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A changing culture in interpersonal and communication skills.

In summary it is essential that we improve our interpersonal and communication skills. We can learn and be taught better skills. We will be evaluated on these skills in the future, and it is important for us to establish ourselves as good role models for the future surgeons who will be entering our profession. It is of benefit to our patients and will give them a better understanding of their disease and elevate their level of healthcare. It is also important to us to help reduce our stress and to eliminate burnout. We can improve our interpersonal and communication skills in many ways. First we must be aware that there is a problem and recognize this as a problem that can be solved and that we do need to improve our current skills. This can be done through multiple educational tools such as lectures, videos, and self-assessments. The responsibility for this culture change ranges from top to bottom, but really begins at the bottom. It is important for all of us especially individuals such as myself, who is not only a practicing surgeon but also a surgeon in a leadership position, a surgeon who teaches medical students and residents, and a chairman who develops the careers of young faculty members. It is important for organizations such as the Southeastern Surgical Congress to recognize this need of our members and to conduct seminars, luncheons, and courses in helping us acquire better skills and also giving us some assessment of the current status of our skills. The American College of Surgeons has already addressed this issue by forming the Task Force on Communication and Educational Skills. Various examining boards have already incorporated this into requirements and expectations of future physicians and surgeons. We must establish ourselves as good role models. Being a good role model cannot be overemphasized. We are very fortunate in being good role models in medical knowledge and mastering phenomenal technical feats; however, this is not enough. It is also important that we also improve our interpersonal and communication skills. We must establish goals and outcomes for ourselves and work on ways of assessing these to ensure that we are effective in improving our skills. We must incorporate interpersonal and communication skills into our training programs, postgraduate courses, and all aspects of lifelong continuing education. Addressing the improvement of our interpersonal and communication skills will have many beneficial effects including improved patient outcomes, a better healthcare status for our patients, and a high level of confidence that patients have in us as physicians and surgeons. We do at times have a less than ideal collegial relationship with other disciplines in medicine. This faulty relationship needs to be rectified. We need to restore and maintain a high collegial relationship with everyone in medicine not only other physicians, but also nurses, paramedical personnel, and others. These changes will require a great deal of effort and will take some considerable time. Initially laparoscopic cholecystectomy and laparoscopic skills were not adequately learned but with recognition of its importance, education, and time, we became master surgeons. We are very fortunate to have residents and practitioners with superb laparoscopic skills that they acquired during their training and in structured postgraduate courses. Likewise it is important to incorporate interpersonal and communication skills into our training programs and our continuing medical educational programs. Finally, this is not just a touchy-feely issue, but it is one of surgical professionalism. It is critical for us to address this as an important issue since it will enhance the good qualities that we already possess. Let's start today. I have enjoyed this year being your President, and wish to thank you for the opportunity of addressing you this morning.

Communication↗

[Communicating with the sedated patient: experience of the caretakers].

How can we interact with sedated patients who are seemingly unable to express themselves? On the basis of these questions, we chose to realize a qualitative phenomenological study aimed at comprehending communication with the sedated patient from the perspective of the nurses who take care of those patients. Ten individual interviews were realized with intensive nurses from a Hospital School in S o Paulo. After data analysis, four general thematic categories were revealed: communication with sedated patient x sedation degree; communication with sedated patient x attributed perception capacity; valuation of communication with sedated patient; forms of communication with the sedated patient. This research concluded that the communication with the sedated patient exists and occurs at different moments and in different ways through verbal and non-verbal communication.

Communication↗

Integrating the art and science of medical practice: innovations in teaching medical communication skills.

BACKGROUND AND OBJECTIVES: This paper describes the content and methods used to teach communication skills in Undergraduate Medical Education for the 21st Century (UME-21) schools and provides suggestions for future efforts. METHODS: Faculty leaders of curriculum projects at UME-21 schools provided reports describing new communication curriculum projects. Reports were reviewed and analyzed, curriculum content and methods were categorized into themes, and findings were confirmed through phone interviews with lead faculty at each participating school. RESULTS: Curriculum projects were designed to improve medical students' communication skills during the clerkship years at 12 participating UME-21 schools. These skills were addressed through a variety of teaching methods and applied in interactions with patients, health teams, and community members. Curricular themes included conflict resolution, delivery of bad news, addressing patient preferences for end-of-life care, patient and community health education, communicating with families, and working effectively with patients from diverse backgrounds. Students' communication skill competencies were assessed through a variety of methods including objective structured clinical examinations, focused observation and feedback, and debriefing sessions based on recall, audiotapes, or videotapes of encounters. CONCLUSIONS: Opportunities for students to develop, apply, and refine their communication skills can be embedded throughout the medical school curricula. Our findings illustrate the variety of methods that may be used to teach and evaluate medical students' communication skill competencies. Future challenges include development of comprehensive longitudinal curricula, practical teaching methods, valid evaluation tools, and faculty development.

