Improving the Patient Experience - Electronic Communication

Caitlin Hebert discusses patient-friendly electronic communication, stressing clarity, proactivity, and human connection for impactful healthcare interactions.

My name is Caitlin Hebert. I'm a clinical nurse educator, and I'm also the vice chair of the nurse professional group at ASRM. And I am so excited to be here talking to you about something that is very near and dear to my heart, and that is romantic comedies of the 1990s.

So have any of you guys seen a little movie called You've Got Mail? You've Got Mail, anyone? OK, good for you, good for you. For those of you who have not seen this movie, it's set in 1998, and it follows the course of a love story between Tom Hanks and Meg Ryan as they fall in love over email. They are so excited to receive an email.

Can you guys imagine that? I don't think I've ever been that excited to receive an email in my entire life. But they're sitting there, messages popping up, hope just shimmering around them in this beautiful orb. OK, so I'm not really here to talk to you guys about romantic comedies of the 90s.

I could, if you guys want to switch this topic up, but actually I am here to talk to you about patient-friendly electronic communication. As we all know, this is even more important today than it ever has been before. For me in my clinic, I used to have the opportunity to meet with my patients after they came in for their new patient visits or after their follow-up visits.

But when COVID hit, all those visits were switched to telehealth, and all of a sudden I was relying a lot more heavily on my electronic communications to build that relationship and to convey important and salient information. So in light of this, I really tried to develop a few ideas to make my patient-friendly, my patient electronic communications more geared towards them, more patient-centric. The three ways that I did this were by making them clear, proactive, and remembering that electronic communications are a supplement to and not a replacement for the human connection.

OK, so to my first point, these patient-friendly electronic communications should be clear. There's this great article in 1990 called Chasms in Communication, which, love the word chasm, sounds very sexy. And what this article basically talks about is how healthcare providers love to talk in jargon and acronyms, and that this can create barriers for the patients.

Now, for you guys that are medical professionals, have you ever noticed yourself talking in jargon to your patients or saying a word and they give you this clear, glazed look on their face? For you guys that are not medical providers, have you been on the other side of that where they might as well be speaking a different language to you? I know I have. And I think in particular about when I very first started in REI. I was so excited to talk to my patients.

I got my physician's note. I was ready to call them. I picked up the phone, I called my first patient, and I'm reviewing everything, and it is going great.

I mean, me and this patient, we are in sync. And then I get to the last line of my physician's note, and it says, continue P and V. I think to myself, you know, I just met this patient. I can't tell her to continue putting the P and the V, even if she is trying to have a baby.

I mean, that is just way too graphic for me. So I decide to just skip right over that, and then I'll come back to it later. So sitting at my desk, I reread the note, and I'm like, oh, they meant continue prenatal vitamins.

That makes a lot more sense. But I tell you this story because it is so easy to misconstrue what an acronym means. And it's so easy for our patients to bring their own baggage and to Google something that may or may not be accurate.

It's part of our duty to make sure that we are being very clear. We're providing context, and we're spelling everything out, particularly when we're conveying it electronically, where there isn't that back and forth. Now, the other thing that we should be doing when we're thinking about patient-friendly electronic communications is being proactive.

Earlier this year, the Journal of Internal Medicine published a study from the University of Colorado that talked about how our patients are currently experiencing an uncertainty gap. And what that means is that our patients don't know the best way to reach out to us. They don't know if they should call us, if they should schedule an appointment, if they should send a portal message.

Oh, and should that appointment be telehealth or should it be in person? Or maybe I should just start sending smoke signals and praying that someone's gonna respond to me. The reality is that we have an opportunity here to proactively set those expectations up for our patients and let them know, hey, this is the way that I'm gonna convey this information. This is the timeframe I'm gonna convey this information.

Oh, and by the way, do you have any preferences about how you receive this information? Another study, this time from the Veterans of Health Administration, talked a lot about how important it is for us to realize the type of communications we're having back and forth with our patients. And in this study, it said that the majority of the communication between the healthcare provider and the patient is the healthcare provider reactively responding to questions. This is an opportunity we have is to make sure that we are getting ahead of those questions.

