Wednesday, May 1, 2013
Advocating for yourself with complex, chronic illness PART 3 - Sharing a common language
If your doctor isn't addressing your healthcare concerns it is a sign you are not speaking the same language. You may need to backtrack, and review and discuss your treatment goals to clarify any miscommunication. Many times patients fail to communicate in a direct way with their doctor or don't share their thoughts, which results in incomplete communication. Be sure to share all your concerns with your doctor, including how you feel about the care you are receiving. In an effort to improve healthcare team communications, the SBAR model of communications was adopted by healthcare teams across the U.S. The acronym SBAR represents Situation - Background - Assessment - Recommendation. Using the SBAR communication model has made healthcare team communication more effective and efficient, which has reduce miscommunication among team members and reduced the number of possible errors. But the disconnect in this model has been the lack of patient involvement. As the pilot of the team, optimal communication among the patient and the healthcare team would include educating patients on the best way to communicate with their healthcare providers.
When talking with any member of your healthcare team, begin by describing your chief complaint, including a brief description of the problem or Situation. This will set the stage for effective and accurate communication by putting everyone involved "on the same page". Next you need to describe more detail about the problem or Situation, which provides the Background information. Share your Assessment of the Situation with your healthcare team so they know what you are thinking about your primary problem. The last step is to share your own Recommendation for this problem. Using this model will put your entire healthcare in sync with what you are thinking and your personal healthcare goals related to the problem or chief complaint. For example, I recently saw a neurologist for the first time. I started by briefly describing my Situation - I have been sick for 20 years and doctors have not been able to definitively identify an accurate diagnosis. Next I described the Background, which is the data piece of this communication model - I had prepared a chronicled timeline of symptom onset which I shared, briefly described some of the diagnoses I had received from doctors, diagnostics that had been done with the results, and described the most current symptoms that I am experiencing. I then moved to my Assessment of the problem, which included my thoughts on a possible neuromuscular disease and the fact that I'm not "just depressed". At this point the doctor moved directly to the Recommendation phase of this communication model. The neurologist stated that she needs to accurately document my illness, create a baseline of information by ordering diagnostic tests, and then refer me to a neuromuscular specialist to definitively diagnose my illness in the case that she was unable to come to a definitive diagnosis. The communication model worked like a charm. The doctor automatically recognized the structure of this model and moved from asking more questions to add to Background data, to her Assessment about a possible diagnosis, and then to her Recommendation. If any of the communication between you and your doctor seems confusing, stop the communication and ask your doctor to clarify what you think you heard. Whenever you have a doubt about the communication accuracy it is critical to stop the communication process. This doubt is what keeps you safer and prevents medical errors from occurring. Always ask for clarification.
Prior to your doctor's visit sit down and write out your thoughts about your healthcare problem using the SBAR communication model. It takes some practice to become familiar using this model, but the result is sharing a common language using a common communication model and developing a common understanding. Blessings to you as you effectively, accurately and safely navigate the complex world of healthcare!