Open communication can boost practice cooperation

Commentary. By Michael Greenberg, MD, amednews contributor. April 10, 2000.

COMMENTARY

Observations on the state of medical practice and medical life

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Most of life's problems are errors in communication. We misinterpret something and feel hurt at a perceived insult. But the longer I practice medicine, the more I realize that most people have good intentions and don't mean to cause harm.

Clear communication increases satisfaction with our practices and decreases potential errors in patient care. Despite the grumbling we do regarding today's medical environment, most of us doctors are dedicated to excellence in patient care. To remain focused on that goal, we have to learn to work together as partners -- among ourselves and with our patients. And to succeed, partners must be reasonable and open to solving problems with and for each other.

"Your referral letters are a problem," a referring physician suggested.

"I know they're terse," I said. "I use my time talking to patients rather than writing lengthy notes."

"I understand that," he said. "The problem is in our office system. If you could indicate the patient's insurance plan on your letter, we could send follow-up referrals much more quickly."

"I can do that," I said. "It helps us both." As we talked, we discovered additional areas where cooperation would be of mutual benefit.

When I began practice 22 years ago, doctors enjoyed greater independence from each other than we do now. Managed care, however, has forced us into an increased level of intimacy in which communication becomes especially uncomfortable when our personal financial security is at stake.

"Do you have to see Mrs. Smith so frequently?" a primary care physician asked about one of his HMO patients.

I hedged, uncomfortable and worried that complete honesty might end his referral stream. "She has severe rosacea," I answered. "And needs oral antibiotics."

"Is that a reason to see her monthly?" he asked.

I took a deep breath and told the whole truth. "I could see her less often. And I know what I'm about to say is managed care heresy, but she, like many others with severe skin disease, has deep emotional issues surrounding her illness and needs a great deal of emotional support." I waited for his negative response.

"That's cool," he said. "I understand." Since that encounter, I have come to see this physician as an understanding friend.

An additional benefit of honest, clear communication is that we learn our problems are not as different from each other as we imagine.

Common ground

My practice waxes and wanes with no predictable pattern. After months of an overwhelmingly full appointment schedule, a slow week suddenly appears. And each time that happens, I become frightened that my half-empty appointment book is the first sign of impending economic doom.

It takes only a phone call or two, however, to discover that my slow periods correspond to other doctors' schedules. And when I express my own fears, colleagues admit they experience parallel emotions.

When, through honest communication, we understand how alike we are and that we don't intentionally mean harm to each other, we can increase our focus on patient care instead of worrying about being taken advantage of. We can find solutions to our issues that are equitable to everyone. The keys to successful partnerships are honesty and respect.

The best communication is, in my opinion, face to face. And it need not always be so serious. During many humor-filled lunches in our physicians' dining room, I've learned some great jokes as well as other doctors' solutions for the problems that confront my practice. While sharing a meal, it's easy to connect with each other and see the commonality of our daily experiences. That kind of talk is powerful medicine against the feelings of isolation.

William Osler, MD, stated that if we listen to patients long enough, they'll expose the nature of their problem. I think he was correct. And because we already know the nature of our common problems, we only need listen to each other long enough to expose the nature of the solutions for our mutual and individual issues.

Dr. Greenberg is a dermatologist in Elk Grove Village, Ill. and author of the novel A Man of Sorrows (http://www.anovelvision.com/). You can contact him by email (offped@aol.com).