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The recent CARES retreat focused on information and communication regarding aging services and health care. A presentation about the Area Agency on Aging Senior Helpline (602 264-HELP) provided an update on services available in Maricopa County, local programs, and changes in Medicare. The presentation was followed by a panel discussion with health professionals (including a nurse practitioner, nursing home administrator, pharmacist, and physician) who described their roles in the continuum of care and answered questions about a broad range of topics related to communication. As representatives of the Arizona Geriatrics Society, panel members were particularly sensitive to the needs of mature adults.
Communication serves several functions with respect to health care and service delivery. It connects us to the environment, provides access to information, and facilitates emotional and intellectual expression. Communication is especially important now that patients have become clients who are expected to assume increasing responsibility for their own well being. Effective communication potentially leads to better care and a more responsive provider. It promotes teamwork and permits shared decision-making. Communication is also an essential element in treatment that supports adherence to care plans and improved follow-up.
Age-related changes in our sensory capacities, most notably hearing and vision, can have a profound effect on communication. Most of us become aware of sensory losses in our forties though they may begin much earlier or go unnoticed until later in life. Normal age-related hearing loss, called presbycusis, primarily entails a decreased ability to hear high frequencies. It is particularly insidious in that people think they can hear, but because they are unable to decipher the words, they are often excluded or withdraw from conversation and are thought - by themselves and others - to be confused. We try to assist them by talking louder which usually means we use more high frequency sounds, the very sounds they can no longer hear. Most people are not aware that communication can be facilitated by talking deeper rather than louder.
When accompanied by decreased mental processes, chronic conditions and adverse events may interfere with sending and receiving messages. Altered body image, impaired physical functioning, diminished self-esteem, and depression associated with a chronic condition or adverse event can also contribute to communication problems.
Good communication in health care settings seems to be at odds with the limited time service providers spend with their clients. Being clear and concise makes a difference. Many of us make a list of concerns before meeting with the doctor. That list should not be scratched down on a slip of paper while en route to an appointment. Instead, one should briefly describe concerns in writing and hand the list to the provider who can then decide which issues need immediate attention and whether another appointment is necessary. Some have even suggested faxing the list to the care provider the day before an appointment.
When medical mistakes are involved, open and honest communication is constrained by fear of litigation. Acknowledgement of mistakes and apologies are rare in our litigious medical marketplace even though evidence suggests that patients are less likely to sue over medical mistakes when offered a thorough explanation and apology by the responsible physician. Health care providers have traditionally been counseled to avoid apologies and admissions of fault. That advice seems to be changing. At least six states now exempt physician statements of apology and compassion relating to patient injury or death from being admissible as evidence in court. Arizona Senate Bill 1036 dealing with medical malpractice procedural reforms would, among other things, exempt from evidence expressions of apology, sympathy, responsibility, and liability. Whether that is in our best interests is for each of us and the state legislature to decide. Such a measure would seem to permit more humane interaction in relationships that rely on trust and communication to foster quality care and compliance with treatment plans.
 Rose Pfefferbaum, Ph.D., mcli
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