What Do I Say? Communicating Intended or Unanticipated Outcomes in Obstetrics, by James R. Woods, MD; Fay A. Rozovsky, JD, MPH. San Francisco, Calif: Jossey-Bass. 176 pages, Cost: $40.00. Copyright 2003 by John Wiley & Sons, Inc.
In this useful book, the authors, a perinatologist and a lawyer by training, address the importance of communication in shaping clinical outcomes. The reader learns about communication techniques that aim to improve patient decision making, decrease misunderstandings and dissatisfaction with care, and show compassion in relaying information regarding adverse outcomes. The authors discuss the human side of medicine and the limits of clinical knowledge in this helpful guide to communicating the unexpected to patients and their families.
The book starts by addressing the litigious climate that defines healthcare, such as the consent process and the importance of full disclosure of the benefits and risks of care. The authors review the legal context for disclosing bad news, including discussion of accreditation, insurance, and consumer choices. Furthermore, they emphasize clinician accountability and the evidence needed for the disclosure of negative information or clinical error.
The second portion of the book is what most readers will find interesting. The authors present clinical cases where a number of communication errors were made, ranging from relaying test results, to dealing with medical mismanagement, to family interpretation of events. Each case offers lessons and tips for effective communication with patients and their families. For instance, there are specific examples of communication techniques to diffuse anger, to educate, to disclose error, and to improve quality of care. These informative cases give directed ways in which the clinician may use active listening, reflection, and appropriate feedback techniques. This practicality is extended to include how to communicate during rounds, how to arrange an examining table for improved communication, and even how to arrange one's office for facilitating communication.
The main strength of this volume lies in the importance of the subject matter and use of informative cases. Its legal focus is an asset as well, although the lack of a more explicit theoretical and conceptual framework poses a bit of a hurdle. In addition, a more extensive bibliography would have strengthened the argument for improved clinical communication and would have pointed interested readers toward further exploration of this essential clinical skill.
While written mainly from a medical perspective in response to the currently litigious climate of obstetric care, clinicians from a variety of specialties and care levels will find this a valuable book. While nurses may find the communication techniques reviewed in the case studies to be intuitive, educators are likely to find it an essential resource for students who struggle with communication. More generally, any clinician interested in improving his or her communication acumen will find this book to be a valuable resource.
Elisabeth Howard, PhD(c), CNM
Brown Medical School, Midwifery Division, Women and Infants' Hospital, Providence, RI.