You may think that you know what your patients heard when you spoke to them, but in many cases you are only partially correct. Sometimes in healthcare, communication is like the childhood game of passing a message from one person to another by whispering in a person’s ear. I hope that you remember that game. What may have started out as “Amos has a green shirt on” could end up by the seventh or eighth person as “A mouse had a spleen out.” Communication is extremely important in healthcare. Communicating poorly can have serious consequences.
I was recently reminded of the nature of communication while reading an article by Dr. Benjamin Brewer in the online edition of the Wall Street Journal (November 1, 2006). He was describing several episodes of treating patients who had recently come from Mexico to his area of practice in Illinois. In the satellite office where he encountered these patients there was very little sophisticated equipment, nothing much beyond a microscope and an X-ray machine. So, he had to rely on his wits and experience to diagnose patients. In the incident he was relating, there was a male patient who had a serious cough and muscle aches and was not getting any better. He later found out from his office assistant, who was of Mexican descent, that the patient thought he had caught the “Aire,” an illness caught when moving from a cold area to a warm one; it is a common folk diagnosis in parts of Mexico.
In fact, the patient had pneumonia and was not following the doctor’s orders; rather he was following folk remedies from home. Once Dr. Brewer understood this folk tradition, he was able to talk about “Aire” and how to treat it. He had the patient stay in a warm place with warm clothes and take the medication that was prescribed. Because the remedy blended well with the folk tradition, the patient was soon well. Dr. Brewer related that he had to learn the culture in order to cure his patients; he demonstrated respect for the culture of his patients and was able to improve their health through a blend of modern medicine and folk traditions. He stated that his patients worked well with him once he learned more about them.
Of course, you can’t be expected to learn every medical folk tradition of all your patients; that would be too time consuming and would probably interfere with your practice too much. However, you should learn the traditions of a group if they represent a significant population of your patients. What do you do for the rest, though? How can you make sure that they heard what you spoke? In fact, how can you be sure that each of your patients understands your directions? I like to use the Socratic method. It is really quite simple. You give some directions and then quiz a patient on it.
For instance, suppose you have described to a patient that he/she should take their medication for hypothyroidism one hour before breakfast in the morning (some physicians recommend a half hour) and have described the consequences of frequently missing their pill. After such a discussion, you might ask, “When is the best time to take your medication?” “Can you take it right after breakfast or should you wait a couple of hours if you miss taking it before breakfast?” “What are the consequences of missing your dosage too often?” Using such question and answer techniques you can improve the patient’s retention of instructions and verify that the patient understood the directions completely.
The Socratic method can be used in other healthcare situations too. Anytime that communication is important, such as passing the care of a patient during shift change at a hospital, one could use this. Too, it makes sense to use this in onsite training situations for students.
The Socratic method is just one dimension of good communication. Good communication is so important in any enterprise, that Stephen Covey in the best selling book “The 7 Habits of Highly Effective People” had communication as his fifth key habit: Seek first to understand, then to be understood. One of our local hospitals, Spectrum Health, believes that the 7 habits are so important to their enterprise, that they require their staff to read it and discuss it in workshops. Mastering empathetic listening–the Socratic method is a form of it–will dramatically improve the health of patients and improve the healthcare work environment. I highly recommend that you read the book if you haven’t already.