This week two of my readers described experiences of fractured communication with their clinicians. One reader, a person in acute treatment for overwhelming anxiety, found himself watching and feeling the effects of dueling clinicians with widely differing diagnoses, medication regimens, and styles of communication. A collaborative, listening, empathetic physician versus a paternalistic, blameful, arrogant physician. Both physicians practiced in the same organization but in adjacent levels of care (one inpatient and the other outpatient). They didn’t coordinate care – they didn’t even speak to each other. The person with acute anxiety had to muster energy to advocate for himself and seek help from his partner. To little effect. The other reader experienced a sickle-cell crisis in a hospital without a sickle-cell specialist. She couldn’t get pain medication known to work for her. She was classified as a drug seeker. The treating physician wouldn’t communicate with the specialist who had treated this reader successfully many times and managed her long-term care.
So many levels of outrage here. How is it that institutions, practices, and people working in these two programs don’t know about disrespect, poor communication skills and lack of coordination within? Does nobody raise a red flag? Where was the medical record? Where were the leaders?
People in crisis usually feel powerless to challenge either the personalities of clinicians or the dysfunction of fragmented care they encounter. How could they not feel powerless? During a health crisis (anxiety, sickle-cell, trauma, or anything), with its consuming, self-focus and depleted reserves is the worst possible time to advocate for yourself. Usually people in crisis suffering these challenges feel outraged, angry, and move on. They don’t go back if they can help it. They talk with their feet.
Clinicians often disagree with each other, especially when the diagnosis is grey, as in mental health, rheumatology, or neurology. But they don’t often express the disagreement in front of the person receiving care. Why this public disagreement – ego, maybe. An African-American young woman hits three areas of common discrimination related to pain management – race, age, gender. Reaching another clinician can take 10-15 minutes. Too long in our productivity conscious system? Accessing health information in another system may be impossible.
Much of the work I do tries to lessen these dilemmas. Improving the experience of people at the center of care: engagement, information exchange, leadership, relationships, training. These dilemmas are ancient. Can we move the dial an inch? I hope so.