Reflection on Communication

Thinking back on our discussions today, the role of communication is crucial for safety in health care. One aspect that I think cannot be stressed enough is that communication is not just speaking well but also listening well. Health providers are often so preoccupied with the things they have to relay to others that they forget to truly hear others.

Following is an example that changed how I view communication: I was asked by the hospice attending to see a patient for a second opinion. I had never seen this patient before. The attending had revoked services for a Alzheimer’s patient due to being stable for a couple of months. When given this news, the husband (who was her caregiver) became irate and threatened to sue the company stating that his wife was declining. On my way to their house, the office manager texted me warning that the husband was verbally aggressive. My thought were ones of anxiety as I had a lawsuit mentioned and a hostile environment. As soon as I entered the door the husband began cursing and arguing his point. Instead of being defensive toward the patient or responding to the negative connotations of the text, I sat the patient down and simply told him ” this is the first time I have met you or your wife. You know her better than anyone. Can you give me some background information”? The husband started off very loud, vulgar, and defensive of the doctor’s decision. He would apologize for his language and I would tell him it was ok. As I sat there and let him talk he started to calm down telling me of their life together, her disease, and the recent progression in her status. I said little but did give a little extra time for my visit. What I came to find out is that his wife was relatively stable when the doctor saw her 6 weeks ago but since that time she had significantly declined to the point that her speech was limited to mumbling, her PO intake was poor, and she could no longer hold her head up. I left and ended up recommending that hospice services be continued.

On my way home I reflected on the situation and realized that what this husband needed most was to feel like someone listened to him and validated his experience. He was the one taking care if her 24 hrs a day; while The doctor and myself only spent 1 hour every other month. The power of silence and active listening is sometimes more important and informative than any book, diagnostic test, or preconceived notions.