call bell

Failure to Communicate in Hospital

When I was fifteen, I was rushed to the hospital because I almost stopped breathing; my throat was nearly swollen shut. I couldn’t talk. I was confined to bed because my doctor was worried that any movement at all could trigger a coughing attack that would completely close my throat. I wasn’t even allowed to try to whisper, because my doctor thought that doing so would irritate my throat, again with the potential to stop my breathing entirely.

My health care providers set up a surgical kit (tracheostomy tray) next to my bed and told me to hit the call button if my breathing got worse. To save my life, they would have to operate on me right there, putting a breathing tube in my neck.

They said there wouldn’t be time to get me to an operating room. I was very scared, but they told me that whenever I hit the call button, someone would come running.

Because I would be using the call button for routine needs as well, they wouldn’t immediately know if it was an emergency or not. But to be safe, the plan was that someone would always come running.

A few hours into my stay, I pressed the call button for the first time. Nobody showed up.

Instead, a moment later, a voice came over the intercom, asking, “What do you need?” Of course, I couldn’t talk, so I couldn’t answer. After a minute, the voice said in an admonishing tone, “If you don’t say what you need, no one will come.” I froze and realized in a flash that I could die that day — in the hospital, with the surgical tools to save my life lying less than two feet away.

That was my first hint that the promise of health care to save lives can fall apart. As Cool Hand Luke said, “What we’ve got here is a failure to communicate.”

Which of the following two mindsets on the part of the person on the other end of the intercom seems more likely?

1. “This is a hospital. The children on this floor are very sick. If a patient presses the call
   button and then doesn’t say anything, I better send someone to see if something is wrong.”
2. “If a child presses the call button and then doesn’t answer me when I speak to her, she must be fooling around, just trying to make our jobs more difficult. I don’t have time for this. I’ll make it clear to her that we’ll interact with her on our terms, not hers.” It’s clear that the second one is a better match for the facts. It assumes that the patient is being deliberately disruptive and frames the encounter in terms of how to maintain power and control.

That attitude on the part of the healthcare professional reflects one of a number of flawed mindsets that are found throughout health care, often resulting in bad outcomes.

That’s not intentional on the part of doctors and nurses. They do not get up in the morning and say, “I’m going to find more ways to harm people today.” Almost every single healthcare professional I’ve ever run into or heard about comes to work intending to do a good job. But things often go wrong.

The healthcare system saves millions of lives every year, but it also has a lot of problems.

Virtually all adults of normal intelligence — and many children, too — are completely capable of understanding their medical condition and the choices they face. But the healthcare system often makes it very difficult for them to do so. That fact reflects a failing of the health care system, not a failing of the patients.

Elizabeth Bewley

Elizabeth Bewley MBA wrote this guest blog. The writer is President and CEO of Pario Health Institute and the author of Killer Cure. The information in this blog post is adapted from Killer Cure.

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