Australian Amy being a good Canadian!

We were so impressed by this piece that we wanted to ask Amy a few questions about herself and about her ideas regarding communication; here are her answers.

1.     Who are you? 

I moved to Toronto from Australia last year to take up as position as a Clinical Fellow in the University of Toronto’s Neonatal-Perinatal Medicine fellowship training program.  Whilst I already have my specialist qualification as a Neonatologist in Australia, I wanted to gain further clinical and research experience, as well as have the experience of living overseas.  My partner, Jeff, came along with me to Canada and he has been a fantastic support, especially when the homesickness hits or when I need to be told to go to bed after a 24 hour in-house call shift!

2.     Why did you feel compelled to write your article?

It really was listening to two former NICU parents that inspired me to write. What they said stayed with me and formed the basis of the article.

Communication is an area I feel passionate about and I believe all health care professionals can, and should, continue to develop and improve their communication skills throughout their careers.  What we say or don’t say to families can have a huge and lasting impact.  Writing the article gave me an outlet to express my thoughts about what I feel is such an important, and sometimes, neglected area.

3.     What kind of response have you had to your article?

I have been excited by the response I have had to my article.  The positive feedback and emails I have received from colleagues has been fantastic – the themes the article touched on seems to have resonated with many of my colleagues who work in the NICU.  The article was also featured as a leading article on 99nicu.org, an internet forum for people working in Neonatology, which was pretty exciting.  Being asked to answer these questions for the Sunnybrook NICU blog has also been a highlight – it means a lot to have had the article so well received!

4.     Where do you think you learned the most about communication? In your piece you mentioned communication skills training courses; does any particular training stand out to  you as most effective?

I have learned communication skills from watching other people communicate well, which is probably what most people do with varying results!  The best training though was a fantastic communication skills workshop back in Australia.

The most useful way to learn I have found is by role-playing, after having learned about various communication techniques – by trying out new skills in a simulated environment.  I am still learning though and make mistakes – having the self-awareness that you still can and should be learning about effective communication is vital.

5.     Why do you think there’s a disconnect between what medical professionals say and parents hear?

I think, as medical professionals, we sometimes forget the complete and utter shock the NICU experience can be.  No one plans for their child to need intensive care and I continue to be amazed at how well our families do cope and how strong they are.  Some of the things we have to talk to parents about are extraordinarily difficult and I think at times are almost too hard to hear.  I have had families say to me that they have heard what we have said but that it was just too soon and too hard to hear at that time.  Being accessible and present for all the families that you care for is one way to ensure that the lines of communication remain open.  At other times though, it is because the communication from the medical professional is not clear and this is where I truly believe communication skill training can be extraordinarily useful.

6.     Why did you choose neonatology?

Neonatology is such a fantastic specialty and I knew that after working as resident in my Neonatal Unit back home for the first time back in 2008, it was what I had been looking for – it was what I was ‘meant to do’.  I am extremely fortunate to be able to work in a field that I love, to care for families and know that I will continue to learn throughout my career.

7.     What kinds of communication errors do you hear regularly?

Calling infants a boy when they are a girl and vice-versa is a pretty common mistake.   Some people probably don’t think it is a big deal but I think to many families it is.

False reassurance is another communication error I hear from time to time.  We all want to reassure families that “everything will be alright” but for some situations in the NICU we simply do not know.  I truly believe there is a way to communicate to families that you do care and are also hoping for the very best outcome but sometimes we do not know what the future will hold.  Telling a family “everything will be ok” when it may not be does not help to establish trust.

8.     Do you have any communication tips for NICU parents?

Always ask questions!  Write them down and some parents also find writing down the answers to their questions can also help.  The NICU is full of people to ask questions of – never be shy to ask questions.  If you find a particularly great person to ask questions of –  ask to speak to them again.  Always know that you can ask to speak to your baby’s doctor or nurse practitioner if you haven’t managed to catch up with them that day.

9.     What is the most important thing you have learned from NICU parents?

The strength of spirit NICU parents have continues to amaze me.  Over the years, I continue to learn more and more about what a great job this is – by far my best experiences in Neonatology have been because of the families I have gotten to know and care for.

