The hidden cost of poor communication in healthcare

What you need to know:

  • Men are the worst culprits in telling lies about their diseases. Many of the men suffering from prostate cancer die unnecessarily because it is a taboo among men to talk about something like erectile dysfunction.
  • Because health records are kept in analogue form, the patient may come back and be given the same treatment, and the cycle may continue until the disease presents new symptoms.
  • Since we have a fibre-optic network throughout the country, we should introduce smart solutions and free up resources to pay doctors competitively.

Poor communication is to blame for the many deaths as well as the high cost of healthcare in Kenya.

Although this issue has not been studied here, doctors tell me that the problem is widespread.

I took it upon myself to interview 28 doctors and virtually all of them confirmed that they have had an incident where the patient misled them.

The consequences of poor communication vary from drug interaction and unnecessary surgery to death. It is a costly affair.

Patients consciously or unconsciously mislead doctors. A majority of those who consciously mislead doctors do so when they feel embarrassed to tell the truth.

For example, if the pain is somewhere around the groin area, they might tell the doctor the pain is in the back.

Men are the worst culprits in telling lies about their diseases. Many of the men suffering from prostate cancer die unnecessarily because it is a taboo among men to talk about something like erectile dysfunction. By the time they start receiving treatment, it is often too late.

Some women too refuse such procedures as pap smears, which tests for cervical cancer. Cases of cervical cancer are lower than those of breast cancer, but former registers higher death rates, either because it goes untreated or it is discovered too late to save the patient.

LANGUAGE CAPACITY

Another problem is related to language capacity and literacy. Some patients, if they cannot speak in English, lack the words to describe exactly how they feel.

At the same time, a lot is lost in translation, because something said in a vernacular language may mean something else that was not intended when translated.

For example, someone experiencing itchiness or a burning sensation may call it pain.

And so practically everything is blamed on malaria. This may sound simple but often doctors, especially in rural areas, go ahead and prescribe a broad spectrum of medication that give temporary relief and within a few days the patient is back.

Because health records are kept in analogue form, the patient may come back and be given the same treatment, and the cycle may continue until the disease presents new symptoms.

This is a major problem precipitated by poorly devolved healthcare management with overworked and underpaid doctors who might have no patience to interrogate the patient more deeply to get to the root cause of the patient problem.

The more our doctors search for their income on protracted street protests, the more we compromise our health systems.

Further, even though most county hospitals recently acquired advanced diagnostic equipment, the capacity to use these modern facilities is not there.

MALPRACTICE CLAIMS

Ordinarily, the diagnostics should validate patient information but if they are not used optimally, the problem is compounded.

Healthcare miscommunication is not unique to Kenya. Many countries suffer the same problem, but the difference is that they keep data and analyse it for trends and other vital clues.

Improvements can only be made if we are aware of the problem and we know the statistics.

In the United States, for example, poor communication costs the US healthcare system $1.7 billion in malpractice costs and nearly 2,000 lives, according to CRICO Strategies research.

The 2015 Malpractice Risks in Communications report found communication breakdowns figured in 30 per cent of all malpractice claims filed between 2009 and 2013.

Further, 37 percent of all high-severity injury cases (including death) involved a communication failure.

While in Kenya we blame the patient, it will not take too long before we begin to see malpractice claims.

We should never take the American route to settling errors. Increasing the use of Big Data analytics and reconfiguring diagnostics could very easily help doctors make informed decisions.

By now, we should know that when a male patient tells a doctor that ni homa inanisumbua (it’s a cold that is giving me trouble), we should take it very seriously as a major disease, including some kind of sexually transmitted diseases (STD) because he do not want to say the real thing.

SMART SOLUTIONS

Doctors too must be trained to see beyond words and for sure they would not make as many mistakes as they do when they make the assumption that the patient would have no motivation to lie.

Since we have a fibre-optic network throughout the country, we should introduce smart solutions and free up resources to pay doctors competitively.

This can be done by aggregating back end-services like imaging in Nairobi, and building world-class capacity not only to serve local patients but globally.

Other lab work should be directly uploaded to a cloud such that the patient can be helped not just by the doctors within the facility but from anywhere in the country.

A good doctor’s network means that once the patient has been interviewed by a doctor, that record is accessible to doctors across the country and when lab work is available, interpretation of the results can be done by any doctor even from overseas in the presence of a nurse.

To post a radiologist in some rural hospital is simply a waste of resources when such can be optimally utilised in a centralized environment.
This will lead to proper use of resources, freeing up much of it for better remuneration.

There is a need to digitise health records and ensure that patients have all of their health records either in a cloud or a wearable radio-frequency identification (RFID) chip for storing and quick access to patient data. This is the direction the world is heading.

This will enable doctors to have a patient’s history such that if the patient has been treated for the same thing over and over, they can do more diagnostics and be able to help him or her.

ELECTRONIC MEDICAL DATA

Records too will help doctors determine the kind of medication the patient is using and avoid prescribing medication that would negatively interact with existing medication.

These records can also be used to study decisions made by doctors in order to improve care in the future. If there are privacy concerns, these can be addressed by stricter data protection laws.

The ministry of Health should be the custodian of all medical data from both public and private health centres.

As it is at the moment, only data from public hospitals is available yet private hospitals take care of up to 50 per cent of the healthcare needs of the country.

Centralized health records are essential for Big Data analytics to understand disease patterns and resource use.

Without such data, we will fail in measuring progress towards the achievement of health-related Social Development Goals.

Accurate data is key to managing healthcare and understanding the disease burden that is now shrouded in miscommunication.

Although we don’t keep records for such things as poor communication in healthcare, there is enough reason to look into the problem much more closely to contain some of the cost that we are not visualising.

African taboos are responsible for the lies we tell doctors. We can work around the problem by tweaking the current systems in healthcare, free more resources and pay the doctors well as a strategy to improve our healthcare and reduce cost.

Irish playwright, critic and polemicist George Bernard Shaw one said, “The single biggest problem in communication is the illusion that it has taken place.”
The writer is an associate professor at University of Nairobi’s School of Business.