When miscommunication in medical space results in untold grief

Josie* lay on her back on the operating theatre, her arms spread out straight beside her on the arm support, with her eyes darting around in anxiety. She had been brought in for an emergency caesarian section due to poor progress of her labour.

We suspected the little one was likely too big to come through as Josie was pretty small herself. Josie had put up a good fight, but after five hours of good progress, everything had come to a standstill for the past three hours, with no more progress of cervical opening despite good contractions. It was time to help the two precious people before us.

Just because we were ready does not mean Josie was. She had never been admitted to a hospital in her entire 19 years. This was a first, and here she was, instead of doing what she thought was a straight-forward biological process of bringing forth her baby and going home, fate was throwing her curve balls at a very fast pace.

As the operating room was being prepared for Josie, the anaesthetist met her at the theatre receiving area and walked her through the anesthetic consent, explaining to her about spinal anaesthesia, and how it would work to keep her pain-free and safe while we do the surgery.

Josie nodded in agreement with everything she was told, but the anaesthetist was well aware that despite the acknowledgement, Josie was too anxious to internalise most of the information. Therefore, he simply put it to her that her lower body would no longer be there for the duration of surgery.

When Josie got to the operating table, the anaesthesia was administered. The assistant set up a screen that blocked her from seeing what was happening below her chest. As standard practice, we do not subject our patients to visualising their insides being pulled out of her abdomen during surgery.

The surgery proceeded smoothly and once the baby had been delivered, cleaned, dried and wrapped, Josie forgot all about us as her anxiety was washed away at the sight of the beautiful little being she had brought forth. She was overwhelmed with joy, and after bonding with her baby for a few moments, he was taken away to keep warm while we finished the surgery.

With the adrenaline gone, Josie gave in to the fatigue and dozed off on the table. She was nudged awake as we were preparing to move her to the post-anaesthesia care unit. Just before we pulled down the screen, in her sleepy state, Josie spoke up and asked if we were going to put her legs back in place before we wheeled her out.

We were all a bit confused before it dawned on us; Josie thought we had literally detached the lower half of her body and set it aside as we did the caesarian section. She just needed to be sure that she would not be left disabled. You bet it took a lot of effort to hold back the laughter. We all threw dirty looks at the anaesthetist as he fumbled to correct the communication mishap.

Hilarious as it may sound, miscommunication in the medical space can result in a lot of untold grief. Patients who did not understand simple instructions on when to take their medication have had unwanted side effects due to poor timing. For instance, medication taken three times a day means every eight hours, and not breakfast, lunch and dinner.

Post-operative patients who go home on pain medication suffer through the night when they take their painkillers at 8.am with breakfast; at 1pm during lunch; and at 6.30pm with dinner. By 2am, the effect has worn off and they are in pain for hours, awaiting breakfast; yet they should have taken the medication at 6am, 2pm and 10pm for continuous coverage.

A young man was distraught to lose his wife to complications of eclampsia, the second-leading cause of maternal death in Sub-Saharan Africa. When the doctors told him that his wife had acute kidney injury, they failed to explain that the kidney function failed as a result of eclampsia. He understood it to mean that when she underwent the caesarian section, the surgeon inadvertently physically injured her kidneys. Imagine his grief when no one even looked sorry for such an error. It took months to find someone to correct this notion.

Patients have complained of abandonment by their doctor when they go to hospital as a general hospital patient because of communication issues. The patient assumes that the doctor in charge of their care is their personal doctor; getting upset when the doctor leaves at the end of the shift, handing over care to the incoming doctor.

Even more discomfiting is when a doctor handles all the outpatient care and planning for procedures, and then the actual procedure is performed by a different doctor they have not met. Even when the doctor performing the procedure is the most competent member of the team, the patient may report abandonment, simply because no one took time to explain the hospital procedure.

Aside from the content of the communication, how doctors communicate with their patient is a huge determinant of patient outcomes. Good clinical skills and knowledge by itself is not good enough. According to Lussier MT, Richard C. (2005); an estimated 70 per cent to 80 per cent of medical litigation involves relationship or communication problems.

Levinson et al (1997) demonstrated in their study that physicians’ communication strategies tended to reflect their history with malpractice suits. Further, they drew inference that the climate of a patient interaction affects patient satisfaction more than the actual content of the discussion does. For patients, a relaxed atmosphere represents a warmer, more personal relationship.

Patients want to be seen, heard and have an opinion regarding their care. They want to be active participants in the decision-making process; hence they need to understand what you are saying to them. The effort to break down information in a language they understand should not be misconstrued to mean dumbing down the complexity of the information. This is insulting to the patient.

Most importantly, as a doctor, do not make promises you cannot keep. Patients will hold you to this and when you do not deliver, it destroys their trust in you. In the event things do not go as planned; you, the doctor, must take the responsibility of communicating the outcomes to the patient and their loved ones fully. This takes a lot patience and empathy, to provide full information to the best of your knowledge, without holding out on them.

Josie did eventually get the joke before she left our theatre unit, and being a good sport, laughed at herself in good humour. She did teach us a thing or two about our profession; what we think we said versus what the patient actually heard us say!

Dr Bosire is a gynaecologist/obstetrician