Communication by @kendonaldson

“My father was in hospital for 2 weeks and not once did I get to speak to a doctor”

“All it would have taken was a phone call, I kept asking day after day, but no-one bothered”

“We were watching Mum get sicker day by day and we knew she was dying but we couldn’t get anyone to talk to us about it. They kept changing drugs and trying new things but nothing was working. We knew she was going to die”

These are just a few quotes from recent complaints that I have read and demonstrate a very common theme – we are not very good at communication. There are many aspects to our failing in communication; with the patient themselves, between specialist teams or between primary and secondary care but it’s the communication with families and loved ones I wish to focus on in this blog.

To illustrate my point here is a short story. A friend of mine texted me about a year ago. I was aware that her mother had been in hospital but did not know the details. This was the text she sent me…

KD 1

I decided to phone the hospital myself and managed to get through to the Consultant looking after her mother. He started to tell me the details but I stopped him and asked him to phone my friend – she was the one who needed to know. His response was “I’m in an MDT meeting and too busy. Tell her to call my secretary and I will meet up with her in a few days.” I was a tad persistent, gave him her mobile number and said “Please phone her today. 5 minutes, thats all it takes.” He was unhappy but said he would try. A little later I received the following text…

KD 2

(Note my text was ‘Not Delivered’. Great communication!!)

And the next day….

KD 3

So, a 5 minute conversation with the consultant completely changed that individuals ability to function at work and at home. 2 weeks of agitation, worry and poor sleep gone….in 5 minutes. So why hadn’t that conversation taken place much earlier? Why did the consultant feel the need for a ‘face to face’ meeting? I would agree these are always much more satisfactory for all concerned but they are sometimes difficult to organise and end up delaying the communication for days. All it took was a phone call.

It got me thinking about my own practice. Do I speak to relatives enough? Am I proactive in phoning families to update them on their loved ones progress? The answer to this was no, so I had to do something about it.

It may seem an overly simplistic approach but what we have done is introduce a ‘Ward Sticker’ (see below) which is effectively a checklist which we put in our patients case sheets at least once a week (sometimes less, sometimes more). Now this list covers many things of which ‘Family discussion’ is only one but it is a way of ensuring that, on a ward round, someone has asked the question “Has anyone spoken to the family?” If the answer is no then we can organise that it happens but what I often do is just pick up the phone and call them. Unless it’s really bad news I don’t see any problem with a phone chat and, often, the information I get from them is extremely useful and changes management plans.

KD 4

Do I get it right all the time? Again, no. It was only a couple of weeks ago that my colleague reviewed a patient in our Medical High Dependency Unit who I had seen several times over the preceding few days. She was young and very sick and, he informed me very politely, no one had spoken to her daughter since admission. I was mortified but then we don’t use the sticker on MHDU. Am I becoming reliant upon it? Must do better!

There is no doubt our patients are getting older, more complex and are increasingly muddled, especially on admission. Making a clear and definite diagnosis takes longer and often feels less than satisfactory – ‘Probable UTI’ or ‘Probable Stroke’ – and its in these scenarios that early family input can make a massive difference. You can feel like you are working in the dark but when you pick up the phone and speak to someone who knows the patient well, and really cares for them, then it can become clearer and, I think more importantly, you can allay that loved ones fears about what you are thinking of doing in the way of tests and treatments.

So if there was one thing I could ask it would be this – think about the family and loved ones early on in admission (preferably the first day) and use your phone a little more. A quick phone call can make a big difference and will often calm their anxieties, make your life easier and, perhaps, reduce the number of complaints coming through the system.

KD 5

Ken Donaldson is a Consultant Nephrologist and Associate Medical Director at NHS Dumfries and Galloway

18 thoughts on “Communication by @kendonaldson

  1. brillinat reminder Ken. three common themes in all our complaints: communication, staff attitude / behaviour and clinical treatment. If we could get the communication right the other two would disappear! what is it that we are all afraid of? what are the previous experiences that have made us wary of a simple telephone call? Back to basics: whose needs are being met and whose voice is being heard?

