The surgeon’s ability to exhibit effective communication skills in specific circumstances is crucial.
For example, knowing how to discuss operative risks
and benefits, obtain informed consent, and convey
bad news are all important elements of patient care
communication. But the ability to modify communication strategies and personalize the message for a
co-resident, attending, patient, or patient’s family is
equally important for success in delivering the best
possible surgical care.
Ineffective communication between surgery residents and attendings typically occurs when the resident
fears losing autonomy or being a bother, revealing a
knowledge gap, and creating misunderstandings. 18
Although there is a proven link between miscommu-nication and medical errors, few surgical residency
programs have formal communication training or specific guidelines for the residents about when, how, and
why to communicate with their attendings. 18 This lack of
guidance could be detrimental to patient care, especially
during the intern year when most surgical residents
teach themselves through a time-consuming “trial and
error” development of their communication skills.
Identification of communication mishaps and under-
standing why they occurred is the first step in dealing
with medical errors resulting from ineffective commu-
nication between patients and surgeons. One effective
way to deal with communication breakdowns is the
implementation of a policy-based intervention across
different hospitals such as the one organized by the
Risk Management Foundation of the Harvard Medi-
cal Institutions in 2005.19 This collaboration brought
together the chiefs of surgery at Brigham and Women’s
Hospital, Massachusetts General Hospital, Beth Israel
Deaconess Medical Center, and Children’s Hospital,
Boston, who all endorsed three communication stan-
dards that had been previously proven to significantly
diminish patient harm because of gaps in commu-
nication. 20 Indeed, this program was deemed to be
beneficial as significant changes in patient manage-
ment were noted in 33 percent of the cases in which
trainees and attendings adhered to the enforced com-
munication strategies. 20
Communication breakdowns may lead to medical
errors, and medical errors may lead to legal claims. The
University of Michigan Health System (UMHS), Ann
Arbor, designed and implemented a comprehensive
medical error disclosure with offer program in 2001.
This program was based on three main principles: 15
•Compensate patients quickly and fairly when inappropriate medical care caused harm
•Support caregivers and the hospital vigorously when
patient care was appropriate
• Reduce patient harm (and therefore claims) by learning
from previous mistakes
TABLE 1. THE CALMER TECHNIQUE
Catalyst for change Acknowledge what can and cannot be controlled. Identify the patient’s current stage of change.
Alter thoughts to change feelings
Acknowledge feelings toward the patient and
assess the effect on the relationships.
Ask: “What can I tell myself about this situation to
make me feel less angry or frustrated?”
Listen and then make a diagnosis The physician is better equipped to listen without bias after completing the above two steps.
Make an agreement Explicitly agree to continue to treat the patient and to work on the problem as agreed upon.
Education and follow up Give an achievable task based on the patient’s stage of change and schedule structured follow-up.
Reach out and discuss your
Reflect on how you feel after the patient
encounter and reach out to other physicians
to engage in discussion and for support.