What physicians say, and how they say it

Editor’s Note:Physician’s Practice features contributions from members of the medical community. The expressed opinions are that of the writer(s) and do not necessarily reflect the opinions of Physicians Practice or its publisher.

Almost all physicians strive to provide exceptional care to each patient. Usually, we focus on clinical acumen, diagnostic accuracy and appropriate and effective treatment choices. However, patients and their families often will make their own judgments about the quality of care based on the quality of physician communication.

In my role as a physician leader, I am frequently asked to review cases in which a patient or family member complained or expressed concern about some aspect of clinical care. Unfortunately, I sometimes do determine that clinical care was lacking. In other circumstances, including a few recent cases, the physician provided the standard of care but what was lacking was communication or establishing a therapeutic relationship with the patient.

There are some general themes that emerge from years of reviewing these concerns. Sometimes, the physician accused of substandard care just happens to be the bearer of news that is upsetting to the patient and family. I believe that delivering bad news well is not only a skill but a necessary competency for any physician. Patients and their loved ones often remember the moment they hear the dreaded diagnosis or prognosis. Without meaning to, we can deliver that news with seeming callousness or impatience. This poor delivery can be confused with poor care.

In other situations, the patient is sent on an odyssey of diagnostic testing and treatment attempts, sometimes without any real benefit. Even if everything is done correctly from a medical standpoint, patients and families can misinterpret the testing and treatment trials as evidence of inexperience or ignorance on the part of their physician. While physicians are highly trained and very knowledgeable, the human body is the most complex machine ever made, rendering medicine an inexact science. Answers are not always discoverable.

I also repeatedly see what I call the “aha” diagnosis. A physician benefitting from all the previously conducted tests and treatments, including tincture of time, makes the elusive diagnosis. That physician can choose to explain how a new diagnosis doesn’t necessarily mean that something was missed, but that doesn’t always happen. This can leave patients wondering why doctors who previously treated them didn’t arrive at the same diagnosis.

When we are talking to a colleague, I believe we each bear an equal responsibility to communicate clearly. When we are talking to patients and families, our responsibility is even greater. Our patients are sick, may be in pain, may be afraid and are trying to process complex information. We owe it to those who place their trust in us to deliver bad news with compassion and grace, explain what we are planning and what we are thinking and provide clarity around how diagnoses are made.

Considering all of the difficulties our patients and their families may have to face - a devastating diagnosis, death, pain, costly testing and/or treatment, fear and worry - it is essential that we first do no harm. I very much feel for those patients and families who are burdened with not only the disease, treatment and medical costs but also with the belief that their physician didn’t provide good care.

When our clinical care deviates from the standard, we owe it to our patients to confess, explain and rectify the situation. When our clinical care meets the standard but is delivered in a way that doesn’t meet the patients’ or families’ needs or expectations, we face a more difficult circumstance - one that is tricky to navigate and can be difficult to address in a way that fulfills their hopes. In our effort to provide the best care, we focus not only on what care is delivered but how the care is provided.

Jennifer Frank, MD is a family physician and chief medical officer in northeastern Wisconsin. She continues to find medicine to be the most rewarding profession imaginable, second only to motherhood. She's married to a fellow physician and has four children. Her family reminds her of what is most important and inspires her study and pursuit of work-life balance.