Ask the Expert Communication Series: Provider to Patient Communication
Q: How do shared medical appointments improve provider to patient communication?
As we discussed in our previous post, shared medical appointments (SMAs) improve communication between providers. With SMAs, the care team members all know what is agreed upon for follow-up. This helps the team communicate better with one another, but also translates into a tangible value for the patient.
Clarity is a hard thing to measure one-on-one. If I am explaining something about fasting for a lipid test, I might forget to mention WHEN a patient should fast. Or I might think that a patient already knows, but they don’t. In a room with other providers, the nutritionist might ask, “Dr. Tucker, when should patient X fast? Is it the same day?” This offers me the opportunity to clarify the instructions and also opens up the floor for the patient to ask questions they were hesitant to before. Other providers in the SMA are hearing what is said as if they were a patient – an opportunity missing in one-on-one encounters. Messages can be clarified because the observer-providers can identify ambiguity and can help clarify our message. I am often surprised to hear a patient’s reflection of things I have said. So frequently, their interpretation bears little resemblance to what I tried to communicate. Having other health care professionals present to help target the message adds value.
Because the team that is caring for the patients is present the whole time that the provider is rendering care and listening to patients, the group as a whole is more able to have consistent communicatation moving forward. We rarely have to deal with the confusion caused when one person on the team tells the patient one thing, while someone else tells the patient a different thing (or the same thing in a different way).
As an example, I could be instructing a patient with high triglycerides to use omega 3 supplements. She might ask me, “Should I use krill oil, flax seed, or fish oil?” I may tell her that it doesn’t matter as long as she gets enough of the active ingredients, especially EPA+DHA. The patient may then go to the nutritionist on her care team and ask the same question. The nutritionist, with more expertise in this area, may realize that the patient is planning a pregnancy and guide her more toward plant-based omega 3 preparations to avoid heavy metal exposure.
Two providers have now given the patient conflicting information, adding to the complexity of the patient’s decision-making process. If she patient then talks to her brother, whose triglycerides are normal and who was told he did not need to take omega 3 supplements, she can become very confused. The experience could reduce her confidence in one provider or another.
If this scenario arose in our lifestyle SMA, the nutritionist would explain why one preparation may be favored for one patient over another and could then clarify that “our recommendation for you is this, and here is why”. Now, everyone in the room, providers and patients alike, knows why and how the recommendation is made. Other patients who may receive a different recommendation understand the rationale behind the difference.
With a SMA, the language used by each of the providers on the care team is in sync. In other contexts, different providers may have been using different language to convey similar meaning, making it easy for patients to misinterpret information or instructions. In our SMA, the language is consistent and is heard by all. When a patient calls with a follow up question about their care plan, team members generally feel comfortable fielding it because each one is familiar with it. The information is richer in content and more consistent in delivery. Our patients begin using similar language to the providers and we all end up on the same page.