Health Communication for Health Care Professionals Essay

Canera L. Pagano, JD, RN, is the director of risk management at Yale New Haven Health System’s Bridgeport Hospital in Bridgeport, Connecticut. She was a malpractice attorney for the defense (providers) for 7 years. She has been the director of risk management for 5 years. She has given invited lec- tures to health professionals on a variety of risk and legal issues, including medical malpractice, medical records, adverse events, and risk management.

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Health Communication for Health Care Professionals

An Applied Approach

Michael P. Pagano, PhD, PA-C

With Chapters on Risk Management and Medical Malpractice by

Canera L. Pagano, JD, RN

Copyright © 2017 Springer Publishing Company, LLC

All rights reserved.

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16 17 18 19 / 5 4 3 2 1

The author and the publisher of this Work have made every effort to use sources believed to be reli- able to provide information that is accurate and compatible with the standards generally accepted at the time of publication. Because medical science is continually advancing, our knowledge base con- tinues to expand. Therefore, as new information becomes available, changes in procedures become necessary. We recommend that the reader always consult current research and specific institutional policies before performing any clinical procedure. The author and publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance on, the information contained in this book. The publisher has no responsibility for the per- sistence or accuracy of URLs for external or third-party Internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.

Library of Congress Cataloging-in-Publication Data Names: Pagano, Michael P., author. | Pagano, Canera L., author. Title: Health communication for health care professionals : an applied approach / Michael P. Pagano. Description: New York, NY : Springer Publishing Company, LLC, [2017] | With chapters on risk management and medical malpractice by Canera L. Pagano JD, RN. | Includes bibliographical references and index. Identifiers: LCCN 2016020114 | ISBN 9780826124418 Subjects: | MESH: Health Communication | Professional-Patient Relations | Communication | Health Personnel Classification: LCC RA427.8 | NLM WA 590 | DDC 362.1—dc23 LC record available at https://lccn.loc.gov/2016020114

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health risks, and a patient-centered focus on wellness.

And to Dr. Sandy Ragan, professor emeritus, the University of Oklahoma, who took a chance working with a nontraditional health care provider

turned graduate student, changed her scholarly focus and taught so many of us the importance of researching, teaching, and writing about interpersonal

provider–patient interactions and improving health communication outcomes.

vii

Contents

Foreword Teresa L. Thompson, PhD xiii Preface xv

1. A Brief History of U.S. Health Care 1 Health Communication 2 A Historical Overview of Health Communication: The First

American Hospital 2 Impact of Wars on Health Care Delivery 3 Bartering for Health Care 4 A Disease-Centered Approach 4 The Rise and Impact of Technology 5 Pharmaceutical Contributions to Health and Costs 6 Contemporary American Health Care and its Impact on Health

Communication 7 Reflections 9 Skills Exercise 11 Health Communication Outcomes 12

2. Health Care Pedagogy 15 Health Communication: A Generalist Approach 15 Training Providers: The Early Years 16 Training Providers: The Flexner Report 17 Biomedical Model 18 Biomedical, Technological Specialization 20 The Nursing Coculture 21 Biopsychosocial Model 22 The Culture of Health Care 23

Share Health Communication for Health Care Professionals: An Applied Approach

viii Contents

Reflections 23 Skills Exercise 26 Health Communication Outcomes 27

3. Interpersonal and Gendered Communication 29 Interpersonal Communication and Health Care 30 Building Relationships 31 Verbal and Nonverbal Competencies 33 Role, Self, and Goal Competencies 49 Sex versus Gender 51 Masculine- Versus Feminine-Gendered Communication 53 Reflections 55 Skills Exercise 62 Health Communication Outcomes 63

4. Provider–Patient Communication 65 Narratives 65 Listening Versus Talking 68 Audience Analysis: Across the Life Cycle 70 Age 71 Education 76 Sex 77 Gender 77 Socioeconomic Status 79 Stereotypes and Marginalized Populations 80 Health Literacy 81 Reflections 83 Skills Exercise 87 Health Communication Outcomes 88

5. Intercultural Communication in Health Care 91 Health Care Culture—Providers 91 Reflections 102 Skills Exercise 104 Health Communication Outcomes 105

