Thursday, June 9, 2005
Miscommunication when people are ill is the cause of complaints

By Dr. Anthony Policastro
Nanticoke Memorial Hospital

I get the opportunity to review patient complaints both in my role at the hospital and as a member of the Board of Medical Practice. In many instances the complaints are related to nothing more than a miscommunication between the patient and the medical personnel. One of the things that I used to explain to my people when I was in the military was that about half of the population gets grouchy when they are sick. That means that we frequently see people who are not their normal cheerful selves just because they are ill. Usually, their family members know this. Therefore, family members do not get upset when they see this behavior. While medical personnel know this, they sometimes forget. Thus, when a patient behaves in a grouchy manner, it can create a conflict. Once that starts, neither person is really communicating. After the fact when the complaint is received, both individuals will have different versions of the same story. It is hard to address this kind of complaint when the truth lies somewhere in between. There are many things that can happen with the medical system to increase the distress of the patient. When you are sick, all you want to do is get treatment and get to bed. However, getting that treatment is not always that easy. The office may not have an appointment that is early enough for how sick you are feeling. The office may not have an appointment at all. When you get to the office or the emergency room, you may have a long wait. Nothing is worse when you are feeling ill than having to wait.
I get allergic reactions. When I get hives all over my body and my hands and feet and face start to swell up, I need to go the emergency room for a shot of epinephrine (adrenaline). I know that they have to check me in. I know that they have to get my blood pressure and pulse rate. I know that they have to take my history. I also know that it takes 15 minutes from the time I get the shot until the itching stops driving me crazy. When I am at home, I give the shot myself with no waiting. When I am not near the epinephrine and have to go to the emergency room, I have to add the extra minutes that all those things take. I could get very grouchy given all the itching. However, I know the reason for doing it. So I do not. One of the things that I used to tell my people in writing every six months was that we are medical professionals. As such we need to understand that sick people do not always behave the same as well people. In such situations, we are the ones as medical professionals who need to understand that. We need to recognize the fact that illness creates some behaviors that would ordinarily not be there. We need to give the patient the treatment that they need with the same compassion as we do individuals with perfect behavior. That is our role. Unfortunately, we too are human. There are certain situations where that is not always easy to do. In those situations, communication problems occur. Once these start, the care that is provided suffers. Since communication is a two-way street, it is as important for the patient to understand the dynamics of these situations as it is for the medical personnel. When two individuals are in the midst of a miscommunication, very little productive activity takes place. For necessary treatment to occur, these kinds of situations need to be recognized. Since the miscommunication is happening on both sides, both individuals have a responsibility to take a step back and ask how each of them might make it better right then and there. A complaint later on will not provide the care that was needed at the time of the interaction.

Dr. Anthony Policastro is medical director at Nanticoke Memorial Hospital.