10.     If there was one thing you could tell a new NICU family, what would it be?

You are the best advocates for your child. Ask questions of all members of the team and draw support from the team – we are there to help and guide you through this journey.  Never be afraid to question someone or something.  Get involved with as many aspects of care of your baby (or babies) as you can.

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Thank you Amy for taking the time to respond to our questions, and for the tremendous work you do with NICU families! 

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The Question: Is it the family physician’s job to gather test results and explain the outcome of those tests – blood tests, ultrasounds, X-rays and CT scans – and offer options going forward? Every test I have had, the results are sent to my family doctor, yet he says it is not his job to explain it to me and offer solutions or options. Half of the tests are missing or have not arrived at his office. There is no follow up. Every time I see him it is like the first time but he has been my primary caregiver for 25 years.

The Answer: You raise a very good question: Whose job is it to communicate test results ordered by one physician and conducted by another? If, as you point out, the test results go missing, you have no way of knowing and may assume [wrongly] that there was a negative finding and all was well. It is for that reason, it is important to ensure that the loop has been closed on every test result.
According to Jocelyn Charles, Chief of Family and Community Medicine at Sunnybrook, a physician who orders a test – for blood, ultrasound, X-rays or CT scans – is responsible for responding to abnormal results and communicating these results to the patient.

“Specialists are expected to communicate their assessments, test results and recommendations to the patient and the patient’s family physician,” wrote Dr. Charles in an email. “The family physician can only discuss results from specialists if they are forwarded to him/her, ideally with a recommendation about any further investigations or treatment.”

Ultimately, it is the responsibility of hospitals, laboratories, radiology facilities and specialists to ensure that family physicians receive results and information pertaining to their patients in a timely manner, she said.

As the family physician has no way of knowing what tests were done by the specialist unless this was communicated to them, Dr. Charles suggested patients call their family physician before their appointment to ensure test results have been received.

In addition, patients can request the specialist’s office, hospital or laboratory to forward the results to their family physician prior to their appointment. Ideally, this should not be necessary, points out Dr. Charles, who said efforts are underway at Sunnybrook to improve accountability for timely communication of information to family physicians.

Frank Martino, president of the Ontario College of Family Physicians, suggested patients remind the specialists that test results should be sent to the family doctor, providing the address if necessary right at the appointment time.

He pointed out that it is incumbent on him, as a family physician, to learn the results of any test he has ordered on a patient.

“I have concerns about this patient’s problem not getting the results,” said Dr. Martino. “And a physician who says it’s not my job to explain things to you. That’s part of the relationship.”

However, not every negative result – a test that has normal findings – needs to be communicated. There are, however, exceptions to that rule: the test ordered was due to a screening test, a suspected cancer, a biopsy, a bad diagnosis such as diabetes or anemia or a condition where symptoms have persisted, suggesting the need for more and different medical investigations to help aid in a diagnosis. In those cases, even though the test has not found anything, it’s vital for the physician to close the loop.

“It’s extremely important to communicate with your patient,” said Dr. Martino. “If there’s a particular test with a particular complaint, such as knee pain, then we go back to the blackboard, and come up with a plan for diagnosis.”

Tracking results, he points out, is not a simple matter and he is particularly concerned about these missing test results you mention.

“What we hope is that physicians have a process in place to reconcile test results that have been sent out to be done,” said Dr. Martino, who is a member of Queen Square Doctors family health team in Brampton. “And we hope that is a strong and fulsome system. Certainly, for critical results, there should be a system in place to reconcile those and act on them.”

I, too, am particularly concerned about your missing test results and for that reason I would suggest you contact your family physician to follow up. That may also be a good time to discuss how you are able to learn of test results with abnormal findings. I would also follow the advice of Dr. Charles and to call ahead of your appointment to ensure test results have been received and to request the specialist, hospital or laboratory fax or send these results to your family doctor.

The post Test Results: Whose Job is it To Tell The Patient? appeared first on Your Health Matters.