Why Clients Lose Trust
As a pregnant woman who has made many visits to the doctor over the last 9 months, I have experienced from a patient’s perspective, what happens when a medical office does not communicate effectively.
For the first part of my pregnancy I had no health concerns. Therefore, there were no problems concerning the continuity of my medical care. However, a week before my due date I began to have some bleeding. I ended up seeing 3 different practitioners over 5 days and my experiences did not instill a great amount of confidence in my medical care.
On Friday, I saw Dr. T. He determined that the baby seemed fine on the monitor and told me that my cervix was not dilated. She sent me home with instructions to call for an appointment on Monday if I was still bleeding.
With no improvement by Monday, I talked to Dr. L about the events that had transpired thus far and filled him in on what Dr. T did and didn’t do on Friday (which apparently wasn’t in the chart yet). He discovered that the bleeding was coming from my placenta and instructed me to limit my activity and keep my regularly scheduled appointment on Wednesday for another recheck and non-stress test to be sure that the baby was still unaffected by the bleeding.
When I arrived for my appointment on Wednesday, it became apparent that midwife M assumed I was there for my routine 39-week check. I had to insist that the only reason I had come back so soon for another appointment was because I was still bleeding and Dr. L had specifically wanted another non-stress test. Once again I had to explain what was done on Monday and fill her in on Dr. L’s thought process. Luckily Dr. L had shared this information with me and I had understood, being a medical professional myself. In the end she acquiesced and everything still seemed fine with the baby, but it left me feeling ill at ease.
What if I didn’t have medical knowledge or had been confused about my condition? What if I hadn’t wanted to create conflict and just nodded and went along with the plan? Thankfully in my case there were not any serious consequences related to the bleeding, but there could have been and I hate to think of what may have happened under different circumstances.
Each individual practitioner may be excellent at what he/she does, but if there is no communication between the various doctors, the important details of a case can get lost. Depending on the patient (or in our case, the client) to fill in those missing links is not good medicine. The trust of the patient is lost when he or she knows more about their case than the doctor. If I hadn’t been at the end of my pregnancy, I would have changed to a different medical group.
Unfortunately similar situations happen in my practice all the time. Follow-up appointments are not scheduled with the same doctor. The doctor does not always look over the patient’s history and/or notes made by the previous doctor. The doctor does not listen to the concerns or goals of the client for that visit to be sure they are on the same page. Again, it all comes down to communication and listening to the client.
How can we minimize these issues? Daily patient rounds certainly help for the more complicated cases. But to me the single most important tool is our charting. It’s imperative to take the time to write detailed notes (those dreaded SOAPs!) and to read previous notes before walking into an appointment. Even if I have a different opinion or plan for a patient after reading the history, at least I can try to win the trust of the client by being knowledgeable about what was done in the past. I cannot expect the client to fill me in on the thought process of my colleagues or to accurately remember all of the information that was presented at the previous appointment.
I have a feeling that these miscommunications and gaps in patient/client care are more common that we would like to acknowledge. What are some of your experiences? Have you found any solid solutions to improving continuity of care? As the number of doctors in a given practice increases, does the challenge of communication increase as well? My own experience has further strengthened my resolve to improve my charting and to be a more aggressive advocate for my own medical care.
