Welcome to LING101 AN INTRODUCTION TO LINGUISTICS Linguistics Myths - - PowerPoint PPT Presentation

AUSTRALIAN INSTITUTE OF HEALTH INNOVATION Faculty of Medicine and Health Sciences

AIHI Seminar Series, Macquarie University. 28 May 2019

Tales of Give and Take Communication and the Diagnostic Odyssey

Dr Mary Dahm, Centre for Health Systems and Safety Research,

Australian Institute of Health Innovation, Macquarie University.

@DrMaryDahm

AUSTRALIAN INSTITUTE OF HEALTH INNOVATION Faculty of Medicine and Health Sciences

Welcome to LING101

AN INTRODUCTION TO LINGUISTICS

Linguistics Myths

• Linguists speak many languages.

They don’t (or not all).

Sing to me of the man, Muse, the man of twists and turns driven time and again

• ff course...
• Homer. Odyssey Volume I: Books 1-12 (ca. 8th century B. C., translation Robert Fagles, 1990).

Ulysses Deriding Polyphemus, 1829 by JMW Turner (1775–1851), National Gallery London.

Failures in the Diagnostic Process

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• IOM. Improving diagnosis in healthcare (2015)

Failure to gather or interpret information?

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Ulysses and the Sirens, 1891 by JW Waterhouse (1849–1917), National Gallery of Victoria, Melbourne. Confirmation bias Premature closure Diagnosis Momentum Framing effect Anchoring Unpacking principle

AUSTRALIAN INSTITUTE OF HEALTH INNOVATION Faculty of Medicine and Health Sciences

Failure to gather information

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Failure to gather information

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• Bluey. Hospitals (2 OCT 2018). Joe Brumm, ABC, Ludo Studio

Patient – interrupted

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5 10 15 20 25 30 35

1984* 1999~ 2019#

Time in seconds Study years Patient speaking time (in seconds) before 1st interuption % of patient who completed initial statement *Beckman & Frankel, Ann Int Med, 101 (1984):692 , ~Marvel et al., JAMA, 281 (1999):283. #Ospina et al., J Gen Int Med, 34 (2019):36

18 23 11 33 28 23

• The failure to elicit all relevant

information (unpacking) in establishing a differential diagnosis may result in significant possibilities being missed

• !!! if the gathering of history

information is limited, potential alternative diagnosis may be discounted.

Unpacking principle

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• Croskery. Acad Med 78.8 (2003):775-780

Patient – un-interrupted

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Langewitz, Wolf, et al. BMJ 325.7366 (2002): 682-683

• 331 patients
• Mean 92s speaking time
• 78% patients speak < 2m

“In all cases doctors felt that the patients were giving important information and should not be interrupted.”

What’s in a word?

History taking – Taking a Record

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SEMANTICS

Anamnesis – Receiving a Memory

Mosby's Dictionary of Medicine, Nursing & Health Professions, 10th Edition, 2016

• “We weren’t trained to listen. We were trained to

ask questions that steered people to a destination […] In turn we were given answers that fit neatly in checkboxes.”

• “We didn’t receive a history from people. We didn’t

sit and listen as it unfolded. […] If we can't be present to receive the story, we can't serve the

• patient. We can't be the physicians that we want to

be.” **  Patient-centred communication skills as solution

Tales of Give and Take

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RECEIVING (NOT TAKING HISTORY) ** From an interview on Good Life Project Podcast 28 Feb 2018 “Choosing Not to Die, When Doctor Becomes Patient – Dr Rana Awdish”

Patient- centred communication skills

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Dahm & Yates. TESL Canada 30.S7 (2013):21

The little things we do, often without noticing…

• More approachable
• Better rapport
• Increased trust
• Better patient participation

The thing about time…

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Oh, by the way…

OFFICE | FACULTY | DEPARTMENT 16

• Patients introduced new topics in 21% of closing phases
• New problems associated with
• less information exchanged previously by doctors and patients and
• less orientation statement by doctors

It really is the little things….

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It really is the little things

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“what’s happened” vs “what happened”

• shorter reports (9 s vs. 18 s, p < 0.001)
• less time to dispatch (50 s vs. 58s, p = 0.002)

AUSTRALIAN INSTITUTE OF HEALTH INNOVATION Faculty of Medicine and Health Sciences

Failure to interpret information

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Failure to interpret information

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• Bluey. Hospitals (2 OCT 2018). Joe Brumm, ABC, Ludo Studio

• Premature closure: It is the tendency to accept diagnosis before it has been

fully verified.

• Diagnosis momentum: once diagnosis labels are attached to patients they tend

to become stickier and stickier […] what might have started as a possibility gathers increasing momentum until it becomes definite, and all other possibilities are excluded.

Premature closure & Diagnosis momentum

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• Croskery. Acad Med 78.8 (2003):775-780

Patient is a poor historian and denies, complains, fails, refuses…

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Coulehan, JAMA 252.2 (1984):221 Fisher, Age & Aging 45 (2016):11-13

= significantly more negative attitudes towards the patient = less aggressive management of the patient’s pain

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Neutral Stigmatising still has 10/10 pain insisting that his pain is “still a 10” He spent yesterday afternoon with friends hanging out with friends outside McDonald’s he is not tolerating the oxygen mask he refuses his oxygen mask

Second review of:

• Samples, test results, film or
• Generated or
• Ungenerated hypothesis
• Interpersonal skills

Challenging failures – just check it a bit closer

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NSW Clinical Excellence Commission

• Red Team - Blue Team Challenges

Diagnostic safety net

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“For all the sophisticated diagnostic tools of modern medicine the conversation between doctor and patient remain the primary diagnostic tool.”

Danielle Ofri, 2017

Communication as a Diagnostic Tool

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“Communication is a key responsibility throughout the diagnostic process.” IOM, 2015

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The Return of Ulysses to Ithaca, ca. 1710s, by Gerard de Lairesse (1640- 1711), Kunstpalast Düsseldorf, Germany

Even the little things we say (or don’t say) and how we say them can have a big impact on the diagnostic process and patient safety.

AUSTRALIAN INSTITUTE OF HEALTH INNOVATION Faculty of Medicine and Health Sciences

Thank you.

ANY QUESTIONS?

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