Leora Horwitz and Allan Detsky published a commentary in the March 16, 2011 issue of JAMA about the pitfalls and promise of modern communication modes entitled Physician Communication in the 21st Century: To Talk or to Text? (Subscription is required for full text; extract available to all.) They note the impact that technological advances enabling the proliferation of asynchronous, non-interactive communication modes including email and texting have had on how physicians transmit and share clinical information. I like this succinct definition:
The fundamental purpose of clinical communication is to generate a shared mental model of a patient and to transfer responsibility for some aspect of care from the communicator to the recipient.
They point out that there clearly are advantages and disadvantages to both modern, asynchronous text-based communication and traditional, synchronous "talk-based" interaction, and that physicians need to be trained to understand when to use which form. They propose six different communication reforms for modern medicine. I particularly agree with #4:
Build clinical information systems to help synthesize data at the time of communication, not to overwhelm the observer with individual data points.
When I was in private practice, I came to loathe the frequent interruptions of phone calls during the days on call from other physicians and health care personnel - and regrettably I'm sure my irritation showed - even though the calls were largely appropriate and the interactions with referring physicians important for building the practice. At the time, I wished some of the messages could simply have been sent via email, but my group was not part of an integrated network with our hospitals and referral base and email penetration was otherwise low. Now that I practice in an academic medical center with the vast majority of my referrals being internal, we communicate predominantly by email, so I am rarely interrupted while seeing patients. While I think this is superior to the old way, there are still plenty of times I wish I could more easily pick up the phone and just ask someone a question instead of typing it!
This commentary reminds me that there is an important science to understanding the optimal ways for physicians to communicate with each other, and we need more thoughtful analysis like this to further the goals of patient-centered care.
(Listen to a short audio podcast of author Allan Detsky discussing this work on the JAMA web site.)