Karen Golding Smith
Founder, Excitant Health
Think of a time when an interaction with your doctor or nurse or patient or patient’s spouse or your therapist or surgeon didn’t go as well as you think it should have, whether it was a conversation, an exam, a test, a procedure – any interaction. Was there a lack of information? A lack of clarity? Was an action taken that you disagreed with or that turned out badly? Did something not happen that should have? When you examine it, it likely was rooted in some failure in communication.
When my son was in the ICU following emergency surgery to save his life, I asked that alternate pain management options be explored because he had a collapsed lung, was very weak and was having apnea spells. He was also in a lot of pain. When the nurse came back and said the surgeon approved an increase in his morphine, I stopped her and asked if she had mentioned the trouble he was already having breathing. She had missed that part. Not intentionally; it was one of many tasks, the surgeon was a bit intimidating and the point got lost. That was a communication gap that I was able to fill, keeping my son safe.
Why is there a communication gap and how can we bridge it? Let’s look at a couple possibilities.
Imagine 5 people sitting around a table working on a design for a shared workspace that they all will be using. There is a graphic designer, a CPA, an attorney, a musician and an architect. Each clearly has expertise in something.
The graphic designer knows what space her team will need for their work, the accountant understands the finances required, the attorney the legalities, the architect how to design the space to meet everyone’s criteria. The musician? The space will house a state-of-the-art recording studio, so her input will be as vital and specific as everyone else’s. She doesn’t have the credentials the others do, but she is successful in her own right.
They all have the need for bathrooms, conference rooms, office equipment, heat and AC and maybe a kitchen and they share the vision of an awesome result. Could one of them design the workspace well without input from all?
Now put your health care team at the same table. Each has an area of expertise and some of their knowledge overlaps. The patient is at the table along with a trusted care partner. Without the information that they share, the rest of the team has an incomplete picture. To uncover the problem AND design the best solution, everyone’s input is needed. The physician’s credentials don’t give insight into the patient’s experience but do provide essential knowledge and skills. The nurse’s credentials show what she’s trained to do, but she might have a perspective the doctor doesn’t that could shift the plan. The neurologist and surgeon have specific areas of expertise that will be important in forming and carrying out the plan, but it’s the patient’s story and life experience that puts into context what everyone else has to offer. And that could be the vital piece of the puzzle.
Another thing to note is that they’re all seated at a round table so that everyone is on the same physical level, no head of the table, nobody standing over another, no captain’s chair. Even if the conversation is around a hospital bed, approach it as if you’re all at that round table, acknowledging equal importance among the participants and downplaying any educational or positional variances. Leveling the perception of authority and power opens the door to a mutually respectful exchange of information that contributes to that shared vision of the best possible outcome.
While traveling on business to a small town recently, my husband sent a too-rare, almost to the point of sushi, salmon dinner back at a restaurant. It was returned to him cooked to oblivion. He didn’t send it back a second time, choosing to suffer through. There were a few things at play there: 1) he didn’t want to have to wait even longer, 2) he didn’t want to upset the server or chef and 3) he didn’t have faith that it would be any more edible the third time.
There was a breakdown of trust. Perhaps the server noticed it was overdone but didn’t want to anger the chef. Or she had noticed but hoped that he wouldn’t say anything. It’s also possible that the chef overcooked it intentionally out of annoyance that it was sent back in the first place even though it was clearly inedible.
Errors can’t be averted or corrected when someone in a subordinate position is reluctant to speak up. A highly respected surgeon might make a call that a scrub nurse knows could jeopardize the safety of the patient but doesn’t speak up for fear of reprisal by the surgeon. A specialist jumps to a wrong diagnostic conclusion out of habit, missing a critical detail that the patient had shared, but the patient doesn’t question it because the specialist is the ‘expert’. Both the scrub nurse and the patient remained silent because of fear or lack of trust.
To build trust we must create an environment where everyone feels empowered to speak up, knowing that their concern will be heard, acknowledged and acted upon. Our mission is to create the expectation of – and provide the tools for – an inclusive, mutually respectful healthcare relationship that taps into everyone’s expertise towards the best possible outcomes. It’s time to bridge the gap.