Communication

In medicine, we are constantly trying to make progress in the field. We achieve this through various mediums: new methods to teach medical students and residents, innovative technological procedures, and even what we call “M and M” (Morbidity and Mortality, a conference during which a case is presented and there is a discussion about what went wrong—usually a negative outcome for a patient). In these M and M’s a misstep in the typical sequence of events occurs, resulting in a poor outcome. People spend hours at these M and M’s in an attempt to decipher where this ‘misstep’ occurred. 95% of the time, mistakes can be traced back to a breakdown in communication. I recently attended a lecture at which the tragic story of Jose Martinez was shared.[1] I will attempt to give you a brief summary of the unfortunate events that led to Jose’s death (although I encourage you to read the article if you can): after being diagnosed with a heart condition, Jose underwent surgery in an attempt to help his ailments. In his recovery, a medication called Digoxin was to be administered. While the Digoxin dose is standardized for adults, it is a medication rarely used in pediatrics. Through a calculation error that was reviewed multiple times prior to administration Jose was accidentally given a dose of digoxin over 10x the typical dose. The immediate knee jerk reaction is to try and ascertain who is at fault. Who can I blame for this? The answer is not so simple. Even though the initial dosing error was made by the physician, the numerous checks in place after the initial mistake should have prevented and caught this error. The bottom line is that an improvement in communication could have averted this tragedy. Improved communication is a vague idea: perhaps if the nurse and physician discussed this dose further the mistake could have been avoided. Or if communication between the pharmacist who dispensed the medication and the receiving nurse were better, Jose would be alive today. Determining the crucial point at which this communication broke down could result in endless hours of speculation. Ultimately, it is miscommunication that led to Jose’s premature demise.

Now, this is not a novel idea: improving communication is a notion that has been prevalent for centuries. What does this idea have to do with my situation? Ironically, even though some of my communication skills were strong before this ordeal, I now realize that I have long depended on verbal communication as my sole means of communication. In today’s age there are countless ways to communicate: e-mails, texts, (snail) mail, telephone, and even Facebook. There are also more classical ways to communicate: face-to-face exchanges, interpreting of body language, and perhaps most importantly, listening. Even though my verbal communication has been hampered, this deficit has allowed me to focus on and strengthen other modes of communication. It is akin to someone who has lost their sight; in most of these cases their other senses become heightened. I hope that in my case that this ‘loss’ of verbal communication has enhanced my other modes of communication. In many ways, I consider myself lucky to have the deficits I have at this time in history. I say ‘in many ways’ because I often imagine my fate if this were to occur even 100 years ago. First off, medicine would not have been at its current stage, and if I went to my doctor with the complaint of double vision, a good doctor might have said, “Well, it’s probably a brain tumor, but there really is no way to treat it even if it is.” His (or her) empathy wouldn’t allow him (or her) to tell me that I’d simply have to wait to determine if there is progression; in essence I would be forced to await death. Let’s say for this hypothetical situation, my condition was somehow treated but left me with these current deficits; remember this is before the advent of luxuries like Internet, or even – gasp – smartphones excluding e-mails, texts, and Facebook. Even though I realize that I have suffered an unfortunate fate, part of me feels incredibly fortunate for this to have happened when it did.

I know that one article may not be able to prevent all consequences of miscommunications, however, I believe today technology should serve to bring us closer together and allow us to communicate more clearly. Even with these advances, it seems intuitive that we should become closer to our fellow man, but in reality we have become more distant from each other.  In my mind, I imagine a couple at dinner engaged not in conversation, but with their phones, sending e-mails and texts—perhaps checking their Twitter feed. Is this now the only way to communicate?

[1] http://www.nytimes.com/1997/06/15/magazine/how-can-we-save-the-next-victim.html

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