Communication in medicine

A while back I wrote a post about interruptions in the ED. One of the lead authors on a lot of the papers left a couple of comments and pointed me to a few of his other papers. And they’re fascinating.

This one makes good reading:

Communication behaviours in a hospital setting: an observational study. BMJ 1998 Feb 28;316(7132):673-6 PMCID 9522794

It was another study where trained observers followed docs and nurses and observed what they did. The people studied also carried mics and recorders so they could assess the communication behaviours going on.

They found that junior docs are more engaged in communication than consultants. Of note the one consultant followed didn’t get paged or phoned or make a phone call in the whole 3 hour period!

One medical reg had to make 8 phone calls to arrange a CT scan

And though juniors complain about nursing staff paging them all the time, it was found that almost 50% of these were generated by other medical staff not the nurses.

And a quote:

We also found examples of inefficiencies with team communication. For example, a senior consultant tried to transfer a patient to another’s team by delegating the request, involving at least two intermediaries. By the time the second consultant received the message it was substantially distorted and had the potential to endan- ger the patient.

We’ve all seen this. The more senior you get the more delegation happens. Sometimes this is appropriate. Sometimes this is just dumping.

In the ED things are a bit different. You’re allowed to interrupt anyone at virtually any time. You may be doing CPR but it’s perfectly OK for the new F2 to stand at the bottom of the bed asking you a question about an X-ray.

Perhaps that’s a bit extreme but there’s not the same hierarchy of communication in the ED that seems to exist in a lot of other places.

I wouldn’t hesitate to walk into the ED consultants office and ask them something but I’d be very hesitant to just walk into the office of one of the specialties consultants.

When a post-surgical patient comes into the ED I want to let the surgeon know (and the surgeon generally wants to know) but I page their junior not the surgeon.

There all kinds of unwritten (and largely unjustified) rules of communication that make the job very difficult.

We don’t carry pagers in the ED as we’re always there and easy to track down. The radiology department seems to be a different story. I’ve spent hours of my life in that department waiting patiently outside rooms for someone to come out so I can pounce on them.

There must be a better way of doing this I suspect!