dosages, lifelong risks, rates of change, etc. can be unclear to patients with limited math skills. |
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| 3 | Values & Preferences Myriad socio-economic factors frame a patient’s envisioned future, and how they prioritize health issues. Each patient’s outlook on life is unique. |
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| 4 | Recommended or Mandated Health Screenings or Preventive Care The importance, efficacy, and limitations of health screening and preventive care is fluid and confusing—especially when medical history, family history, and genetics are variables. |
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| 5 | Signs/Symptoms Confusing or conflated terminology, cultural or regional variations of terms used to describe health-related signs/symptoms and their duration, frequency, and intensity |
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| 6 | Testing and Referrals Follow through on ordered testing or referrals depends on the patient understanding why, what to expect, the time and costs involved, and the degree of urgency. |
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| 7 | Results and Diagnoses Even seemingly straightforward concepts as positive/negative can befuddle ailing and anxious patients. Likewise for diagnoses, which may sound overly troublesome for patients unfamiliar with clinical terms. |
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| 8 | Treatment Risks and Benefits Population-based risk projections and general descriptions of the potential benefits and risks (of either undergoing or foregoing treatment) can be difficult for a patient to personalize. |
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| 9 | Alternative or Non-evidence-based Medicine Questions, expectations, or misinformation regarding outlier treatments or clinical trials |
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| 10 | Shared Decision Making An expectation to make health care decisions can be empowering or burdening, depending on a patient’s comprehension of key factors. |
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Of course, not every clinician-patient encounter raises these communication concerns, but providers who are able to gain an understanding of a patient’s information filters are more likely to connect when they do need to convey important instructions or recommendations.
Additional Material
- Helping patients understand their medical treatment
- Liability and informed consent in the context of shared decision making
- From the patient perspective, consent forms fall short of providing information to guide decision making
- Cracking the code for better rapport among generations
- Health literacy universal precautions toolkit
- Absolute vs. relative risk: what does percentage risk really mean?