6. Ethics and Health Care 107 Autonomy 107 Truth Telling 109 Confidentiality 110

Contents ix

Consent for Care 112 Paying for Health Care 113 Quality of Life and/or Death 115 Reflections 117 Skills Exercise 121 Health Communication Outcomes 122

7. Capitalism, Health Care, and Health Communication 125 Capitalism, Technology, and Specialization 126 Managing Health Care 127 Capitalism and Medicine—Influence and Bias 129 From a Clinical to a Business Model 131 The Economics of EMRs and EHRs 132 Rewards for Treating, Not for Preventing, Illness/Injury 135 Reflections 137 Skills Exercise 140 Health Communication Outcomes 141

8. Health Care Organizational Communication 143 Organizational Communication 143 Organizational Communication Theories 145 Mission, Values, and Goals 148 Marketing and the Media 150 Health Care Administration 151 Reflections 153 Skills Exercise 155 Health Communication Outcomes 156

9. Team Communication 159 Team Communication in Hospitals/Health Care 160 A Systems Approach 164 Team Development 165 Roles 166 Norms 167 Status 168 Relationships 170 Team Roles 171 Managing Conflict 172 Reflections 174

x Contents

Skills Exercise 176 Health Communication Outcomes 177

10. Provider–Provider Communication 179 Hierarchy and Autonomy 179 Electronic Medical Records 182 Systems Approaches 184 Burnout 186 Reflections 189 Skills Exercise 191 Health Communication Outcomes 192

11. Health Care Leadership Communication 195 Traits, Skills, and Styles 196 Contingency, Path–Goal, and LMX Theories 198 Reflections 204 Skills Exercise 205 Health Communication Outcomes 206

12. Risk Management and Health Communication 209 Canera L. Pagano Changing the Landscape of Risk Management 209 Adverse Events: State and Federal Oversight 211 Disclosure of Adverse Events 213 Communication Problems: When Behavior Becomes a Risk 215 Reflections 218 Skills Exercise 219 Health Communication Outcomes 220

13. Medical Malpractice and Health Communication 225 Canera L. Pagano Communication in Medical Malpractice 225 Elements of a Medical Malpractice Action 229 Causation 231 Initiation of a Lawsuit 231 Reflections 232 Skills Exercise 234 Health Communication Outcomes 234

14. Palliative Care and End-of-Life Communication 237 Palliative Care 237 End-of-Life Communication 240

Contents xi

Acceptance in Stages 242 Taking a Patient-Centered Approach 244 Utilizing a Family-Centered Approach 246 Reflections 248 Skills Exercise 251 Health Communication Outcomes 252

15. Changing the Culture and Communication of Health Care in America 255 Health Care and U.S. Cultures 255 Business versus Clinical Model 266 Reflections 267 Skills Exercise 271 Health Communication Outcomes 271

Index 275

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xiii

Foreword

I’ve been teaching both a social science–oriented health communication class and a skills-oriented communication for the health professions class for several years. I have no difficulty finding a good book for the former, but the books that are geared toward skills for health professionals tend to ignore a sophisticated conceptualization of communication processes. They tend to be based more on anecdotal evidence rather than empirical work. As I revised my plan for the course for health professionals a few years ago, I got in touch with Michael P. Pagano, as I was using his case studies book within that class and I wanted his input on the cases that coordinated most effectively with the vari- ous chapters in the other text I was using in the course. He provided very help- ful feedback, and even created some individual case studies for my students and simulated patients that semester. As we communicated, he shared some ideas that I found useful for my course. This led me to say, “Why don’t you write a better book for me to use as the primary text in my class?” And he did! This book is the product of that conversation and I am delighted to be able to use it in my course. Thus, I am partially responsible for this volume. I’m per- fectly willing to share in the credit.

The reader will find the best of both worlds in this book. Michael, with the help of Canera L. Pagano, has a sophisticated understanding of communica- tion processes as well as a thorough understanding of the complexities of the health care process. Most people who write in this area have only one or the other, but a good health communication book that can help health profession- als requires both. Both teachers and students will benefit. The communica- tion process and both health and health care delivery are notably intertwined. Communication is directly related to the accuracy of diagnosis and to the ade- quacy of information communicated by patients and care providers. Health care providers may improve provision of care by understanding and empathiz- ing with patients more completely.

