Medical Communication - Written v. Spoken

I am a great fan of the Great Courses company (http://www.thegreatcourses.com/). The courses are of consistent high quality and cover a range of subjects. One of my favorite lecturers is Dr. John McWhorter from Columbia University. I just finished the series titled Myths, Lies, and Half-Truths of Language Usage. In this lecture series, I was introduced to differences between spoken and written language and that until relatively recently in human history, the written languages used by learned people were generally different from the spoken languages used. He also introduced me to the concept of formal and informal language. Spoken English may be either formal or informal and recently, written language has expanded into informal uses, especially with newer forms of communication such as texting.

This course made me think about language and communication in health care delivery. I realized that for the most part, physicians value spoken communication over written communication. We interact via rounding. We have conferences and tumor board where cases are discussed. If there are problems with communication we emphasize that the best way to address these issues is to meet of call someone. I agree that the spoken word is valuable, but what are the limits of the spoken word in medicine?

All one needs to do is sit through one deposition to understand issues with spoken communication in medicine. What is said is almost never really translated with real fidelity into the written record in healthcare. We use the written record to justify billings and to cover our assess (and assets). However, the real value of the written word in healthcare should be to communicate with as little ambiguity as possible. The written record rarely does this.

Part of the problem is cultural. We have not been trained to value written communication. However, there are system issues as well. Our workflows are also not conducive to capturing the richness of discussions which happen on rounds or in clinical conferences. We may have very pithy discussions regarding specific challenges we face in the management of specific problems in specific patients. However, by the time that someone is responsible for generating a written product of those discussions and it gets into some written form which should be translated into actionable items, the nuance is generally gone and message is garbled. That is the problem with spoken communication. What is spoken may be different from what is heard, which is also different from what is remembered. It is ephemeral.

All of this may have been less of an issue when the number of moving parts inc are delivery were limited and the size of the health care teams was very limited. We are much more ambitious in what we aim to accomplish and the people involved in any give care pathways may get into the dozens if not hundreds. The number of tasks involved is similar. No single person can keep it all straight in their heads. However, in the absence of formal written communication and coordination tools, traditional spoken communication approaches and tools can't scale to meet current demands.

We need a culture change in medicine and need to recognize the personal relationship driven, verbal communication mode of coordination of care needs to change to a system complemented by structured written tools that help better define clear roles, responsible parties, care teams, and team leaders.