Chapter 1: Communication Skills for Surgeons

INTRODUCTION

• Communication failure occurs across all phases of the surgical pathway.

• Suboptimal communication between surgeons and their patients can lead to misdiagnosis/delayed diagnosis.

• Problematic team communication is a root cause in more than 60% of serious adverse events (“never events”).

• The majority of serious adverse events in hospitals occur in surgical patients.

BACKGROUND

Effective communication between surgeons and patients is critical to patient safety in all phases of the surgical journey.^1,2 Communication problems contribute to patient harms in multiple ways, and, according to The Joint Commission, they are root causes of more than 60% of serious adverse events leading to patient harm.³ Moreover, the majority of serious adverse events in hospitalized patients occur in patients undergoing surgical treatment.^4,5 Skillful physician-patient communication was often characterized (and minimized) in the past as bedside manner and considered to be secondary in importance to the fine motor skills of surgery.⁶ However, it is increasingly apparent that communication and other nontechnical skills are critical to safe surgical performance and outcomes, in the same way these skills were found to be critical to aviation safety. Crew Resource Management training (the model for medical team training) has been mandatory for commercial aviation since 1991.⁷ Although most surgeons consider themselves to be good communicators, our patients and the nurses and other professionals with whom we work do not rate us as highly.^8,9 A systematic literature review of surgeon-patient communication studies showed that the greatest “opportunities for improvement” (ie, deficits) lie in surgeons’ discussing patients’ concerns and using empathy.¹⁰

Surgeons face many barriers to safe, effective communication. Among these are time/production pressures, interruptions, distractions, the physical layout of the exam room, multiple patient complaints/concerns, patients’ limited health literacy, and language barriers.¹¹

Our communication style (“warm” vs “authoritarian”)¹² and our training (focused on constructing a differential diagnosis)¹³ also represent barriers to communication, patient-centered care, and shared decision making. Communication difficulties can lead to incorrect or delayed diagnosis, and, in the case of patients with limited health literacy and/or limited English proficiency, they are associated with a higher rate of adverse events.¹⁴ Patient dissatisfaction⁹ and surgeon dissatisfaction (with increased risk of burnout) and lawsuits are associated with communication problems (over 70% of patients who sued their physicians cited communication problems such as feeling disrespected, devalued, or even abandoned by the physician). A closed claim study of orthopedic surgical claims, although focused on technical errors, acknowledged that more thorough discussion of uncertainties about surgical risks and outcomes was warranted in almost ...