In addition, the reader of this book will find that it is replete with use- ful and interesting examples, reflections, discussion questions, and exercises.

xiv Foreword

This is a very interactive volume that will facilitate student engagement and learning at all levels. It focuses on both verbal and nonverbal dimensions of communication and examines the impact of all key audience characteristics on the communicative process. In each case, opportunity is provided to prac- tice and analyze relevant skills. I am particularly pleased with the foci pro- vided within the book on outcomes, ethics, organizational issues, malpractice, end-of-life communication, and cultural concerns. The book is simultane- ously well grounded in medical knowledge and in communication theory and research. The reader will appreciate the focus on avoiding communication problems in health care.

I am delighted to be able to use this book in my class, and am proud to have been a part of talking Michael into writing it. It fills an important void in the market for professors, students, and future health care professionals. I think you will enjoy and appreciate it.

Teresa L. Thompson, PhD Editor, Health Communication

Professor University of Dayton

Dayton, Ohio

xv

Preface

This text is intended to enhance and stimulate the exploration, effectiveness, and education of the behaviors and skills of health professions students (RN, MD, physician assistant [PA], doctor of osteopathy [DO], advanced practice registered nurse [APRN], physical therapist [PT], etc.) and practicing health care providers related to provider–patient, provider–provider, and provider– organization interpersonal, health, team, and organizational communication. According to a report from the Institute of Medicine, between 40,000 and 100,000 Americans die annually from medical errors. This text is intended to highlight the fact that, at the most fundamental level, all medical errors are communication based.

Therefore, whether you want to better understand the theories that under- lie the messages sent via verbal and nonverbal communication, or you want to enhance your listening, speaking, and/or interacting abilities, this book is intended to support your efforts. The primary author has more than 50 years of combined experience/ expertise as a health care provider (PA, registered nurse, and army corpsman). Canera L. Pagano has more than a decade of health care/ malpractice law and risk-management experience. Their diverse backgrounds cross numerous health care contexts (hospitals, clinics, surgery, OB/GYN, family practice, occupational health, emergency medicine, provider education, mal- practice defense, administrative, etc.). They use these experiences to help read- ers apply the theories and behavioral recommendations discussed in this text to enhance providers’ understanding of health communication and its role in U.S. health care delivery.

This book is intended to serve as a source of information, primarily as a stimulant for interaction, exploration, application, reflection, and self- assessment. Effective health communication is the result of a complex process that begins with understanding the theories related to various interdependent and interrelated communication disciplines (interpersonal, intercultural, small group/team, organizational, health, etc.). To assist you in better assimilating and utilizing these disciplines, each chapter provides real and/or hypothetical

xvi Preface

examples that can be assessed and analyzed. Therefore, the authors encourage you not to just read each chapter, but also to apply what you are studying to your daily interactions with patients, peers, friends, family, and so forth. The more conscious you are of how you communicate, verbally and nonverbally, in all contexts, the more likely you are to enhance your effectiveness in the most challenging and emotionally charged communication context of all— health care. Most communication between providers and patients is psycho- logically affected as a result of a number of predictable factors:

■ Patient’s fear

■ Health literacy inequality

■ Provider power/control (perceived and real)

■ Prior experiences (patients with providers and providers with patients)

With these understandings and goals in mind, please begin your journey through this text by asking the simple question “why”? Why study health communication when you have been interacting with friends, lovers, profes- sionals, clients, patients, and so forth for years or decades? We urge you to keep asking that very important “why” question throughout your exploration of this text and your application of the material provided. Perhaps you could seek “why” answers not to a defensive, “why do I need to study communi- cation” query, but rather to a more reflective “why don’t health care provid- ers do more (listening, translating of medical jargon, collaborative decision making, etc.)?” Or “why do health care organizations communicate with (providers or patients or both) in such an authoritarian fashion?” The authors do their best to help you assess these difficult, but very important, questions in an effort to help you become the most effective interpersonal communica- tor of health care information possible.

In addition to this text, qualified instructors can obtain a Power- Point presentation and Instructor’s Manual by e-mailing textbook@ springerpub.com.

Michael P. Pagano

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