Case study: Failure to communicate
A 42-year-old patient arrived for her annual gynecologist appointment complaining of a self-detected breast lump. She had several questions about her condition and wanted to tell her doctor about a family history of breast cancer.
The doctor was in a hurry, therefore, he advised her to talk to the staff. However, the staff was busy with other patients. They told her to call them later. However, the patient did not call.
The gynecologist ordered a mammogram but did not include the patient’s complaint of the breast lump on the requisition. The mammogram was read as “normal” but the report noted a “very dense stromal pattern.” This reduces the sensitivity of the study for the detection of cancer.
The radiologist did not recommend an ultrasound and described the mammogram as “normal” in the report to the gynecologist. Therefore, a follow-up appointment was not scheduled.
Several months later, the patient scheduled another appointment with the gynecologist when she noticed the breast lump had increased in size. Subsequently, she was unfortunately diagnosed with breast cancer and scheduled for surgery.
Related content: The Anatomy of a Good Doctor
Missed opportunities to engage the patient
What were the missed opportunities to help engage this patient in her healthcare? If the doctor or his staff took a little more time, would the patient have asked her questions and provided additional information? This possibly could have resulted in an earlier diagnosis?
Cases like this reveal the importance of engaging patients as a strategy to prevent adverse outcomes. When patients do not feel involved in their care, they are less likely to follow through with treatment, keep the physician informed, and follow the treatment plan.
Patient engagement has emerged as a key component of reducing the likelihood of an adverse outcome.
Further, when patients are angry, they are more likely to sue. Similarly, patients are more apt to file a claim when they feel like they are not being heard or their questions are not being answered.
Patient engagement is a quality measure
Active patient engagement is a quality measure of the Institute for Healthcare Improvement’s Triple Aim Initiative, a framework targeted at optimizing health systems
“to improve care, improve population health, and reduce costs per capita.”
Opportunities to engage patients begins when they first contact your practice. And, it’s not just the physician who is responsible for fostering patient engagement. It is, in fact, a critical strategy that must be incorporated into all levels of your practice. That includes the receptionist answering the phone, the physician doing check-ups in the exam room, and everyone else in between.
At each level, the question that must be answered is “Does the patient feel his or her needs are being met?” For engagement to occur, everyone has to make the patient feel involved.
Through effectively promoting patient engagement, physicians and practice staff can enhance patient safety by reducing the likelihood of adverse outcomes. This also reduces the likelihood of a malpractice claim.
Related content: Re-shaping Patient Engagement in a Multicultural World
4 things you can do to improve patient engagement
To achieve engagement, physicians must be aware of the patient experience within their practices. Consider the following tips:
1. Learn what your patients are experiencing
Doctors should conduct regular tests on their systems and processes to see what patients experience in each of the following scenarios:
- when they call for an appointment
- walk into the waiting room
- or talk with office staff
Doctors can even use family members or friends as testers and solicit their feedback on the experience. From there, physicians should identify any system weaknesses and take appropriate measures to improve them.
2. Get feedback through surveys
Ask your patients to provide feedback about their whole experience with your practice and their satisfaction with their treatment. Measure patient engagement through Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys from the Agency for Healthcare Research and Quality (AHRQ)
3. Create an open communication channel
When a patient is first seen at your practice, tell them they will get a survey to provide feedback about their experience with your practice. Be sure to use this as an opportunity to open the door to additional communication. In addition, make sure a patient feels comfortable airing complaints about any aspect of their treatment, your practice, or their relationship with you or your staff.
4. Train your staff
Based on feedback from patients and on identified process weaknesses, conduct trainings to educate your staff on patient engagement and its importance at all levels within your practice.
Additional patient engagement strategies
Some additional strategies you can use to improve patient engagement and communication at your practice can be found in these videos:
Don’t Interrupt. Let Your Patient Talk
Successful Communication Techniques
Four Elements of Successful Communication Training
This post was sponsored by The Doctors Company, the nation’s largest physician-owned medical malpractice insurer. It was first published on May 1, 2016. It was reviewed, updated, and republished on September 9, 2019.
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David B. Troxel, MD and Robin Diamond, MSN, JD, RN
David B. Troxel, MD, (L) is secretary of the Board of Governors and medical director of The Doctors Company. Dr. Troxel is clinical professor emeritus, School of Public Health at the University of California at Berkeley. He is past president of the American Board of Pathology and the California Society of Pathologists. He serves as chairman of The Doctors Company Foundation and as a member of the Patient Safety and Technology Committees at The Doctors Company.
Robin Diamond, MSN, JD, RN, (R), Senior Vice President, Department of Patient Safety and Risk Management, has over 37 years of experience in healthcare administration, including nursing, quality, medical-legal consulting, and risk management. She frequently speaks at national conferences on risk management and patient safety and is the author of nursing textbook chapters, along with other publications on the topics of nursing leadership, risk management, and patient safety. In 2010, she served as an examiner for the Baldrige Performance Excellence Program. For the past 16 years, she has worked in the medical malpractice insurance industry and now leads strategic planning and operations at The Doctors Company for the Department of Patient Safety and Risk Management.
Very disturbing example at the start of the article. We keep hearing Patients need to be active participants
I. Their care, but who takes the time to educate.
In this week blog post from Nurse Advocate I shared tips that consumers (patient and caregivers) as well
As nurses, case managers, physicians and other members of the healthcare team can use to inform
And educated. Here is the link to the post.
Feel free to share
Heck, this advice is so rudimentary it’s laughable. We nurses are taught this in Nursing 101 and it’s reinforced in every course thereafter. What’s with docs that they have to be told this after years of practice which should have wised them up ?
“Listening with your 3rd ear” with focus on patients’ feelings is essential PS It is also very effective in everyday communication. Since few folks put their own feelings to one side and LISTEN and ENCOURAGE any feelings from others, All of us would do better if we learned to do this everywhere, but esp. with patients who are already pretty anxious just meeting with us healthcare providers!.
Sandy Oestreich ARNP for 35 years; RN for 45 yrs
Co-author, internationally distributed pharm. ref. texts
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