Electronic Communication with Patients

Electronic Communication with Patients

Annabelle Rae C. Norwood, MD

Electronic communication has now become a routine part of clinical practice. A lot of non-urgent communication with patients and their providers now occur through on-line channels such as secure messaging and e-mails.  In particular, MaineHealth is highly encouraging patients to sign-up for and utilize MyChart, wherein patients can directly send messages to their providers. As such, there may be a need for medical educators and health care institutions to provide more guidance and education about this topic. (1) It has been shown that electronic communication with patients, can actually improve patient care and outcomes such as improved medication adherence (2). However, everyone communicating with patients through these online portals should be cognizant of privacy, confidentiality concerns, and HIPAA rules. Therefore, communication with patients should only occur in secure networks and not through personal e-mails, and definitely not social media. Institutions themselves, however, should also reinforce with patients that online communication should be only about non-urgent matters such as refill requests, that messages should be brief and descriptive and that these messages are going to be a part of the medical record (3).

There are also certain business e-mail etiquette (4) that may be applied to answering patient communication.

  1. Use a professional salutation. “Hi”, “Hello” or a more formal “Dear (name)” are all appropriate salutations. “Hey”, “Hiya” or “Yo” are not.
  2. Try to answer messages in a timely manner. Two business days is usually standard. It may also to just help the patient acknowledge that you have received the message, even if you don’t have an answer right away.
  3. Don’t send angry messages. In that rare instance where a patient were to send offensive or threatening e-mail, in one study analyzing secure messages in two Veterans Administration health care centers, offensive or threatening messages only comprised 0.2% of all messages sent. (5) Formulate an appropriate response when you’re calmer is better.   It would also be good to bring up this situation to your supervisor or team on how best to address this patient’s concern.
  4. Avoid using abbreviations like LOL, writing in all CAPS, using emoticons and using a string of exclamation points!!!!! These are not professional.
  5. Proofread your messages before sending them.

References

  1. A critical appraisal of guidelines for electronic communication between patients and clinicians: the need to modernize current recommendations. Joy L Lee, Marianne S Matthias, Nir Menachemi, Richard M Frankel, Michael Weiner. 4, 2018, Journal of the American Medical Informatics Association, Vol. 25, pp. 413-418.
  2. Creatine a synergy effect: A cluster randomized controlled trial testing the effect of a tailored multimedia intervention on patient outcomes. Annemiek J Linn, Lisetvan Dijk, Julia C M van Weert, Beniam G Gebeyehu, Ad A van Bedegraven, Edith G Smit. 8, s.l. : Patient Education and Counseling, 2018, Patient Education and Counseling , Vol. 101, pp. 1419-1426.
  3. Expanding the gidelines for electronic communication with patients: Application to a specific tool. Stephanie L Prady, Dierdre Norris, John E Lester, Daniel B Hoch. 4, 2001, Journal of the American Medical Informatics Association, Vol. 8, pp. 344-348.
  4. Whitmore, Jacqueline. The Do’s and Don’ts of Email Etiquette. [Online] 2016. [Cited: May 28, 2019.] https://www.entrepreneur.com/article/272780.
  5. An analysis of patient-provider secure messaging at two Veterans Health Administration medical centers: message content and resolution through secure messaging. Stephanie L Shimada, Beth Ann Petrakis, James A Rothendler, Maryan Zirkle, Shibei Zhao, Hua Feng, Gammae M Fix, Mustafa Ozkaynak, Tracy Martin, Sharon A Johnson, Bengisu Tulu, Howard S Gordon, Steven R Simon, Susan S Woods. 5, 2017, Journal of the American Medical Informatics Association, Vol. 24, pp. 942-949.

Mastering Millennial Mentoring

MITE Monthly Tip: April 2019-Angela M.  Leclerc, PA-C

Mastering Millennial Mentoring

Generation gaps between teacher and learner are encountered every 10-20 years. Generations are shaped by unique historical circumstances.  Currently, millennials make up approximately 25 % of our workforce and this will increase to 40% and 75% of the workforce in 2020 and 2025 (1).  Adapting to changes in expectations and work habits is imperative to educating learners, preparing future master educators and fostering productive mentoring relationships.

Millennials are frequently labeled to be distracted, impatient, entitled and too engaged in social media and not infrequently found to be on personal device during moments of teaching.  These labels are often misguided.  This generational cohort has been dubbed the “digital natives” with most of their lives accompanied by rapid expansion in technologies, having information and instant communication at their fingertips within seconds.   The millennials have been characterized to appreciate honesty, instant feedback and collaboration. (2)

Here are some tips when mentoring millennials:

Tip What they desire How you deliver
Micromentoring accessibility, frequent short meetings, fast responses Hold brief meetings on narrow topics to discuss progress.  Meetings would be about a single topic with a focused question or set of questions to be addressed.
Reverse mentoring flat leadership structure Find strengths of the mentee, perhaps social media as a means of disseminating research, journal club and networking, harness and promote their unique leadership abilities
Mentorship teams collaboration A team of mentors, interdisciplinary, providing cognitive diversity and the ability to capitalize on the individuals strengths

Adapted from Chopra V1,2, Arora VM3, Saint S1,2. Will You Be My Mentor?-Four Archetypes to Help Mentees Succeed in Academic Medicine. JAMA Intern Med. 2018 Feb 1;178(2):175-176

Finally, the millennial generation has been shaped by the #metoo era.   I agree with the author in JAMA, Mentoring in the Era of #MeToo, with her fears of gender-based neglect.  I most certainly harbor a great amount of empathy for those women who have suffered from sexual harassment and sometimes worse.  However, many of my mentors have been male and have professionally influenced my practice and career path and are close colleagues of mine, likely for life.