  2. Great blog Ken – here’s a quote I picked up from the Ayrshire & Arran blog this week – it highlights exactly your point……
    American author Anatole Broyard wrote movingly about his encounters with medicine while he was dying.
    “I wouldn’t demand a lot of my doctor’s time” he wrote,
    “I just wish he would brood on my situation for perhaps five minutes, that he would give me his whole mind just once, be bonded with me for a brief space, survey my soul as well as my flesh, to get at my illness, for each man is ill in his own way.”
    (Intoxicated By My Illness)

  3. This is so true – my elderly mum was in hospital 2 hours away for 10 weeks and it was very hard to get to speak to anyone about her. I suffered the sleeplessness, inability to function at work, etc. One day, as we were driving down the M6, the consultant phoned my mobile and we had a good chat, he answered all my questions honestly and it made a huge difference.

  4. In my own experience the ability to listen to the patient and their family is also key along with communicating with other consultants from other hospitals invovled in a patients care when asked specifically to do so.

  5. Ken,

    Good blog as usual, are you using improvement approach to the sticker process? could be ideal candidate for data for process – is the sticker being updated/used and for outcome – sampling a small number of cases to see if communication has taken place and perhaps even, how was it for the patient/carer and anything we could improve?

    • Thanks Gareth. I was expecting the QI question!! To start with no but recently our Improvement advisers have picked it up and are refreshing the form and looking to test. Small measures like numbers of forms filled in and, as you say, what could be improved. Thanks for the feedback, Ken

  6. Really enjoyed this. I try to be proactive in speaking to relatives early into the admission. When I manage it’s always positively received and appreciated. Usually phonecalls or trying to catch people at visiting (evening is quite handy if I’m on call). I admit it’s not always possible with competing demands of meetings etc. I do think our junior doctors are being de skilled at speaking to relatives though such is the expectation of speaking to ‘the boss’. I try to bring them into face to face meetings for that reason.

    I also really like the term ‘sleeper’. Think I’ll adopt it in Ayrshire 🙂

    • Thanks Claire. Its always tricky to get the balance between the ‘Boss’ communicating clearly what they think and plan and juniors perhaps not doing it quite so well but learning on the job. I agree that bringing them along to those meetings is very useful but I do encourage them to ‘fly solo’ as much as possible.

      I suspect, like us, you would rather eradicate the need for sleepers!!

  7. Excellent blog, Ken.

    In GPland we use phone contact all the time & have dedicated phone slots in our appointment systems so that patients or their representatives can guarantee that we will call them back. Heather Currie is doing some great work on streamlining outpatients & the low-tech telephone is one of the solutions (much better than e-mail). I wonder if some dedicated clinic time for busy consultants to do this communication would help. This could be found from cancelled appointments for patients who only need a discussion or explanation of results & what the plan is.
    That’s not to say that we out here always get our communication right either!

    • Thanks Bob. There is no doubt that there is a lot we could learn from Primary Care when it comes to communicating. Heathers work is excellent and hopefully will bring significant changes. We need to be offering options that suit patients; Skype, VC, FaceTime, telephone etc. Will take time but we’ll get there…I hope.

      Its not just patients either, as I hint at in the blog we (secondary care) need to talk to you (primary care) a little more often too.

  8. Reblogged this on Simple Stuff Blog and commented:
    Good points from this blog by Consultant Kidney doctor. I suspect that it wouldn’t be possible for all admissions & discharges to have a telephone consultation with the patients relative or carer – wonder what it would take to put this idea into action ?

  9. Thanks Ken, I was really moved by your honest reflections and deep compassion for your patients and their families. You’re also a great model for learning and ‘being the change you want to see in the world’ to paraphrase a leadership quote I read somewhere once.

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