When I published Notes from the Waiting Room: Managing a Loved One’s End of Life Hospitalization in 2008 I included a chapter with proposals for medical system reform. Among them was something I called Communication Algorithms:
Physician-scientists are trained in and use “decision trees” to arrive at diagnoses. The series of if/else questions is referred to as a diagnostic algorithm, a process or set of rules to follow when solving medical problems. Although the best doctors are adept at thinking outside the decision tree to arrive at diagnoses for particularly challenging health problems, the model offers an effective framework for starting many diagnoses.
Accurate communications are as important as accurate diagnoses. All doctors ought to be trained in communication algorithms appropriate to their specialties and be required to prove their competence for licensure.
Communication algorithms should include a range of conversations every specialist can reasonably be expected to engage in based on the nature of their specialty. It should be acknowledged that effective, proactive communication is rightfully the responsibility of the physician (rather than the patient-family), by virtue of their repetitive experience. Every physician must be capable of engaging in a range of complete conversations that arise as part of their practice.
Yahoo! They’re here—at least in part. At IHI/Institute for Healthcare Improvement’s annual conference I took part in a role play (referred to below) designed to teach providers how to conduct The Talk (when a hospitalized loved one is known to be dying). The session was conducted by David E. Weissman, MD and Lyn Ceronsky, DNP, GNP. David and Lyn coached accomplished surgeons and doctors through a multistep process designed to teach the cognitive, emotional, and situational awareness required to initiate, sustain, and complete The Talk. This session was so engaging that I failed during it to realize that what I was experiencing was exactly what I’d asked for in Notes: a communication algorithm.
If more providers replicate David’s and Lyn’s work throughout the range of conversations germane to their specialties, half or more of the patient advocacy battle will be won or moot.