The author refers to key behaviors exhibited by her male mentors:

  • Always demonstrate exemplary professional behavior during and outside of the work day (never compromised by alcohol consumption or flirtatious interactions)
  • Behave comfortably, but as if others are watching, demonstrating integrity
  • Refrain from physical touch except in larger social settings where you may give a hug in greeting.
  • Never mention anything about appearance or appearance of others and avoid generalizing comments about gender
  • Text with important or urgent things, and sometimes just very funny things, but never anything that wouldn’t share with either spouses.
  • Most importantly, they have chosen to speak up to support women while other men have chosen to sit quietly or, worse, offend (4)

 

References

  1. Waljee JF1, Chopra V2, Saint S3. Mentoring Millennials. 2018 Apr 17;319(15):1547-1548
  2. Williams VN1, Medina J2, Medina A3, Clifton S4. Bridging the Millennial generation Expectation Gap: Perspectives and Strategies for Physician and Interprofessional Faculty. Am J Med Sci. 2017 Feb;353(2):109-115
  3. Chopra V1,2, Arora VM3, Saint S1,2. Will You Be My Mentor?-Four Archetypes to Help Mentees Succeed in Academic Medicine. JAMA Intern Med. 2018 Feb 1;178(2):175-176
  4. Byerley JS. Mentoring in the Era of #MeToo. JAMA. 2018;319(12):1199-1200

A Compassionate Script

A Compassionate Script-Kathryn Brouillette, MD

With stressors abounding of record-level hospital census, the opioid epidemic, flu season, the holiday rush and the day-to-day grind of showing up for work while also managing household IADLs, I hope to offer a little salve for burnout.

It is simply compassion, the root meaning of which is to suffer or feel (-passion) with (com-) another person, in this case, our patients and their families. A quick reminder as to what compassion is not[i]:

  • Pity or sympathy
  • Kindness
  • Benevolence
  • Social justice

Compassion is much more specific, regarding a particular person’s feelings about the present situation.   It requires[ii]:

  • Imagination, as we put ourselves in another’s circumstance.
  • Intimacy, as we learn of the hardships of another.
  • Honesty
  • Time

Providers may suffer atrophy in these qualities as their medical education and careers progress.  These are, however, precisely the items touted to be antidotes to burnout[iii], litigation[iv], and medical error[v].  How do we get them back into our lives, our patients’ lives, manage the patient’s care safely, and still make it home on time for dinner?

One possible answer of many: fake it till you make it.  Use a script, perhaps this one:

  • Sit down when you speak with a patient. Lean towards your patient.
  • Ask your patients to tell you about themselves in an open-ended way: “Tell me about your family. Where are you from?  How do you like to spend your free time?”
  • Let them speak, without interruption, for at least 2 minutes.
  • Find something you share in common with them, e.g. “I grew up in a small town as well…”
  • Offer information about yourself, perhaps even revealing some of your own vulnerability. e.g. “I really miss my family around the holidays, too, especially since my parents died.” Gentle humor can sometimes be appreciated
  • After gathering the necessary history/information and performing your exam. Use supportive statements as the history is recounted, e.g. “Oh my, that sounds very scary.” Summarize your thoughts on their case using plain language. If you have uncertainty about the diagnosis, tell them and explain why.
  • As you are leaving, provide supportive statements, e.g. “I am with you”; “I hear you”; “Let’s get you feeling better”; “You’re not alone”; or “I’ll be thinking about your care tonight.”

These added minutes do take time, but the payouts include:

  • A closer rapport with your patient, who will be more likely to divulge important information regarding symptoms.
  • An enriching human interaction for both provider and patient
  • A patient who feels both validated and cared for is more likely to comply with medical therapies.
  • Better medical outcomes for patients and providers.

Whether it is second nature to you, or something that takes practice, compassionate interactions, just like apathy, can be infectious.  Try to share them as much as you can.

 

 

 

[i] Pence, Gregory E.  Can Compassion Be Taught?  Journal of Medical Ethics. 1983, 9, 189-191.

[ii] Pence, Gregory E.  Can Compassion Be Taught?  Journal of Medical Ethics. 1983, 9, 189-191.

[iii] Vallerand et al.  On the Role of Passion for Work in Burnout: A Process Model.  Journal of Personality. 2010, 78(1), 289-312.

[iv] Levinson, Wendy.  Doctor-Patient Communication and Medical Malpractice implications for Pediatricians. Pediatric Annals.  1997, 26(3), 186-193.: I

[v] Shanafelt et al. Burnout and Medical Errors Among American Surgeons.  Annals of Surgery.  2010. 251(6), 995-1000.

August Faculty Development: Teaching communication skills for difficult conversations

Teaching communication skills for difficult conversations-Annabelle Rae C. Norwood, MD MMP Geriatrics

As professionals working in the medical field, we are often tasked with difficult conversations of delivering bad news, disclosing medical error, or initiating advance care planning and end-of-life discussions with patients and their families. More often than not, skills needed to effectively communicate with patients about these difficult topics are not developed fully during medical training.  As such, the Accreditation Council for Graduate Medical Education now requires competency in communication skills for residents and fellows.1 There are different methods available in order to hone these skills.

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