Hospitalists Have Room to Improve Communication

CHICAGO — Hospitalists could do more to improve communication with their patients, a survey of 420 hospitalized patients suggests.

The proportion of “excellent” ratings for 21 individual hospitalists evaluated using the Communication Assessment Tool (CAT) ranged from 38.5% to 73.5%, with an average of 58.8%, Darlene Ferranti and her associates reported in a poster at the annual meeting of the Society of Hospital Medicine.

For individual items included in the previously validated CAT, the highest ratings for the group as a whole were for treating the patient with respect (68%), talking in terms the patient could understand (65%), and letting the patient talk without interruption (65%). The lowest ratings were for involving the patient in decisions as much as he or she wanted (53%) and encouraging the patient to ask questions (50%).

“A significant proportion of hospitalists in this sample may benefit from targeted training to improve communication with patients, particularly in the areas of encouraging patients to ask questions and involving patients in decision making,” they wrote.

The patients, who were hospitalized on general medicine inpatient units of an urban, academic hospital, were eligible to participate in the study after they had been assigned to a hospitalist for 2–3 days. Overall, 26% of patients were aged 44 years or younger, 39% were 45–64 years, and 35% were 65 years or older.

The survey included 20 patients for each of the 21 hospitalists. The hospitalists ranged in age from 30 to 36 years, and 57% were women. They had an average of 2.8 years of experience practicing as a hospitalist (range 1–8 years).

Differences between hospitalists' scores may be partly explained by specialization in a particular service, according to Ms. Ferranti, research study programs coordinator at Northwestern University Feinberg School of Medicine in Chicago, and her associates. These effects were minimized by capturing patients from different services and on different units, when possible.

The 15 items on the CAT describe performance in key aspects of effective communication, but do not reflect the particular skills and content used in successful patient-physician interactions.

“Future work could identify specific techniques used in medical interviews by highly rated physicians, with the goal of developing tools for targeted improvement,” they wrote.