Clinical Clerkship↗

Effect of language immersion on communication with Latino patients.

BACKGROUND: In the US, the fastest growing segment of the general pediatric population is Latino children. Language barriers may impede optimal care for these patients. Programs are needed to enhance communication effectiveness with Latino patients. We examined the effect of language immersion training for pediatric faculty on their communication with Latino patients. METHODS: Five general pediatric faculty physicians were sent to Guatemala for a two-week language immersion course and then had monthly one-hour Spanish language meetings for one year. Before and after immersion, six, and twelve months later, their Spanish skills were assessed. Before and after faculty training, Latino parents of pediatric patients were surveyed to assess their trust in and communication with the attending pediatricians. Spanish survey instruments were pilot tested and revised (trust scale alpha = 0.79; communication scale alpha = 0.80). RESULTS: Language proficiency increased for all the faculty participants, from a baseline score of 28% to a post-intervention score of 55%, p < 0.001. This increase in proficiency was sustained six and twelve months after the intervention. General linear modeling with repeated measures was used to examine associations between physician, parent, and clinic variables and the doctor-patient communication and patient trust scores. Even though baseline communication and trust scores were high, both improved after the intervention, p < 0.01. CONCLUSION: A two-week faculty language-training program can improve physician' language skills, communication, and trust between non-Latino doctor and Latino patient. Other measures of cultural competence should be measured and cost-benefit analyses conducted to assess the impact of immersion versus classroom experience.

Adult↗

Pitfalls in health communication: healthcare policy, institution, structure, and process.

The state of health communication for a given population is a function of several tiers of structure and process: government policy, healthcare directives, healthcare structure and process, and the ethnosocial realities of a multicultural society. Common yet specific to these tiers of health communication is the interpersonal and intergroup use of language in all its forms. Language is the most common behavior exhibited by humankind. Its use at all tiers determines quality of healthcare and quality of life for healthcare consumers: patients and their families. Of note, at the consumer end, mounting evidence demonstrates that barriers to health communication contribute to poorer access to care, quality of care, and health outcomes. The lack of comprehensible and usable written and spoken language is a major barrier to health communication targeting primary and secondary disease prevention and is a major contributor to the misuse of healthcare, patient noncompliance, rising healthcare costs. In this paper, we cursorily examine the relationship among government policy, institutional directives, and healthcare structure and process and its influence on the public health, especially vulnerable populations. We conclude that limited health communication in the context of changing healthcare environments and diverse populations is an important underpinning of rising healthcare costs and sustained health disparities. More research is needed to improve communication about health at all tiers and to develop health communication interventions that are usable by all population groups.

Communication↗

Effect of a multidisciplinary intervention on communication and collaboration among physicians and nurses.

BACKGROUND: Improving communication and collaboration among doctors and nurses can improve satisfaction among participants and improve patients' satisfaction and quality of care. OBJECTIVE: To determine the impact of a multidisciplinary intervention on communication and collaboration among doctors and nurses on an acute inpatient medical unit. METHODS: During a 2-year period, an intervention unit was created that differed from the control unit by the addition of a nurse practitioner to each inpatient medical team, the appointment of a hospitalist medical director, and the institution of daily multidisciplinary rounds. Surveys about communication and collaboration were administered to personnel in both units. Physicians were surveyed at the completion of each rotation on the unit; nurses, biannually. RESULTS: Response rates for house staff (n = 111), attending physicians (n = 45), and nurses (n = 123) were 58%, 69%, and 91%, respectively. Physicians in the intervention group reported greater collaboration with nurses than did physicians in the control group (P < .001); the largest effect was among the residents. Physicians in the intervention group reported better collaboration with the nurse practitioners than with the staff nurses (P < .001). Physicians in the intervention group also reported better communication with fellow physicians than did physicians in the control group (P = .006). Nurses in both groups reported similar levels of communication (P = .59) and collaboration (P = .47) with physicians. Nurses in the intervention group reported better communication with nurse practitioners than with physicians (P < .001). CONCLUSIONS: The multidisciplinary intervention resulted in better communication and collaboration among the participants.

Adult↗

Residents' perceptions of communication skills in postgraduate medical training programs of Pakistan.

BACKGROUND: The importance of communication skills in postgraduate medical training is likely to be highlighted given the convergence of research and educational forces. Assessment of these skills in residency training is vital since it can provide basis for policy undertaking among Pakistani medical academia for improving postgraduate training programs. AIM: To assess the perceived status of communication skills of residents in different specialties. MATERIALS AND METHODS: A cross sectional survey was conducted in four teaching hospitals of Karachi between July 1999 and January 2001. A total of 455 residents in different residency programs were contacted. Residents registered both with College of Physicians and Surgeons of Pakistan and Postgraduate Medical Education office of selected hospitals were included in this study. Responses of residents were obtained on 5-point Likert scale. Indices were formed for three components of communication skills: informative, affective and professional communication. STATISTICAL ANALYSIS: Differences between residents' groups were assessed through analysis of variance. RESULTS: Total informative communication index was lowest for multi-disciplinary (12.05, SD = 4.87) and highest for surgical (15.27, SD = 2.51) residents. Total affective index was lowest for multi-disciplinary (12.58, SD = 5.68) and highest for medical (15.74, SD = 3.59) residents. The group differences for four groups of residency programs were not statistically significant for either professional attributes separately or for the total professional index. CONCLUSIONS: The residency programs must establish goals, process and outcomes to incorporate communication skills in postgraduate medical training since this can enhance residents' performance as effective health care providers. Accomplishment of better communication skills can be achieved if the importance of its teaching and training is valued by residency program coordinators.

Adult↗

Clinician-patient E-mail communication: challenges for reimbursement.

Clinicians are rapidly gaining experience with online clinician-patient consultation, and more tools are becoming available to support these efforts. In addition, we now have evidence that using electronic communication is cost-effective to payers and appealing to patients and providers. At present, there appear to be few barriers to the adoption of these solutions for practices that use other online services. Security concerns can easily be overcome by using programs described in this commentary. Larger and longer studies that evaluate the benefits and cost savings in more detail may help convince other payers and providers of the utility of the Web-based programs. More studies are needed to understand the effect of dinician-patient electronic communication on the costs of caring for chronic illness. When these solutions also include support tools, such as electronic prescribing, which could improve patient safety and quality of care, they should be encouraged. In their article entitled, "Electrons in Flight-Email between Doctors and Patients," Delbanco and Sands postulate that the future of e-communication in medicine will be integrated with a patient-controlled health record and will include secure synchronous and asynchronous communication, video conferencing and messaging, instant transcription into the written record, full-patient access to the record, translation into different languages, connectivity to multiple data sources, incorporation of multi-media educational materials. It-will also allow data from home-based diagnostic technology to be sent to clinicians. "Electronic communication will move medicine inexorably toward such transparency, enabling doctors and patients to share knowledge, responsibility, and decision-making more equally. We need to explore rapidly how this change will affect the quality of care for patients and the quality of life for doctors." The widespread dependence on Internet-based electronic communication to support a variety of commercial, educational, and entertainment needs and interests offers us an opportunity to develop innovative approaches to some long-standing problems-assuring the accessibility of clinicians to their patients and the effectiveness and timeliness of communication between them. It is exciting that we now have well-documented examples of how these new technologies can be used to enhance the quality of primary care practice in both large and small practice organizations.

Blue Cross Blue Shield Insurance Plans↗

Communication about palliative care for patients with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and disability worldwide. For many patients, maximal therapy for COPD produces only modest relief of disabling symptoms and these symptoms result in a significantly reduced quality of life. Despite the high morbidity and mortality, patients with COPD do not receive adequate palliative care. One reason these patients may receive poor quality palliative care is that patient-physician communication about palliative and EOL care is unlikely to occur. The purpose of this review is to summarize recent research regarding patient-physician communication about palliative care for patients with COPD. Understanding the barriers to this communication may be an important step to improving communication about EOL care and improving patient-centred outcomes. Two areas that may influence the quality of care received by patients with COPD are also highlighted: 1) the role of depression, a common problem in patients with COPD, in physician-patient communication; and 2) the role of advance care planning in this communication. Further research is needed to develop and test interventions that can enhance patient-physician communication about palliative and EOL care for patients with COPD, and we describe our perspective on a research agenda in each area.

Advance Care Planning↗

Assessing communications effectiveness in meeting corporate goals of public health organizations.

Much evaluation of health communications in public health is considered from a program perspective of smoking cessation, weight reduction, education on sexually transmitted diseases, etc. These studies have advanced the knowledge base of communications theory and evaluation and have contributed to program effectiveness. In program-based evaluation the communications process is structured as part of the program itself. This article extends program-based communications evaluation to view communications from the perspective of the consumer and how effectively public health departments respond to consumer expectations. It develops a conceptual model for evaluating elements of communications such as its importance in defining mission and goals within the community, managing strategic constituencies, and enlisting individuals and groups as customers and co-producers of health. It gives a broader perspective on how communications in public heath organizations are managed and a basis for assessing whether they are being managed effectively.

Communication↗

Communications--the future of dentistry.

Superior communication is a vital key to success in practice. Excellent communication with patients and prospective patients can build a practice more quickly than any other technique. Strengthening of team relationships depends on open communication. Sound communication builds long-term allegiance from patients who accept recommended treatment, enroll in the recare system, and refer others. And connecting with other health-care providers is an exciting challenge in communication. This article explores avenues of communication--with patients, with prospective patients, with coworkers and with other health-care providers through five techniques: listening, speaking, writing, reading, and nonverbal/body language. The author shares specific ideas and methods for honing these five skills to assure improvements in communication, the universal glue that binds people together and assures excellence in practice.

Communication↗

Communicating in the 1990s: a technology update.

With the variety of available technologies, choosing among them will be difficult at best. Waiting for integration and standardization among technologies may effectively eliminate a competitive edge and productivity improvements for health care organizations. Also, selecting which one communication technology is needed may not be the issue since several technologies likely are needed to solve different communication needs in organizations. One might begin to sort out options by performing an assessment of current communication patterns and deficiencies. Ideally, the assessment should be completed by someone who is able to assess needs over an entire organization, not just one service or one organizational level. The assessment should focus at least on some of the following questions. Are three major problems with staff or client communications? If staff-related, are primary needs interactive with routine communication needs? If they are interactive, time-sensitive, and inter-organizational then a form of video-conferencing may help. Short-term interactive needs might be met by leasing video-conferencing rooms. Long-term, time sensitive interactive needs might require PC-based video-conferencing, Non-time-sensitive, interactive, inter-organizational needs might be met with voice mail or e-mail, which allow some time-delayed but single-mode interactions. If communication needs are routine, one might examine how e-mail, or fax could help. If text-based paper traffic through the mail room is enormous or slow, e-mail may help. If communication among persons at any level of geographically separate organizations is needed, modem-based or public e-mail may be the answer.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Communication Networks↗

Biomedical communications centers--a profile/evaluation instrument study of underlying standards.

The "ABCD Profile/Evaluation Instrument" offers directors of individual biomedical communications centers a way to measure their own progress towards meeting standards of excellence. It provides guidelines for review of biomedical communications centers in a model similar to the clinical and basic medical science departments' review. Based on the results of this study, many of the directors seemed to be looking for more formal structure of biomedical communications centers involvement. Use of the Profile/Evaluation Instrument helps address this need and allows discussion in areas such as the department's existence and function in relation to its host institution. In March of 1985, the ABCD used the Profile/Evaluation Instrument standards as parameters of responsibility and service provided by biomedical communications units in its analysis and response to the AAMC GPEP report (Allan and Bradford 1985). The instrument also triggers discussion of new areas of review needed within departments. The process of matching biomedical communications job requirements and assessment training criteria will be explored in the future expansion of the personnel section of the instrument. These and other areas are crucial to the survival and well-being of biomedical communications centers. The "ABCD Profile/Evaluation Instrument" establishes a concrete reference for external review by outside agencies and internal review by administration or the department directors themselves. It offers a continuing body of information that provides the basis for future planning in the field of biomedical communications.

Communication↗

Graduate program in biomedical communication.

The need for harnessing the achievements of communication technology to the burgeoning mass of biomedical information is critical. Recognizing this problem and aware of the short supply of professionals with the skills necessary for the job, a group of leaders from the fields of medicine and communications formed a consortium in 1967 and have developed a twelve month graduate program in biomedical communication. Designed to ground the advanced student in the development and administration of biomedical communication programs, the curriculum focuses on the principles and practice of communication and the development of communications media. Courses are given in the control and communication of information; the printed and spoken word; visual media of photographic arts, television, and motion pictures; computer science; and administration and systems analysis.

Communication↗

Quantitative selectivity of contact-mediated intercellular communication in a metastatic mouse mammary tumor line.