Now, for some of you guys that have had done a lot of patient care, you know that your patients are asking a lot of the same kind of questions, right? You hear a lot of the same ones over and over again. Now, if that's the case, take that opportunity to create a frequently asked question that you can go over with your patients. When I did this, it created a space for us to have this open dialogue, this opportunity where they felt there was no question that was unsafe.

And it really gave us this opportunity to get into more detail. Additionally, I found that my patients sometimes feel like the information I'm conveying is technical or is a lot of steps. So, for example, I call triggers, right? I say, hey, you're gonna give yourself a shot at this time, you're gonna take this, don't take this, show up here, bring this, don't bring that.

That's a lot of steps for the patients to remember. So, whenever I can, I make sure that as I'm reviewing this information with them, I let them know, hey, I know this is a lot of information, but don't worry, I'm gonna send you a tip sheet after we're done talking. Through your patient portal, it's gonna review all of this information and you can have it as a reference.

Our patients really appreciate these things. Particularly, it's a huge opportunity for these electronic communications to serve us. Now, one of the things you're gonna notice about that story that I just told was that in it, I am still having a conversation with my patient, right? So, that leads me to my final point.

Electronic communications are a supplement to and not a replacement for our human connection. Now, there's this great saying, and I don't know if I saw it on a poster at a middle school or scrolling the internet, but it says, people won't remember what you said or what you did, but they will remember how you made them feel. And I've really lived by this in my practice.

And because I put such an emphasis on this, I've discovered I have a superpower. And that superpower is my ability to listen. And I have some really good news for you guys all here.

You too can have the superpower. All you have to do is value it. The ability to listen, to actually not just hear the words people are saying, but also to understand the meaning behind it is a huge, crucial key to delivering successful care.

If we rely exclusively on electronic communications, we miss the opportunity to listen, to have an open, synchronous discussion about the patient's care. Now, you don't have to take my word for it. The earlier cited Journal of Internal Medicine talked to patients about what's important to them.

And one of the things they stressed was having a positive, established relationship with their providers, and that this relationship would translate to their patient portal. Additionally, they talked to patients about their experiences with and preferences for receiving difficult information, such as a cancer diagnosis. They overwhelmingly preferred to receive this information in person or via phone than receiving it via electronic communication.

And they also trusted that their providers knew not to send this type of information via the portal. So they have a lot of faith in you guys. So keep that in mind when you're having these discussions with them.

We have a lot of great talks with our patients. We celebrate a lot of wins, positive pregnancy tests, good OB ultrasounds, but we also have some difficult conversations. I think about one time, I had a patient who was an oncofertility patient.

She was gonna be pursuing chemotherapy and radiation, and we had been really optimistic that we were gonna be giving her a good embryo inventory. And unfortunately, we did only get one embryo, which was a huge disappointment for us, and it was an unexpectedly low yield. My physician called the patient and reviewed that information with her, and then afterwards, I followed up with her just to see how she was doing.

And she told me that the call that she'd just received from the physician had been harder than the day she'd received her cancer diagnosis. There is so much grief in our world, but there is so much hope. Part of our job, part of our mandate, is to hold these two different ideas together and help the patient understand.

We have to be able to understand the nuances and acknowledge the grief while lifting up the hope. And we do this so that our patients can persevere through a difficult time in their lives. So that they can persevere through treatment and hopefully get the outcome that we're all reaching for.

So, how do we execute patient-friendly electronic communications? Well, our patient-friendly electronic communications should be clear. We should avoid jargon, we should make sure we're providing context, and we should make sure we're not using acronyms. Additionally, our patient-friendly electronic communications should be proactive.

We should be trying to answer patients' questions before they ask them, and provide resources and tip sheets as needed to support them. And finally, our patient-friendly electronic communications are a supplement to and not a replacement for our human connection. They should never be used to convey very nuanced or difficult information to the patient.

Now, we may never be able to capture that specifically nostalgic feeling of opening an email in the 90s a la Meg Ryan, but we can leave our patients feeling satisfied and empowered. And I think that's an incredible opportunity that I challenge all of us to embrace. Thank you so much.