An Article by Irene Etzkorn posted to Thoughts on Feb 19, 2014

Treating the Problem of Inadequate Hospital Communications

In a recent op-ed in The New York Times, Theresa Brown, an oncology nurse, wrote about the inadequacy of doctor/patient communications. She astutely zeroed in on one major point: it doesn’t matter what a doctor or nurse says, only what the patient hears.


In my book, Simple: Conquering the Crisis of Complexity, I discussed the need for empathy when writing, speaking, drawing or otherwise communicating. While the unfamiliarity of medical terminology is often what springs to mind as a communication impediment, several other factors also play a role in miscommunication.

One key element is the context of the interaction. A patient lying in bed, talking to a doctor who is standing over her, is an unnatural setting for conversation. Similarly, the patient never knows when a doctor will appear; as a result she is unprepared to capture vital information. Of course, the anxiety associated with medical news often blurs memories and clouds mental processing, but even just realizing the setting can be revelatory.

As Ms. Brown mentioned, studies show that a doctor sitting down, rather than standing, improves the interaction because it makes the doctor seem more interested in the conversation and less hurried. It also helps when doctors verbally repeat what a patient says to affirm that there is mutual understanding. Providing a pen and paper for patients to write down questions and record answers can also aid retention of key information.

Another communications issue is the degree of engagement. This has become critical with the advent of electronic records. Doctors spend the majority of a conversation inputting data on a computer, rather than making eye contact with the patient. This is a dehumanizing scenario, which is likely to make patients feel that they are “interrupting” the doctor if they speak over his typing.

Lack of time also leads to poor communication. Doctors are not the villains in this piece. Ponder the fact that a dermatologist must sign his name on forms almost 30,000 times a year, according to an article in the Southern Medical Journal, and you can sympathize with their curt interactions. Add the fact that they are working 20-hour shifts in hospitals and the stage is set for brisk, abrupt conversation.

What to do? Eliminate all the unnecessary complexity in the hospital experience and mitigate what must remain. Most hospitals, insurers and healthcare providers tweak and modify small moments of the patient experience but rarely step back and take a comprehensive, blank-slate approach. Voluminous paperwork, repetitive questions, confusing care instructions, multiple phone trees and intimidating terminology all affect the patient experience—often adversely.

A rare few healthcare institutions recognize that empathy is the key to clarity and simplicity. Patient experience is the culmination of myriad interactions—every sight, sound and engagement is important. As one leading hospital found, simply noting the questions and impressions formed by patients during their journey from diagnosis to treatment can be remarkably revealing, and lead to insights for improvement.

Mapping a patient journey illustrates several “hassle factors” that surface:

1      Interminable waiting. Wait times in doctors’ offices are reaching the 20-minute threshold, which many surveyed patients cite as their tolerance limit. The average wait time jumped nationally to 19 minutes, based on a report from Vitals, a healthcare survey organization that analyzed patient-reported wait times in 2012 from its database of more than 870,000 physicians. Updating patients via text or in-person announcements about delays would reduce frustration. Giving them surprisingly useful information (not the typical waiting room video about eating your vegetables and exercising regularly) would also help to mitigate frustration.

2      Annoying repetition. “I told a nurse my entire medical history in the ER and she entered it in a computer at my bedside and then someone asked me the same questions upstairs when they admitted me.” In addition to the annoyance of constantly explaining symptoms, repetition also plants a seed of doubt about the validity and accuracy of the institutions’ recordkeeping.  Faith and confidence are critical in healthcare much as they are in finance. If my brokerage firm asked me to recite the history of all my stock trades every time I transacted business, I would feel mighty uncomfortable. Instead of asking again, tell the patient what you have already gleaned and ask them to verify the information.

3      Jargon and verbosity.  Jargon is intimidating to patients, and unnecessary.. Wake up from coronary bypass surgery and the nurse asks if you are in pain from your “cabbage.” Patients must also ask when they don’t understand—you wouldn’t skip over it if your homebuilder told you he had to “sister-beam” the house.

4      Digitizing complexity. There has been a lot of discussion (and some progress) about the liberating promise of information technology and the power of a single platform for electronic health records. We couldn’t agree more. However, unless we first address the underlying complexity in processes and communications, we fear that this will lead to incremental, rather than comprehensive, change.

Streamlining and simplifying how patients, doctors, scientists, managers and public health officials communicate, transact and interact with each other can deliver dramatic increases in productivity and efficiency. We know this from our work with insurers, providers, pharmaceutical companies and government agencies. What’s also clear is that these efforts can lead to savings of hundreds and potentially billions of dollars each and every year.

Accept the simplification challenge

We challenge everyone in the industry to take a deep breath and remember what the mission of healthcare is: to treat patients. A valuable first step in healthcare reform will be to adopt a truly patient-centric approach by spending the time, effort and resources necessary to simplify and rethink patient communications.

Complexity is the coward's way out. Breakthrough simplicity requires empathizing (by perceiving others' needs and expectations), distilling (by reducing to its essence the substance of one's offer) and clarifying (by making the offering easier to understand or use). Hospitals, doctors and patients will benefit from all three. Be brave—treat patients as people.


Irene Etzkorn is Chief Clarity Officer at Siegelvision and believes complexity is the greatest barrier to progress. Siegelvision helps organizations achieve clarity of purpose, clarity of expression and clarity of experience.