I am returning from Italy on a personal and professional high, which I owe to my wife and daughter, who convinced me to take my first 10-day vacation in over a decade.  We began in Florence, where I was invited to speak on “Working as a Team and Communicating with Patients in Oncology,” at the behest of the Instituto Toscano Tumori (more on that experience in a moment).  We then took a 45-minute train ride to Arezzo, where my daughter is on a semester abroad program.  It was great to see her thriving in her new environment.  

We ended the journey in Rome, visiting the Pantheon, Trevi Fountain, Spanish Steps, and the magnificent St. Peter’s Basilica and the Sistine Chapel. In the Last Judgment,  Michaelangelo painted the Vatican Master of Ceremonies, Biagio da Cesena, as Minos, the gatekeeper of the underworld, after da Cesena commented that Michaelangelo’s art belonged in a bar rather than in the Sistine Chapel.  It reminded me of how carried away that we can be in our personal hostilities and made me wonder what might result if physicians and hospital leaders used art to convey their feelings.

During my talk in Florence, I recalled how helpful it was to learn the SPIKES protocol for conveying distressing news to patients and families when I worked as a fellow in surgical oncology at Memorial Sloan-Kettering Cancer Center.  Talking about teamwork in patient care gave me insight about how I can do better when I see patients during my locum tenens coverage assignments.  The SPIKES protocol stands for:

• Setting: respect privacy, involve others, be seated, look attentive and calm, listen actively, be available; let patient know of any time constraints ahead of time
• Perception: ask patient’s and family’s viewpoint and concerns
• Invitation: ask how much information patient wants to know
• Knowledge: warn of upcoming news; give information in small chunks and clarify understanding at each step
• Empathy: acknowledge patient’s and family’s emotion with phrases like, ”I can only imagine how you must feel.”
• Strategy: summarize events, check understanding, and plan for the future

Following the talk, we engaged in a lively 30-minute discussion that centered on two topics:

1) Why is the debate so heated between physicians and hospital leaders on both sides of the Atlantic Ocean and what can we do about it?

2) We are all busy people; what shortcuts can we take to improve communication and collaboration?

Please think a moment about how you would have responded before reading below what I replied:

1) Heated debates

• We are in a state of siege with little control of how we spend our time from the time we arrive in the hospital until we leave.  I try to remind myself as I leave my car each morning, “Only good days in healthcare,” to remind myself that we entered the healing profession to make a difference in patients’ lives and that the only control we have is over our responses and not over events.  Inadequate time for sleep, family, exercise, and outside pursuits magnifies our feelings of helplessness and conspiracy; so does inadequate time spent resolving conflicts which fester and erupt later for reasons that seem plausible only to the volcano and not to those feeling the lava’s heat.

2) Shortcuts to collaboration

• Unfortunately, I don’t know of any shortcuts.  The complexity that we face today appears to require face-to-face conversations characterized by active listening:
    – concentration
    – attention to body language and tone of voice as well as avoidance of hot-button words
    - suspending judgment
    – empathy, putting oneself in the other’s perspective. 

Most healthcare situations involve dotted-line interactions rather than direct commands, favoring inquiry and persuasion rather than zealous advocacy.  Part of the reason that collaboration requires time is that all cultural changes embody personal change, and as a surgeon confessed to me, “Only a baby desires change!”

What do you think?

• Why do you think that the debates between physicians and hospital leaders can be so personal and heated
• Do you know of any shortcuts to communication and collaboration
• Have you seen any artwork that symbolizes the current state of physician-hospital relations; what paintings, sculpture, or other art forms come to mind

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn