Solving the challenges of communication

January 15, 2020

Impossible to realize, but always worthwhile to strive towards.

The more experienced I become as a physician, leader, wife and mother, the more crucial I consider the role of communication. Recently, as I was completing performance evaluations for people I supervise, I came across a feature in the evaluation software that picks up on potentially inappropriate language. It flagged both “short” and “broad” as potentially pejorative words. Happily, I used both of them in completely appropriate and professional ways and smiled to myself at the naiveté of the computer for not recognizing the obvious meaning of my words.

Yesterday afternoon, I met with a patient who is significantly impacted by a physical symptom for which I have no explanation and for which extensive diagnostic testing failed to yield an answer. She made an offhand comment about being concerned that I would think she was a hypochondriac. I responded by relating that I’ve taken care of patients who carried the actual diagnosis of hypochondriasis and she was not one. Later in the visit, I told her that I believe my patients even when I don’t have an explanation. I meant both comments to be reassuring and supportive. However, I’ve been in practice long enough to recognize when my comments do not hit the mark, like a joke falling flat because of poor delivery or a poor pun. I doubt my comments reassured or supported my patient, despite my best intents.

I believe that solving the challenges of communication is the equivalent of world peace. Impossible to realize but always worthwhile to strive towards. Within my offices-both my medical one and my “corporate” leadership office-there is no greater challenge than to communicate well, clearly, completely, and timely. In both cases, it is also the most important part of my job. I could be a brilliant diagnostician but if I cannot instill confidence in my knowledge and expertise in my patient, a correct diagnosis may still not lead to correct treatment if the patient is unwilling. 

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One of the greatest threats I find to my own effective communication is the quantity and incessant roar of distractions. This is what my children most frequently complain about-that I didn’t listen to, didn’t respond to, didn’t attend to, or didn’t remember a conversation. With four children each operating in their own orbit, it is impossible to pay attention to every request and call for “Mom”. With the quantity of data each of my patients has available in the electronic health record combined with the dozens of other patients floating around in my brain at any one time and the medical knowledge that I need to both remember and learn, I rarely find myself ability to fully focus on the patient ahead of me. 

Recognizing the central need of excellent communication in all roles we fill and the potentially devastating impact of poor communication, I am amazed at how little effort is made to actively resist the threats to good communication. This can be choosing to send an email instead of calling to deliver an emotionally charged message. Or, it can be skimming through an electronic health record while a patient is relating something of great importance. It can be the time-honored tradition of interrupting a patient within the first 11 seconds of relating their history to us. All common and all compromising our ability to do that which is most important in medicine, in leadership, and in our relationships – communicate well. 

Jennifer Frank, MD is a family physician and chief medical officer in northeastern Wisconsin. She continues to find medicine to be the most rewarding profession imaginable, second only to motherhood. She's married to a fellow physician and has four children. Her family reminds her of what is most important and inspires her study and pursuit of work-life balance