Lost in Translation: When Healthcare Conversations Go Wrong
This is something that I’ve pondered a LOT lately. I’ve seen it many times, over and over. A patient comes to see me after a consultation with a specialist or another health practitioner. They are confused, frustrated or even scared following a consultation that should have had the opposite effect. A consultation that was intended to offer clarity, a diagnosis, exploration of options and reassurance. I wonder what happened.
And I wonder if someone has left my office with the same problem?
It begs the question - where did things go wrong.
I am yet to meet a healthcare professional who does not want to help their patients. I’ve certainly see differences in opinion on HOW to help people, and enjoyed robust discussions about WHAT is the best approach in situations to help people. But never have I met someone working in health who wishes confusion, fear and worry upon their trusting patients. We all want to help.
So where do we go wrong?
My thinking about his has led to me to three main ideas:
Assumptions
Misaligment on values and priorities
We fail to make learning safe
Let’s talk about these things - because if we do, we might all find ways to do better. As treating practitoners we might find ways to better help our patients. And when we seek care ourselves, we might better advocate for ourselves and achieve more desireable outcomes for our health.
Assumptions (are the mother of all F*** Ups)
Yes - they are. And yet most of us spend an incredible amount of time making them on a daily basis. I know I do! We assume so many things, because it’s easier, faster and makes for a smoother level of existence. However, when it comes to talking health and medicine, assumptions can lead to the most hilarious of moments at best, and total messups at worst. Like the doctor who assumes the patient has reported all relevant symptoms regarding their backpain, but has failed to mention the numb foot and frequent tripping over. Or the patient who assumes since their physio hasn’t asked, they aren’t interested to hear about the upsetting and seemingly linked bladder problems.
Assuming someone has understood you, or that they have asked all the questions they need to leaves a weird and problematic void where all kinds of imaginary gap-filling can occur, often post-hoc. Well, the physio didn’t mention anything about NOT mowing the lawn on the weekend, so what harm could it do to my newly diagnosed disc bulge? (hint, it’s a terrible idea right now, the physio doesn’t know you have a back yard with grass). The patient didn’t mention sexual dysfunction, so it's not an issue for them (hint, it is, but they were too shy to bring it up without a supportive prompt).
But there’s good news. Stating an assumption out loud highlights it’s existence, and allows for course correction. Taking ownership of your assumptions empowers both you and your consulting practitioner/patient to bridge the gap and close communication holes.
“I assume you’ve told me everything that is worrying you today about your health. But, before we move on, is there anything else that is a concern for you?
“I assume that you’re going to take it easy and rest this weekend. But, before we move on, do you have any planned activities you’d like you discuss in the context of your new diangosis?”
“I’m assuming that it’s okay to keep taking my herbal supplements with these drugs you’ve prescribed, but before I leave, can I check with you that there’s not a clashing ingredient?”
The magical moments that occur as we identify and update our assumptions can course-correct, build trust and ensure that we achieve what we set out to do. Get healed or do the healing.
2. Misalignment on values/priorities
This is a cracker, and frequently occurs. It’s usually quite simple. A patient has a set of values and priorities, and their health practitioner has a different set. These sets have minimal overlap, and usually lead to talking at cross-purposes, both parties departing their interaction frustrated, jaded or even offended.
But how to solve this?
Easy - ask. This goes for both sides of the exchange.
A clinican can ask what a patient is prioritising for their health, and what they envision as a result of the consultation. They can ask what matters most to them, and if there are any concepts or interventions they value most - such as taking a holistic approach, getting imaging to support reaching a clear diagnosis, or having a chance to explore their care options.
Equally, a patient can ask their clinician about how they approach their practice, what they think is most important for finding a solution, and if they have priorities that they can advise upon for ongoing care.
If there is a clear differential in the answers you’re hearing from the other party - it might be time to identify how to meet each other in the middle, or seek alternative options. This might be as simple as referring to a colleague who can provide a more aligned approach, or asking for a referral to a clinic that offers services you are seeking. We can’t be everything to everyone, and there’s a wise humility in recognising when we’re not the right person to help a patient.
3. We fail to create emotional and intellectual safety (and don’t meet patients where they are)
A third and commonly occurring breakdown. I’ve experienced my own mistaking in this space, and whilst it can be recovered, I reflect upon the patients of my early practicing days who never came back for a follow-up. disappearing into the ether and into another clinician’s care. (Fortunately that number is lower these days as improve on my communication skills). Luckily there are enough good-natured and patient folks out there willing to advocate for themselves and offer a teachable moment to us well-meaning (and very human) clinicians.
The most memorable of moments have taken the form of a returning client who has exclaimed with exasperation that their diagnosis (completely misunderstood) is not playing out as they imagined (or assumed!?). Or perhaps they did the prescribed solution activity, then doubled their dose and couldn’t understand why their recovery wasn’t twice as fast, or made them feel WORSE!)
And that is ENTIRELY OUR FAULT as clinicians.
It is our job to ensure that we communicate our medical knowledge in terms that match our patient’s education, language and health literacy level. AND also their capacity mentally and emotionally to take on new information whilst experiencing pain, dysfunction and other big emotions tied to experiencing a health concern. Did we write information down? Did we share a useful website resource? Did we give some space and silence for questions to arise? Did we ASSUME our patient could understand medical jargon? In many instances, we miss the mark on many of these things.
Whilst I don’t pretend to know all the answers to solving the complexities of healthcare communication, I can’t help but wonder if a simple question I learned from a fantastic tutor I had in physio school can close the gap. After an explanation, a pause, a smile and a short verification goes a long way. “Does that make sense to you, or can I explain it a different way to make it clearer?”. And then wait. Wait at 5-10 seconds and maintain eye contact. It might feel like an aeon of weirdness, but it’s where the communication gold is mined from.
The second solution lies in cultivating emotional safety for your patient - making it clear that it’s absolutely fine to not know the answer to something. Modelling this to your patient can make it feel easier, lighter and more appropriate for them to ask questions they may fear they will be judged for asking, particularly when they assume it’s something they should already know or understand.
Modelling this can be as simple as making a statement that shows you are a human who is still learning new things, and doesn’t contain multitudes of universal knowledge in their brain. “I don’t have all the answers for you just yet, but here’s what I can suggest”. Or “I don’t know the exact answer for that question - let’s look it up together now”.
Showing that you as the expert can find ways to learn and build on knowledge creates a shared learning environment for you and your trusting patient. And a trusting patient is more likely to tell you they didn’t understand something, or to ask you a burning question they were previously afraid to ask.
The way forward
Ultimately, we can only do our best. We have to encourage both patients and health practitioners to meet in the middle - where communication is open, effective and productive. Whilst I don’t have all the answers to all the problems, I’ll keep continuing to work on my own practice of challenging assumptions, cultivating alignment and fostering emotional/intellectual safety, because I see the rewards it reaps. May these little gems of inspiration help you on your own journey into health and wellbeing!