By Jeni Miller
Case managers and other medical professionals are daily tasked with communicating with patients and their families. The reality is exceptional communication skills are often hard wrought. However, it is important to the patient and their families that the care can seamlessly engage with them in ways they can understand and appreciate.
Hospital Case Management asked Erik Shessler, MD, associate medical director of general pediatrics at Dartmouth Hitchcock Clinics Manchester, to discuss best practices for engaging with patients and their families so case managers and leaders can continue to hone these skills.
HCM: Why is it important for providers to engage with patients and their families in a clear, understandable way?
Shessler: When you come down to it, healthcare is a service industry. Without engaging with your patient and families, we can’t most effectively meet their needs. There are times in healthcare when we sometimes forget that what’s most important is we need to start by truly listening to understand the concerns and work to meet families where they are. Only by doing that first can we start to consider what assistance we may have to offer and take next steps. On the back end, we need to ensure that whatever plans/actions we put into place work for our patient and families. They need to be involved and engaged, as well as clearly understand and agree, or the outcomes won’t be what we envision.
HCM: What happens if that is not the case, or if a provider assumes a patient/family understands when they truly do not?
Shessler: It’s quite sobering to read statistics about healthcare literacy. By that term, we are describing how much patients and families understand about what we in healthcare positions communicate. Over and over, we see studies showing that there are significant gaps between what we in health think families understand after our discussion and what is actually retained. Not recognizing and taking steps to address this gap leads to poorer outcomes and poor satisfaction for all involved patients/families and healthcare providers.
HCM: Why is it sometimes difficult to use language and terminology that patients and families can understand?
Shessler: Healthcare providers and staff are essentially trained to speak a different language. In large part, this is done so we as healthcare providers can most effectively and accurately communicate situations to each other and characterize scenarios so we can continually learn and grow. To that end, the medical terminology and language works well. It can be difficult at times to remember that this is not a common language outside of medicine — and even within medicine if not in the same field. As a pediatrician, I use different language at times with my colleagues than, say, adult surgeons might. Thinking they understand everything I might say if they are the family involved in my current visit also is folly. Communicating with patients and families is a critical and special skill we all need to recognize as such and practice. Like any skill, some individuals start off stronger or weaker than others, but we all need to continually strive for improvement.
HCM: How can providers learn this skill?
Shessler: Practice, and in particular observed practice. Hearing feedback from colleagues and patients about your approach can be quite eye-opening and valuable. For example, patient satisfaction scores and questions explore this in great detail. This information can be extremely useful for providers. Learning and utilizing various teach-back methods also helps. As a pediatrician, I often use the concept of homework to help summarize a visit: What’s my homework, let’s identify this together, what might the patient or families be. Written directions that we [create] and review together works nicely as well. We all have different learning styles, so providing various methods can be helpful. Asking yes-or-no questions, such as “Does that make sense?” is not as helpful as you might think as the patient/family would have to acknowledge that they didn’t understand — or, say, you as the provider didn’t explain it well, and this could make folks uncomfortable; it would be easier to smile and nod.
HCM: What advice would you give case managers and other providers who are constantly switching back and forth from engaging with medical professionals and patients/families?
Shessler: In many ways, case managers get to really work with patients, families, and medical professionals to be that go-between. The care plans they help establish and the follow-up education can be invaluable in translating success from one location to another. In my mind, case managers are perhaps the most crucial piece to establishing a real medical home.
HCM: Can you share a time when medical terminology affected communication with a patient and/or their family?
Shessler: One of the common scenarios I see is confusion around effective asthma management. Medically speaking, it’s not the most complicated of problems. But if patients, families, and medical professionals are not on the same page with what medicines are used, then there are very serious implications. When this comes up, it’s easy sometimes to think, ‘Why doesn’t this family get it?’ when we probably should be thinking, ‘What could we be doing differently to assist?’ There are different medications for controlling/preventing asthma vs. rescue medicines. Use of effective education in visit, after visit, and with the patient and their care committee, including caregivers, schools, [and more], can be extremely effective in preventing subsequent urgent or emergent care or hospitalizations. Examples that we use might be color-coded asthma action plans, home devices to help determine how sick someone might be, [and] hands-on device teaching.
HCM: Do you have any other advice to share?
Shessler: Learning from our colleagues and mentors. I joke with the medical students that I work with that part of their job when in training is to “steal shamelessly.” If you see one of your preceptors is particularly good at a skill, steal/copy that approach, adapt it to feel comfortable for you, and teach it going forward. One of my mentors was particularly skilled at delivering bad news. How she did this while creating a strong, therapeutic relationship and getting folks to understand what she was saying was truly an art form. While I may never reach that renaissance level, I can continue to strive for her excellence.
Case managers and other medical professionals are daily tasked with communicating with patients and their families. The reality is exceptional communication skills are often hard wrought. However, it is important to the patient and their families that the care can seamlessly engage with them in ways they can understand and appreciate.
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