Patients at risk when message misunderstood
PATIENTS’ LIVES could be at risk because of frequent miscommunication between GPs and the people they treat, researchers say.
In many cases doctors may not be aware their patient has completely misunderstood what they said and doctors need to be ‘‘very careful’’, Sam Murton the medical director of the Royal New Zealand College of GPs said.
In a recent case, highlighted in a paper by University of Otago researcher Sonya Morgan, a patient was told by her doctor she urgently needed to see a specialist about a bleeding mole.
The GP explicitly expressed her concern about the mole and her view that it needed to be removed. The patient rang a week later to inquire about delaying the mole removal procedure and it was only then it was discovered she had not understood the urgency of the procedure.
In a second case a patient misunderstood the reasons for taking Cartia – a drug which can help prevent heart attack and stroke – and was therefore not taking it. The GP was able to recognise the mistake and clear up the miscommunication but not before the patient put himself stroke.
Morgan said the GPs in the cases cited were ‘‘ typical, experienced clinicians’’.
‘‘They did not make poor decisions in their care of these patients, and yet, despite this, misunderstandings with potentially adverse consequences occurred.’’
Morgan said research had shown that communication problems were a ‘‘common feature’’ of medical consultations and could have ‘‘significant adverse consequences for patients’ quality of care, health outcomes, adherence to treatment and satisfaction’’.
Miscommunication was also the most common reason for patient medical complaints.
Morgan said GPs needed to consider adopting strategies to minimise the risk of communication problems.
Murton, a Wellington GP as well as the director of the college, said GPs knew they had to be careful.
She said research from interviews with Wellington Hospital outpatients showed that people had forgotten 80 per cent of what the doctor had said by the time they reached the front door of the hospital.
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‘‘It doesn’t really matter who the patient is . . . sometimes we don’t realise that people latch on to one thing and don’t listen to the other things that you said.
‘‘We are careful but people will pick up on the bits they want to hear. You do have to be very careful because if your patient is expecting to hear certain things. Patients do need to ask back and say, tell me more.’’
Murton said registrars were trained to communicate well including using techniques such as getting people to repeat back what the doctor said or talk through and show them how and when they take their medication.
Researcher Morgan said GP consultations were ‘‘extremely complex’’ and there were many things that could get in the way of good communication including ‘‘ strict time constraints’’.
GPs could not rely on patients to take action after a consultation so they needed to make sure people were prompted and reminded.
As well it was important for GPs to help patients remember information by summarising and repeating information towards the end of a consultation. A written summary or checklist was one idea suggested.