A Thinking Man

I mentioned in my last posting how communication was one of the issues that contributed to the high stress levels of my hospital stay. I want to expand on that today. However, I must acknowledge that the communication confusions were also a source of mirth, albeit unintended.

From my perspective there were four communication issues that needed to be addressed in order to greatly improve patient experience. I have every confidence that none of them ever will be, and I write this, simply to get it off my chest - an appropriate thing to do, given my present condition.

Problem One: Jargon

It is interesting how people who are part of the in-crowd - those with knowledge and power - use their own technical language with ease, and forget how foreign it is to those on the outside - those without the inner knowledge and without the power. While in hospital you would expect there to be some difficulty with patients trying to come to terms with obscure medical terminology. However, I never encountered that during my brief stay. What I did encounter was people struggling to understand and use relatively common medical terminology.

On my ward, everyone had had at least one angiogram, or were on their way to have one. It was a term in common usage. It was amusing therefore when one patient quite seriously and genuinely told his wife that the doctor had said that he needed to go for an ‘anagram’. If she ever looked that up in a dictionary she might be unnecessarily alarmed and confused.

An even better example of assuming that everyone knows the meaning of a relatively common medical term came in the following conversation.

Doctor: What medication were you taking before you came into hospital?

Patient: Oh, I’m not taking any medication … (long silence while the doctor looks confused …) only my blood pressure tablets.

He clearly didn’t think ‘tablets’ were ‘medication’, perhaps linking ‘medication’ more closely with ‘medicine’. Although amusing, the consequences could, of course, have been dire.

Problem Two: The Context

There were lots of contextual factors that could have interfered with communication in hospital. In my ward most of the patients were white caucasions of a certain age, and virtually all of the doctors were young and of different ethnicity. Given age, accent, and cultural gaps, there was much potential for misunderstanding and on several occasions I witnessed older men with slight hearing problems struggling to understand English spoken with a non-native accent.

What struck me most, however, was the problem that some of the patients had in adjusting to the formality of a professional ‘medical’ interview, something they rarely encountered.

Doctor, speaking to a retired agricultural worker: Do you live in a house of a bungalow?

Patient: House, bungalow, they’re all the same aren’t they.

Clearly the patient knew the difference between a house and a bungalow, but didn’t appreciate that in a professional interview, the need for precise information was important and may have been used to determine whether or not they let you go home. The patient’s own, casual, jocular style was inappropriate in this context.

Problem Three: Noise

By noise, I don’t mean volume, but just a constant stream of background communication. There was no privacy, and certainly no silence. There was just a constant stream of noise.

As I ate my first meal in a hospital bed trying to get my head round the fact that I had had a heart attack, I listened to:

• two nurses describing the ‘bowel accident’ that had happened in the bed next to me and what they were having to do as they cleaned it up
• the ramblings of a demented patient opposite me telling the whole ward how her husband had allegedly abused her
• the anguish of a woman who I had sat next to in Accident & Emergency who had come in with an arm rash and was struggling to cope with the fact that she had just been told that she probably had leukaemia.

The constant noise added to the stress in at least three ways. First, the fact that it was there meant that it was difficult to relax, even at night. Sometimes I literally buried my head under a pillow in a vain attempt to get rid of it. Secondly, the fact that everyone knew what was going on behind your curtains and you knew what was going on behind theirs was humiliating. (At one delicate point, a nurse bravely shouted to the ward as she came at me with a needle: “Don’t get upset Mr X. None of us like needles!”). Also, hearing the stress of others can add considerably to your own stress. Thirdly, given my needle, blood, vein, and artery phobia (see The Blood Donor) being compelled to listen to what was happening to everyone on the cardiac ward and what might happen to me really was stressful beyond words.

Problem Four: The Silence

If the noise produced periods of acute stress, the silence (or rather what wasn’t communicated) added to the background levels. By that, I don’t mean that people were deliberately keeping things from me, but rather that because so many people were involved in my care (I calculate 7 doctors and at least 14 nursing staff), it was sometimes difficult to know what was happening. It certainly must have been difficult for so many people to know what was happening.

I had wonderfully thorough examinations, but saw different doctors each day. I struggled to catch what they mumbled to each other. I endured a (for me) traumatic procedure but never understood why. I had to remind a nurse that a doctor had ordered a particular procedure the day before because she clearly didn’t know. I had to remind a doctor that a test had already been taken. I had to tell a nurse that the medication I was receiving was a different dosage to the one she was asking me to take.

On paper, someone may have been responsible for my overall care. In practice it felt that too many people were temporarilly involved and were not communicating sufficiently clearly with each other. I longed for someone to give me the overall picture and to ensure that everyone involved was ’singing from the same hymn sheet’. I wanted the doctors to talk to me and to talk more carefully to each other and to the relevant nurses. The latter may have happened behind the scenes, but it didn’t feel as if it did.

At some point in medical history staff started to take germ control seriously realizing that infections were killing people. I only hope that at some date in the not too distant future medical staff will realize that hospital stress is harmful to patients and do more to minimize it. It seems to be undermining a lot of the excellent work that they are doing.

Tags: angiogram, cardiac, hospital, medication, stress