Terry Schraeder: Helping Doctors Communicate Better
From working for the ABC television news affiliate in Boston to writing about her experience taking care of a drug overdose survivor in an intensive care unit, Dr. Terry Schraeder has developed skills in both journalism and medicine that she shares in a new book aimed at helping doctors communicate better with patients, journalists and their medical colleagues.
In "Physician Communication: Connecting with Patients, Peers, and the Public, " Schraeder — a clinical associate professor at the Warren Alpert Medical School of Brown University and a long-time screener for the AAAS Kavli Science Journalism Awards — offers a wide range of techniques for improving understanding between physicians and patients. She also strongly encourages physicians to concentrate on communicating well with journalists.
"Miscommunication, whether it occurs in the headlines or the hospital, can have serious health consequences," says Schraeder. "In medicine, communication problems are one of the leading causes of sentinel events, meaning death or serious physical or psychological injury not related to the natural course of the patient's illness. In the media, medical information may not only be misrepresented, but also interpreted differently by patients and physicians. Individuals may or may not understand risk, data analysis, or how medical information in the media may or may not relate to their own health."
In the following Q&A, Schraeder discusses her book and her background as a journalist and a doctor.
Q. I understand you were a medical journalist before becoming a physician. How did you first get interested in reporting on medicine?
A. I was on my way to medical school in my early 20’s when my father unexpectedly died, so I deferred my admission and decided I would try to work as a medical journalist for a year. I had always written for school newspapers and was very interested in medical journalism. I was fortunate to be hired in Boston to work with Dr. Tim Johnson (ABC News). I was happy that my job included reading medical journals and books, attending medical conferences, interviewing leading physicians and public health officials, and learning about many different issues in medicine. I thoroughly enjoyed it. Medical journalism can be a terrifically interesting career and certainly was for me for eight years. But ultimately, I reapplied to medical school, completed my training and became a medical internist. I still thoroughly enjoy both medicine and journalism.
Q. You are also a professor. How similar do you think teaching is to journalism?
A. I think teaching and writing are very similar professions in many ways. In both academia and journalism, you need to translate complex concepts and information into accurate, understandable, engaging and interesting presentations for your students or your audience. As a journalist, I always loved explaining and teaching medical and public health topics so everyone could understand and benefit from the information. If you don’t understand a topic, you cannot teach it or write about it. My job as a teacher and a writer is always to communicate the medical and science information my audience needs. I try to make sure my audience understands and cares about the topic as much as I do — and if at all possible, I always try to predict and answer all of their questions.
Q. What guidelines do you give for clear communication by physicians, whether they're speaking to patients or journalists?
A. One of my favorite quotes is from the Irish playwright George Bernard Shaw, “The biggest problem in communication is the illusion that it has taken place.” It is probably very true — where both parties may walk away having slightly different conclusions about the same interaction.
Preparation is always key. But overall, my advice is that for each interaction, we need to remember to realize the shared goals between the parties. We need to actively listen, be fully present, use and read body language appropriately, imagine the interaction from the other person’s eyes, and continually negotiate a positive outcome for both parties. We need to monitor, analyze, and improve our human-to-human communication skills, especially in this digital age when we seem to be having more electronic interactions and fewer face-to-face conversations.
And I think for physicians it is important to remember, “The patient will never care how much you know, until they know how much you care,” as Dr. Terry Canale from the American Academy of Orthopaedic Surgeons said.
Q. You talk a lot in your book about how physicians need to hear out what their patients have to say. Do you think journalists and physicians should also be listening to each other better?
A. While journalists and physicians have very different jobs, both professionals need to ask the right questions, encourage people to talk and actively listen. I do think we may be able to learn something from journalists about how in a sensitive and appropriate way they can sometimes encourage and allow people to share important and personal information. Many of the best journalists are able to get people to share information with them in a very short amount of time and often without any prior relationship. How journalists do this, as well as how they listen closely to what the person is saying without trying to fit the answers into a preconceived construct, is important. We physicians need to remember to listen for context and intent, and almost with a sort of sixth sense for any unspoken messages or information that will help us understand and take better care of our patients.
Q. I found the article you wrote for the Tufts Medicine magazine about a young man who barely survived a drug overdose very compelling. Could you talk about your motive in writing it?
A. I wrote about the young man for two reasons — so people would remember the risks of street drugs and also the important lesson of how and why doctors need to stay emotionally connected to patients and families. That night so early on in my training as an intern, I learned that I needed to use empathy, clarity and calmness to keep the family informed during such a critical moment in their son’s life. I realized then that my communication skills were just as important as my medical skills in taking care of patients.
Q. You make the point that communication problems in the medical field can result in serious injury or even death. Could you talk a bit about the potential consequences of inaccurate health-related articles or broadcast segments?
A. More than a decade ago, the Joint Commission that accredits more than 21,000 healthcare organizations and programs in the United States, concluded that communication problems are one of the most common causes of medical errors. Today, communication problems between doctors and patients or between health care professionals continue to cause harm to patients.
Of course, communication problems also occur in medical journalism, and while the immediate stakes might not be as high as they are in the examination room or the operating room, misinformation and mistakes by the media can cause harm by propagating inaccurate information.
I think that is why professionals in both fields, medicine and journalism, should work together. By understanding each other’s roles and responsibilities, teaching each other what they know, and working on improving communication, the public and patients will be best served.
Q. Could you talk about your role helping to screen AAAS Kavli Science Journalism Award entries for scientific accuracy?
A. As a journalist and a physician, I have thoroughly enjoyed serving as a screener for the AAAS Kavli Science Journalism Awards. Assessing the entries keeps me informed and learning about what science journalists are writing about, and often times even learning about new topics. As a screener, I always get a chance to read a wide range of newspaper and magazine articles on many different subjects regarding biology, physiology, public health, genetics and a variety of current issues in medicine. It gives me a chance to see publications I don’t normally see and read some of the best writing and science journalism for the public from around the world. I am continually impressed by the topics, the coverage, and the ability of science journalists to translate complex subjects into informative, accurate and engaging articles for the public.
Q. Have the type and quality of entries been changing over the years?
A. I think the quality of the articles has certainly improved (and the quantity has increased) as science journalism has continued to grow as a profession. I am always proud to see journalists accurately translating research data and interpreting controversial issues with context and clarity. There are so many excellent articles on diverse scientific and public health topics submitted to the AAAS Kavli Awards each year. It is amazing to see so many science journalists from around the world doing such great work.
Associated homepage photo by Adam D. Cohen