Sep 30

Sep 30 The Relevance of Communication, Team Work and Rumours in the Healthcare System.

Introduction

Medicine is often described as an interdisciplinary profession where a medical practitioner is usually and often interacting with many other healthcare professions. Hence, the ability to communicate effectively not just to patients but to other colleagues of similar profession and other professions is crucial. I have learnt that the patient is the absolute centrepiece in health, where they are surrounded by a tightly connected healthcare system that involves an extensive set of professions who all have different skills. With so many allied health workers and medical practitioners working together, to communicate effectively and professionally with colleagues in the same profession as well as different healthcare profession is an everyday challenge (1). This would include formal and informal communication where sharing ideas, feelings or communicating whether at work or outside the premises or whether it is direct or through the internet should still be done with caution as to not reveal any sensitive information (2).

Communication, Andreas Astier. — Teamwork, Communication and Rumours

Salas E et al defines teamwork as “two or more people who interact interdependently with a common purpose, working toward measurable goals that benefit from leadership that maintains stability while encouraging honest discussion and problem solving” (3). Teamwork in the healthcare profession brings everybody together to share a common goal which is to treat the patient towards recovery and provide good and quality healthcare. Without teamwork, working independently will never benefit the patient in any ways and will hinder his or her outcome in health.

Communication skills involve and relate to sharing ideas and thoughts, feelings and information effectively which is an important skill to have in the healthcare profession (4). Communication skills can always be improved throughout someone’s life and should be a mandatory update for every healthcare professional so that the right message and information is conveyed properly. From the Oxford dictionary, rumours who shares synonyms similar to tittle-tattle, gossip, whispers, stories, tales, canards, titbits, buzz, smear, scandal and many more, demonstrate that its meaning is not similar to professionalism, dignity, confidentiality, respect and so on. It is clear that communication and rumours have different meanings where communication is formal, direct, thoughtful and conveys meaning whereas gossip/rumours, which is also a form of communication in a way, is more informal, malicious, untrue and unprofessional. Gossiping will eventually become a rumour.

The challenge is to know when someone, or yourself, is communicating effectively or is gossiping as there can be a blurred line or a grey area between both meanings and act. I have witnessed first-hand gossiping and felt a little uncomfortable. These generally tend to happen after seeing a particularly difficult patient where the act of debriefing would be describing the situation and talk about it. Sharing experience, feelings and ideas often feels better as one could relate to one another. This is a normal human interaction to express ourselves and share enthusiastically information about our own and personal experience. The question is how harmful and what are the consequences of these gossips and where would one draw the line? What would be the damage if these debriefs occurred in a local pub between healthcare staff at a rural town where information can easily spread as well as finding out who that person is due to a close and small community. Of course, in the professional work areas gossiping is seen as unprofessional and a breach of conduct especially when healthcare staff have strict moral and professional conduct all taken under an oath (5).

Communication from one healthcare staff to another when skilfully done is pleasant, effective and meaningful, however, I have experienced communication that was unpleasant, mean and sometimes felt like a form of bullying. These generally left me with negativity, resentment and a decrease in productivity as I had lost, at that moment, self-confidence. This especially is enhanced when it is communicated through the internet or instant messages where the emotions are usually stripped away within the text. It is far easier to criticise and spread negativity when one feels protected behind their computer screens than saying it personally in front of the person that is being involved. Of course, constructive criticisms are always welcome and important but I digress.

Whilst participating in the urgent care ward of a hospital, I have experienced excellent teamwork and communication that was skilfully done between healthcare staff. When the patient arrived with an emergency condition, which was unexplained chest pain, the course of action from each healthcare staff was done smoothly, effectively and quickly. Everyone cited clearly and effectively; what they were doing, what medication has been given whilst being rechecked by someone else, what was the range of vital signs, what was the course of action, the follow-ups as well as the handover. There was no miscommunication, unnecessary panic or running around and it was clear that the staff knew exactly what they were doing and who’s task were being done. Due to excellent teamwork and communication, this situation resulted in an effective and positive outcome.

However, I have heard from someone about an incident (who knows if it is true or not… and isn’t ironic since this blog is about rumours?) where teamwork and communication did not go as planned. There seemed to be a miscommunication between wards where a patient filed a ‘Do Not Resuscitate’ form at the hospital and essentially this was not communicated between staff at the handover. The patient went into cardiac arrest and was resuscitated by mistake. Imagine speaking to a patient the next day and that you are speaking to another human being who was not supposed to be alive due to a mistake. What are the legality issues? Apparently, the patient complained of a sore chest of where the compressions were made. Did the patient know what happened after all? From hearing that story, was it possible the healthcare staff did not tell the patient what happened? Maybe, who knows. If this story is true or not it is still an interesting example of the immense impact when not communicating and sharing information effectively.

