Communication Now Part of the Cure

Retired Boston physician Jonathan Fine became a patient advocate in 2004 when he realized communication between doctor and patient is often the first casualty of a major illness. Miscommunication puts patients at greater risk of becoming victims of preventable medical errors, according to a report this year by the Joint Commission, a national hospital accreditation organization. And the Institute of Medicine reports that medical errors cause up to 98,000 deaths a year.

The problem is so widespread that the federal government, non-profit agencies and individual advocates, including Fine, are working to improve communication practices at hospitals.

Three years ago, Fine's close friend was hospitalized for congestive heart failure and pneumonia. "I went to see him, and he looked like death warmed over," Fine says. "He was pale and gasping for breath. I really thought he might die right then and there."

Seeing that his friend was too weak to talk to his doctors, Fine, 75, immediately started taking notes, asking questions and relaying information. The first night, he slept on the hospital floor.

Fine realized that night that having an advocate to act as "eyes and ears" for a patient debilitated by illness is crucial. "There are so many patients who can't speak for themselves because they're in pain, or frightened, or feeble, or under the influence of medication or drugs," he says.

Language barriers, even in English

In 2005, Fine started Bedside Advocates, a Massachusetts organization that enlists volunteers to act as patient "guides" through the confusing terrain of the health care system. Fine's job is often to "translate" information from doctors, even for those patients who are fluent in English.

"Patients will turn to someone like me and say, 'What did the doctor just say?' " he says. "They're afraid to ask questions, and if they do ask questions, they don't understand the answers."

Hospitals often employ teams of specialists, which can present a daunting communication challenge, according to Mark Meaney, president and chief executive of the National Institute for Patient Rights and author of 3 Secrets Hospitals Don't Want You to Know: How to Empower Patients.

Specialized care means that a patient must communicate with a different doctor for each body part that is affected by their illness, such as the heart or the liver. Often, Meaney says, specialists focus too closely on the area of the body in which they specialize and fail to diagnose the "whole" patient.

Patients, Meaney says, are often left feeling confused, frustrated and unsure of who's in charge of their care.

Evaluation and improvement

Hospitals, however, will soon be held accountable for how well their doctors communicate with patients. The results of a new nationally standardized patient satisfaction survey, known as the Hospital Consumer Assessment of Health Providers and Systems, will be posted online by the Centers for Medicare and Medicaid Services next year. Hospitals must begin collecting the data beginning this month or lose a portion of critical Medicare and Medicaid funding, CMS officials say.

The data will widely reflect hospitals' performance when it comes to doctor/patient communication, and the assessment will standardize the reporting criteria across the nation.

"During this hospital stay, how often did doctors listen carefully to you?" the survey asks. "How often did doctors explain things in a way you could understand?"

The new standardized data, which will be available to the general public at hospitalcompare.hhs.gov, can help patients make more informed health care decisions, says Melvin Hall, chief executive of Press Ganey Associates, a health care performance measurement company. "Patients will now have the opportunity to vote with their feet, which is to say, 'This hospital is not meeting my needs. Therefore, I'm going to go somewhere else.' "

Some hospitals are not waiting to begin improving communication.

"The main thing we're trying to do is listen to our patients," says Faye Deich, chief nursing officer at Sacred Heart Hospital in Eau Claire, Wis. The hospital, which ranks in Press Ganey's top 1% for patient satisfaction, has hourly nursing rounds, strict behavioral standards for doctors and follow-up phone calls with patients after they have been discharged.

"We ask each patient what good care means to them, and that's communicated to the staff," Deich says. "If patients know you are there for them, they are more likely to tell you if something doesn't seem right."

Whether improvement measures take place at the government level or at the bedside, Fine says, the bottom line is making sure patients voice their concerns.

"Be assertive without being obnoxious. If there's something on your mind, speak up. If you don't understand something, ask the doctor to explain it to you."

By Erin Donaghue, USA TODAY