Valuing Face to Face Communication, Oops, Wait, Don’t We Have an APP for That?

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Psychiatrist and writer Elissa Ely recently had an interesting op-ed piece in the Boston Globe on the increasing role of electronic devices for communication in hospitals.  She notes that “these are times of unremitting technological contact, we just can’t avoid each other, yet patients are admitted and — even more often — unsafely discharged, without a word of communication”.

Of course there is much gain from new technology.  We read that text messaging saved a life and marvel at London to Congo communication.  Smartphones are reported to be causing a paradigm shift in how hospitals function.  We learn that communication badges can “help hospitals achieve next generation performance in patient experience, patient flow and patient safety”.   Hospitals are urged to develop smartphone apps.

No one can deny the benefits of such trends.  But, as Ely points out, one downside is that they lead to confusion.  It is not like automobiles replacing the horse, because the new devices do not supplant the old ones like telephones.  So hospitals are becoming like the consumer who has a desktop, laptop and smartphone and now wants a tablet.

One result is that costs grow and training needs increase.  Communication scenarios become more complex and the possibility of miscommunication may even increase.  And failures of communication can lead to patient deaths.

From the point of view of patient satisfaction the expansion of communication devices also can have adverse effects.  Even assuming the new technology tends to improved patient outcomes, satisfaction depends on how they are treated as persons.  And if hospital staff are spending more time on communication devices, doesn’t that suggest that they have less time for face to face communication with patients?

True, patients may be pleased to use such devices themselves.  Already there are ads “improve patient satisfaction with a hospital mobile app”.   But, while we may some day evolve into cyborgs, with something like a smartphone implanted into our brain at birth, at this point in time people still need face to face communication.  News stories tell about employees learning that they are being laid off via text messages.  Are we going to hear of patients notified of their discharge or informed that  their condition is incurable through electronic means?

When there is an emotional content to the message, when it is very important that there be confirmation of understanding, when decisions have to be made – there are many situations in which research shows that face to face communication is superior or even necessary for a successful outcome.  Surely all of these factors apply in medical settings!

Cartoonists often show inappropriate or incredible use of e-communication.  We laugh because we know that in so many situations feeling is important and cannot be conveyed that way.  In face to face discussion, we use verbal and nonverbal means, but emoticons are no substitute for the latter!

So one hardly needs a study to realize that patients will feel better if they have good and sufficient face to face communication with doctors and nurses.  It is not simply a matter of effectiveness or satisfaction but also just human nature that talking with and being heard by other people makes us healthier.  If hospitals want to make patients better and, yes, improve patient satisfaction scores, then they need to make sure that electronic communication does not detract from face to face.

I wish I could explain it all more.  But my phone is ringing, I’m getting a text message, I need to check my e-mail, and I just saw a pop-up ad for the latest tablet!






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2 Responses to Valuing Face to Face Communication, Oops, Wait, Don’t We Have an APP for That?

  1. Lucy Pilon says:

    Great posting Jim. I can honestly see this coming and it is quite a scary thought! I agree totally with Beth, that we need to keep the person in caring and not substitute it for another electronic device. In nursing a great deal of information is collected in face to face interactions with our patients. It is also an expectation that we develop therapeutice nurse-patient relationships that support their care and help achieve positive outcomes. Electronics are a valuable asset to make some things easier to complete but I do not think it replaces the real thing – if that were the case we might all be replaced by robots in the future, thanks for the insightful posting! Lucy

  2. Hi Jim,

    Thanks for this provocative post! At first, I laughed about the text message of discharge, but then I realized, it wouldn’t surprise me! And I don’t see that as a good thing!

    I’d like to add a couple of points, first that it is well known that 90 % of our communication takes place in non verbal stuff like tone, facial expression, and body language. You suggest the importance of this with your point about communication of emotional content or need for confirmation of understanding. I can imagine emoticons helping a little here, but worry about what we loose in terms of understanding each other. Both in terms of clinical assessment and caring. I also think there are wonderful advances that can help us, but I believe that if they are utilized in addition to relationship building efforts rather than substituting for them we’ll all be a lot better off! Beth

What are your thoughts?