Wednesday, July 09, 2008

Poor communication = Poor healthcare?

A study published in the June 2008 issue of the Canadian Medical Association Journal, asks whether poor communication was an important risk factor in adverse events for hospital patients (1).

In order to try to answer this question, the researchers randomly chose 2,355 patient charts from 20 hospitals across the province of Quebec, Canada, looking at reported communication problems (language, hearing abilities, and more) and then comparing these to the 'adverse events' reported.

Adverse events, in medical lingo, are 'unintended injur[ies] or complication[s] caused by delivery of clinical care rather than by the patient’s condition.' (1)

It may not come as a surprise to you that some patients with communication barriers were 3 times more likely to experience preventable adverse effects during their hospital stays. The two main contributors to the likelihood of adverse effects were found to be communication barriers and poor clinical management.

As an editorial in the same issue puts it, 'elderly women, those who were admitted to hospital because of an emergency and those whose ability to communicate with health care providers was limited because of a foreign language, deafness or a psychiatric disorder were the patients most likely to receive inadequate care.(2)'

The authors have called for more research looking at what can be done to identify people with communication problems, and then to consider these barriers in providing health care.

Solutions to the problem of health communication are both simple and complex. In the editorial mentioned earlier, the use of 3 questions is referred to as a way for health professionals to be sure that understanding is achieved:

What is my main problem?
What do I need to do?
Why is it important for me to do this?

These questions are suggested by the Partnership for Clear Health Communication, based on work done by Iowa Health ( The idea here is that patients should be able to answer the three questions after talking with their health providers to ensure that understanding has been achieved.

Other problems are more complex, says Frankel (2): health care is often based on providing the most efficient care for a very large population, and this may be a barrier to recognizing communication problems and helping those who are impaired in some way.

1. Bartlett, G., Blais, R., Tamblyn, R., et al. (2008, June 3). Impact of patient communication problems on the risk of preventable adverse events in acute care settings. CMAJ 2008 178: 1555-1562.
You can read it for yourself at (PDF).

2. Frankel, A. (2008, June 3). Health literacy and harm: Who is at risk? What is the fix? CMAJ 2008 178: 1573-1574. You can read it for yourself at

Summary and comments not otherwise cited are the opinion of Carol Perryman.