How Communication “Failed” or “Saved the Day”: Counterfactual Accounts of Medical Errors

Abstract

Communication breakdowns among clinicians, patients, and family members can lead to medical errors, yet effective communication may prevent such mistakes. This investigation examined patients’ and family members’ experiences where they believed communication failures contributed to medical errors or where effective communication prevented a medical error (“close calls”). The study conducted a thematic analysis of open-ended responses to an online survey of patients’ and family members’ past experiences with medical errors or close calls. Of the 93 respondents, 56 (60%) provided stories of medical errors, and the remaining described close calls. Two predominant themes emerged in medical error stories that were attributed to health care providers—information inadequacy (eg, delayed, inaccurate) and not listening to or being dismissive of a patient’s or family member’s concerns. In stories of close calls, a patient’s or family member’s proactive communication (eg, being assertive, persistent) most often “saved the day.” The findings highlight the importance of encouraging active patient/family involvement in a patient’s medical care to prevent errors and of improving systems to provide meaningful information in a timely manner.

Patient coaching: What do patients want? A mixed methods study in waiting rooms of outpatient clinics

“…Fostering the relationship, the first function of effective communication, is an essential basis for quality of care. The absence of such a relationship or a poor relationship between the patient and medical specialist may lead to withdrawal of care, non-adherence, misunderstandings, dissatisfaction, formal complaints, or medical errors [ 30 , 31 ]. Essential elements for fostering the physician-patient relationship are building respect, trust, and rapport, which all contribute to the patient’s feeling of being known [ 29 ].…”

‘More than words’ – Interpersonal communication, cognitive bias and diagnostic errors

“…Figure 1 provides a summary of definitions following Croskerry [11] alongside examples and associated communication issues. Safe and effective communication in health care is vital to collect and truly hear critical information provided by patients and relay it to the right person at the right time [7].…”

“…An awareness of the relational impact of communication breakdowns on diagnostic error is only starting to emerge [7,8]. Similarly, meaningful partnerships with patients to investigate misdiagnosis have been called for [2,9] but have been slow to develop.…”

“…Systemic issues such as time and resource pressures or hierarchical workplace cultures affect patient safety, patient engagement and diagnostic error, and all forms of interaction between clinicians and patients [7,10]. When communication fails, patient safety is at risk and patients are harmed [7,10].…”

Beyond communication: an update on transforming healthcare teams

“…This perspective article offers a quick update, providing a new set of observations based on the latest findings. As a point-of-departure for these observations, we use one of medicine's most cited culprits of error: communication [see Table 1 for a complete list of articles discussing communication; see also Etherington et al ( 2 ), Street et al ( 3 ), Tiwary et al ( 4 )]—and our belief that while important, a sole focus on it fails to take a holistic approach.…”