As demonstrated of how a hypothetical bad handover can have severe consequences and a massive impact on the patient and healthcare professionals, I was able to do an ISBAR myself. An ISBAR (Identify, Situation, Background, Assessment and Recommendation) is a type of mnemonic which improves the safety of the transfer of important and critical information. This proves to be useful and requires some skills to be able to deliver information to other healthcare staff quickly and successfully (6,7). As much as I tried to read the patient file and being actively involved with the patient as they came into the urgent care, I still struggled and panicked whilst delivering the ISBAR to a medical practitioner over the phone. Hence, communication skills can always be improved as it is always needed for handovers or talking to patients in palliative care or delivering unpleasant news. I pledged to work on and better myself at my communication by attending seminars and workshops on communication skills. I believe every health care staff should do a touch-up or attend more communication workshops. That is not to say of course that health care staff are bad at communicating but I believe there are rooms for improvement.

There is a new challenge which concerns social media and communication between staff via the internet where these provided new ethical issues. Thompson et al have shown that 64.3% of medical students use Facebook frequently and that 83.3% of those accounts had at least 1 form of personally identifiable information. It was also shown that 37.5% of those accounts were made private and some accounts displayed unprofessional description, videos and photographs (8). However, there was a significant decline as students were nearing their last year of medical school (8). The difficulty and the dilemma arose when one should be friends through Facebook if there are working together professionally at a healthcare level. The exposure to social media and networking platforms or blogs or other media-sharing sites may increase the risk of confidentiality breach and inappropriate and unprofessional conversations (9). It is also a lot easier to gossip and spread rumours when someone feels protected behind a computer screen. Kind T et al has shown that in the US medical school, Facebook was highly present and there was not set policies to teach students about social networking, risks and provide proper guidelines. Another issue arose from patients or even healthcare staff trying to get into contact via social media which has a detrimental effect on confidentiality and professionalism appropriateness. Hence, social media or any communication via the internet have introduced new ethical practice in health and must be utterly protected where, when done correctly, can be advantageous and positive as long as professionalism is kept at a high standard.

Published 30th September 2019. Last reviewed 1st December 2021.

Reference

1. MacKay RC, Matsuno K, Mulligan J. Communication problems between doctors and nurses. Qual Assur in Health Care. 1991;3(1):1040-6166. https://www.ncbi.nlm.nih.gov/pubmed/1873527. Accessed August 13, 2019.

2. General Medical Council. Domain 3: Communication partnership and teamwork. General Medical Council website. https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice/domain-3---communication-partnership-and-teamwork. Updated April 29, 2019. Accessed August 13, 2019.

3. Salas E, Swezey RW eds. Toward an understanding of team performance and training. Norwood, NJ: Ablex; 1992.

4. Matin HZ, Jandaghi G, Karimi FH, Hamidizadeh A. Relationship between Interpersonal Communication Skills and Organizational Commitment. Eur J Soc Sci. 2010;13(3):387-398. https://pdfs.semanticscholar.org/2eec/720d7ca2b7437398398fc84244a0ab61bc1f.pdf. Accessed August 13, 2019.

5. General Medical Council. The duties of a doctor registered with the GMC. General Medical Council website. https://www.gmc-uk.org/-/media/documents/Good_medical_practice___English_1215.pdf_51527435.pdf. Updated April 29, 2019. Accessed Aug 13, 2019.

6. Thompson JE, Collett LW, Langbart MJ et al. Using the ISBAR handover tool in junior medical officer handover: a study in an Australian tertiary hospital. Br Med J. 2011;87(1027):340-344. https://pmj.bmj.com/content/87/1027/340. Accessed Aug 13, 2019.

7. Eggins S, Slade D. Clinical handover as an interactive event: Informational and interactional communication strategies in effective shift-change handovers. Commun Med. 2012;9(3):215-227. doi: 10.1558/cam.v9i3.215.

8. Thompson LA, Dawson K, Ferdig R et al. The Intersection of Online Social Networking with Medical Professionalism. J Gen Intern Med. 2008;23(7):954-957. https://link.springer.com/article/10.1007/s11606-008-0538-8. Accessed Aug 13, 2019.

9. Ventola CL. Social Media and Health Care Professionals: Benefits, Risks, and Best Practices. Pharm Ther. 2014;39(7):491-499. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103576/. Accessed Aug 13, 2019.

10. Kind T, Genrich G, Sodhi A, Chretien KC. Social media policies at US medical schools. Med Educ Online. 2010;15(1). https://www.tandfonline.com/doi/full/10.3402/meo.v15i0.5324. Accessed Aug 13, 2019.