We have examined contact-mediated intercellular communication by measuring the transfer of thioguanine sensitivity to a hypoxanthine phosphoribosyltransferase (EC 2.4.2.8)-negative clone (66cl-4) selected from one subline isolated previously from a spontaneously arising mammary tumor of a BALB/cfC3H mouse. We tested other sublines from the same tumor and unrelated cell types for their ability to serve as 6-thioguanine nucleotide donors to 66cl-4 cells. The degree of communication, measured by the number of donor cells required to reduce the number of thioguanine-resistant colonies, varied with the donor cell type. The 66cl-4 line communicated with the parent cell line from which the thioguanine-resistant cell was selected and with other sublines from the parent tumor, with some unrelated tumor cells, and with some nonneoplastic cells (3T3, hamster kidney and lung fibroblasts, and mouse mammary epithelial cells). There was a quantitative difference in the amount of communication which took place with the various cells tested, but no pattern of difference could be discerned. Line 66cl-4 did not preferentially communicate with cells of epithelial versus fibroblast morphology, nor with tumor versus nontumor cells. The 66cl-4 cells retained the ability of their parent line to form metastatic tumors when injected s.c. into BALB/c mice. A quantitative selectivity of communication is thus expressed in these malignant metastatic cells, but it is apparently unrelated to either the morphological or malignant phenotype of the donor. Contact-mediated communication between tumor subpopulations may differentially affect growth and drug sensitivity within a tumor.

Animals↗

[Communicative and social behavior of speech disordered children].

The spheres covering behaviour disorders, social behaviour and communicative behaviour of speech impaired pupils which until now have been analyzed on a more theoretical level, ought to be studied using psychometric testing procedures and an esperimental observational situation in order to gain base data with which to set up a concrete catalogue of aims (learning program) based on the deficits thereby obtained. The study took place at the special school in Esslinger-Berkheim (Baden-Wurttemberg). By taking into account relevant specialized literature and the results of other studies, the following general hypotheses were advanced, namely, that the communication of speech handicapped children is troubled in respect of its content and relation, and that their social behaviour shows more egoistic than cooperative features. In order to determine social motivations and attitudes, we used Muller's "Social Motivation Test" (SMT) and Jorger's "Group test for the social attitude" (S-E-T). Due to the inconsistency between the attitudes measured by means of psychometric methods and the sbusequent free and genuine behaviour, an observational situation was developed during which the pupils, either in pairs or in groups of four and using puppets, took turns in thinking up a story, discussing the plot, roles, etc. and finally putting on the play. The whole was then analyzed by means of tape recordings and film shots, the interaction of the communicating partners being analyzed and categorized in two separate assessment stages: communicative behaviour and social behaviour. The pragmatic axioms of P. Watzlawick, the communication researcher, functioned as theoretical background. Flanders's linear time diagram was used as assessment system. Communicative and social learning aims were prepared in accordance with confirming hypotheses to enable a "preliminary area" for the practical work in (special) education to be defined. In addition, a rough outline was made of the conditional areas pertaining to social and communicative education of the speech impaired for the purpose of carrying out a systematic change.

Child↗

Communication in health care.

For routine communication, care providers still mainly rely on paper documents and paper mail. Evidence exists, however, that this communication can be improved, both by a better content of information exchange and by a more timely deliverance of this information. At present, several alternatives to paper-based communication are available, such as the Fax, the Smart Card, electronic mail, and electronic data interchange. This paper describes existing communication problems, and examines the current state of development and research aimed at improving this communication using electronic communication techniques that are gradually replacing paper-based communication. Applicability and shortcomings of these new techniques are also discussed.

Computer Communication Networks↗

Effective physician-patient communication and health outcomes: a review.

OBJECTIVE: To ascertain whether the quality of physician-patient communication makes a significant difference to patient health outcomes. DATA SOURCES: The MEDLINE database was searched for articles published from 1983 to 1993 using "physician-patient relations" as the primary medical subject heading. Several bibliographies and conference proceedings were also reviewed. STUDY SELECTION: Randomized controlled trials (RCTs) and analytic studies of physician-patient communication in which patient health was an outcome variable. DATA EXTRACTION: The following information was recorded about each study: sample size, patient characteristics, clinical setting, elements of communication assessed, patient outcomes measured, and direction and significance of any association found between aspects of communication and patient outcomes. DATA SYNTHESIS: Of the 21 studies that met the final criteria for review, 16 reported positive results, 4 reported negative (i.e., nonsignificant) results, and 1 was inconclusive. The quality of communication both in the history-taking segment of the visit and during discussion of the management plan was found to influence patient health outcomes. The outcomes affected were, in descending order of frequency, emotional health, symptom resolution, function, physiologic measures (i.e., blood pressure and blood sugar level) and pain control. CONCLUSIONS: Most of the studies reviewed demonstrated a correlation between effective physician-patient communication and improved patient health outcomes. The components of effective communication identified by these studies can be used as the basis both for curriculum development in medical education and for patient education programs. Future research should focus on evaluating such educational programs.

Communication↗