Apr 28, 2015
By Jack Lambert, Staff Writer
Morning rounds often began with a text message to residents from Jeanne M. Farnan, MD, MHPE, indicating the time and location of the daily meeting.
Once, a resident replied with information about a patient’s test results, a no-no under the Health Insurance Portability and Accountability Act (HIPAA). Dr. Farnan asked the resident to set up a phone call in the future to discuss specific patient results, setting standards for how to communicate certain information.
“If you are not given clear expectations [for communication], you need to ask for them,” said Dr. Farnan, Assistant Dean of Curricular Development and Evaluation at University of Chicago Pritzker School of Medicine. “It’s very hard to play a game if you don’t know the rules.”
The rules of professional communication can be murky. Should you call a patient’s primary care physician as a courtesy, even if you understand the information in the medical record? Does your supervising physician want you to text, email, or call for a question? What is the best way to disagree or raise concerns with your supervisors and colleagues without looking arrogant or jeopardizing future business?
Effective communication skills can reduce time-consuming follow-up phone calls, lengthy emails, or in-person meetings to re-explain or clarify intent. Conveying the right message through the right medium keeps a doctor from harming professional relationships that could prevent career advancement.
Connecting with Unfamiliar Faces
Interacting with primary care physicians is a specific communication challenge familiar to oncologists and many other specialists.
The Affordable Care Act has led to a rise in patient-centered medical care taking place outside the hospital. Specialists have fewer opportunities to interact with a patient’s primary care doctor, leading to a lack of familiarity that occasionally makes coordinated care more difficult.
A study of 4,720 physicians published in 2011 reported that only 34.8% of specialists said they “always” or “most of the time” received notification of a patient’s history and reason for consultation, despite 69.3% of primary care doctors saying they “always” or “most of the time” sent that information.1 The Joint Commission, a nonprofit representing 20,500 U.S. health care organizations, reported in 2010 that an estimated 80% of serious medical errors involve miscommunication between caregivers during the transfer of patients.2
Primary care doctors are increasingly less likely to perform rounds at hospitals alongside specialists, said Ronald M. Epstein, MD, Director of the Center for Communication and Disparities Research and Professor of Family Medicine, Psychiatry, Oncology, and Nursing at the University of Rochester Medical Center. As a result, specialists increasingly receive patient referrals from unknown doctors. A lack of communication between a specialist and a referring physician may mean the reason for the referral gets lost in the process.
“It’s best to take a collaborative approach and use all of the information that you can get from the referring physician, whether they are primary care or not,” Dr. Epstein said.
The onus is on the oncologist not only to contact the referring physician, but also to approach the conversation with the right attitude, said George A. Sotos, MD, FACP, a partner with Maryland Oncology and Hematology.
He noted that a young professional can develop a potential referral stream by establishing a relationship with a primary care or referring physician, and entering a conversation with an open mind and without bias helps an oncologist accurately assess the patient’s previous care.
“When I speak to a referring colleague, I try to be as helpful as I can be,” Dr. Sotos said. “I assume that the other doctor knows their field and that there’s a good reason they are sending the patient to me. So I need to know how I can help them and what they want from me specifically.”
Text, but with Caution
Cellphones are gradually supplanting pagers in many hospitals as physicians and medical professionals increasingly communicate quickly during the workday using technology.
Multiple studies report between 90%3 and 98%4 of doctors own a smartphone. A 2012 study of 106 pediatric hospital physicians indicated that 57% of doctors either received or sent work-related text messages during the day. A separate study among resident and faculty physicians for patient-related care at the University of California Davis Medical Center reported 59% of residents and 65% of attending physicians contacted faculty by text during the day, and 88% of residents and 71% of attending physicians texted other residents.5
To protect patient information, hospitals are developing encrypted or virtual proxy network connections in their information technology systems and using mobile device management systems for smartphones or tablet devices.6
Dr. Farnan co-authored a set of guidelines for the American College of Physicians and the Federation of State Medical Boards in 2013 regarding online medical professionalism. Although doctors are aware of HIPAA regulations, she said, some occasionally send identifiable patient information by text or through an unsecured server.
Sending identifiable information is not worth the risk, said Dr. Farnan, who recommended that early-career oncologists ask their supervisors about the best method to share patient information.
“We have yet to have the big scandal in medicine where somebody hacks a phone server and finds out all kind of patient information, but I imagine it’s only a matter of time,” she said.
Text messages present another set of communication risks, said Barbara Pachter, communications expert and author of The Essentials of Business Etiquette. Tone is difficult to convey in text, and some doctors may prefer an email or phone call for information.
“If the text is going to cause confusion, then the sender is going to have to correct it,” she said. “It’s a lot better to think about the audience and make sure your text is appropriate.”
Ms. Pachter offered several tips for trainees and early-career oncologists communicating via text. One, never change a meeting time or location by text. The recipient may miss the message, leading to confusion or annoyance. Two, never send bad news via text message. Consider whether you would want the information quickly and delivered in a conversation—if so, make a phone call instead of texting.
Finally, consider the source of a text message when deciding how quickly to respond, Ms. Pachter said.
“If it’s a higher ranked person, you respond immediately or as soon as you can,” she said. “Rank has its privileges.”
- O’Malley AS, Reschovsky JD. Arch Intern Med. 2011;171:56-65.
- The Joint Commission. www.jointcommission.org/assets/1/6/TST_HOC_Persp_08_12.pdf. Accessed March 30, 2015.
- American Academy of Pediatrics. www.aap.org/en-us/about-the-aap/aap-press-room/pages/More-Pediatric-Hospitalists-Using-Text-Messaging-to-Communicate.aspx. Accessed March 30, 2015.
- O’Reilly MK, Nason GJ, Liddy S, et al. Ir J Med Sci. 2014;183:573-7.
- Shah DR, Galante JM, Bold RJ, et al. J Surg Educ. 2013;70:826-34.
- Farnan JM, Snyder Sulmasy L, Worster BK, et al. Ann Intern Med. 2013;158:620-7.