Maria R. Dahm

Enhancing international medical graduates’ communication: the contribution of applied linguistics

International medical graduates (IMGs) make up one‐third of the Australian medical workforce. Those from non‐English‐language backgrounds can face cultural and communication barriers, yet linguistic support is variable and medical educators are often required to provide feedback on both medical and communication issues. However, some communication difficulties may be very specific to the experiences of IMGs as second language users.

Trust, talk and the dictaphone: Tracing the discursive accomplishment of trust in a surgical consultation:

Using discourse analytical methods, this article examines the interactional accomplishment of trust. Focusing on a case study drawn from a corpus of 28 surgical consultations collected in a gastro-intestinal clinic, it traces the trust-building process in a specific, communicatively challenging encounter where the patient is seeking a second opinion following an operation that she deems unsuccessful. Discourse analytical findings make visible the doctor’s strategic interactional work to build interpersonal trust with the patient and to regain her trust in the surgical profession. This work extends beyond interaction with the patient to include dictation of a letter to the referring doctor in the patient’s presence. Close analysis of the encounter reveals how this co-constructed consultation letter is deployed to strengthen the fragile patient–doctor trust engendered thus far. The article therefore provides insights into the discursive processes of trust building that could potentially be of considerable practical relevance to the medical profession.

Health Information Infrastructure for People with Intellectual and Developmental Disabilities (I/DD) Living in Supported Accommodation: Communication, Co-Ordination and Integration of Health Information

ABSTRACT People with intellectual and/or developmental disability (I/DD) commonly have complex health care needs, but little is known about how their health information is managed in supported accommodation, and across health services providers. This study aimed to describe the current health information infrastructure (i.e., how data and information are collected, stored, communicated, and used) for people with I/DD living in supported accommodation in Australia. It involved a scoping review and synthesis of research, policies, and health documents relevant in this setting. Iterative database and hand searches were conducted across peer-reviewed articles internationally in English and grey literature in Australia (New South Wales) up to September 2015. Data were extracted from the selected relevant literature and analyzed for content themes. Expert stakeholders were consulted to verify the authors’ interpretations of the information and content categories. The included 286 sources (peer-reviewed n = 27; grey literature n = 259) reflect that the health information for people with I/DD in supported accommodation is poorly communicated, coordinated and integrated across isolated systems. ‘Work-as-imagined’ as outlined in policies, does not align with ‘work-as-done’ in reality. This gap threatens the quality of care and safety of people with I/DD in these settings. The effectiveness of the health information infrastructure and services for people with I/DD can be improved by integrating the information sources and placing people with I/DD and their supporters at the centre of the information exchange process.

Coming to Terms with Medical Terms – Exploring Insights from Native and Non-native English Speakers in Patient-physician Communication

Using medical terminology involves a large risk of miscommunication in English-medium consultations as patients often do not know or misunderstand the terms commonly used by physicians, or even misuse terms in their interactions with medical professionals (Hadlow/Pitts 1991; Street 2003). Patients and physicians also frequently associate different meanings with the same medical terms, which further threatens patient-physician communication (Hadlow/Pitts 1991). To date most investigations on the impact of medical terminology have focused on native English speaking (NES) individuals in monolingual encounters, while insights from non-native English speaking (NNES) physicians and patients have been largely neglected. Through semi-structured interviews, this qualitative explorative study investigates the experiences of patients and physicians from diverse linguistic backgrounds in medical encounters within Australia. A particular focus is given to the way NES and NNES participants perceive and judge the impact of the meaning of medical terms on patient-physician communication. Findings suggest that both the use and meaning of medical terminology are perceived and judged very differently by individuals who come from different language backgrounds and who hold varying degrees of medical knowledge. Findings indicate that common blanket recommendations urging medical professionals to avoid or explain jargon may be futile since physicians and patient also diverge in their understanding of what constitutes jargon or medical terminology.

Point-of-care testing across rural and remote emergency departments in Australia: staff perceptions of operational impact

New South Wales (NSW) Health Pathology is implementing one of the worlds largest managed PoCT services across rural and remote Emergency Departments (EDs) in New South Wales, Australia to improve patient access to care. The aim of this qualitative study was to gain a context-rich understanding of the operational impact of the NSW rollout of PoCT across rural and remote ED settings as experienced by frontline clinical staff. Clinical professionals (n=14) participated in interviews and focus groups in August 2015 at four rural and remote NSW EDs. Participants perceived that PoCT provided greater access to pathology thus facilitating more efficient and effective patient care via faster test turnaround and time to treatment and more effective decisions about the need to transfer patients to appropriate sites when required. These factors have a potentially important role in saving lives. Staff also identified innovative and disruptive challenges to clinical work patterns associated with PoCT implementation, particularly in relation to work flows, resource allocation and the governance arrangements.

Into the Spotlight: Exploring the Use of the Dictaphone During Surgical Consultations

The study of computer use during consultations and in clinical communication teaching has generated considerable research interest in recent decades, but few studies have investigated how the use of other technological devices such as the dictaphone may be linked to the acquisition of interpersonal communication skills. Research on the dictaphone has focused on “backstage” activity such as dictating consultation letters after consultations, and largely neglected its potential in “frontstage” interactions with patients or as an educational tool in teaching clinical communication. This article draws on 28 consultations recorded in a gastrointestinal clinic and a follow-up interview with the participating surgeon to explore the use of the dictaphone during consultations. All data were transcribed and reiterative thematic analyses were conducted. The analyses presented here show how the dictaphone can serve a range of important relational and medical functions when used to co-construct consultation letters with patients. These functions include establishing and maintaining rapport, building trust, checking and clarifying information, aiding information accuracy, and closing the consultation. This study shows how a technological device usually reserved for “backstage” medical communication can be successfully used as a communicative tool in “frontstage” interactions and illustrates the multifaceted and beneficial functions of the dictaphone.

Patient groups, clinicians and healthcare professionals agree – all test results need to be seen, understood and followed up

Abstract Background Diagnostic testing provides integral information for the prevention, diagnosis, treatment and management of disease. Inadequate test result reporting and follow-up is a major risk to patient safety. Factors contributing to failure to follow-up test results include unclear delineation of responsibility about who is meant to act on a test result; poor coordination across different levels of care; and the absence of integrated health information systems for the efficient information communication. Methods A 2016 Australian Stakeholder Forum brought together over 30 representatives from 14 different consumer, clinical and management stakeholder organisations to discuss safe and effective test result communication, management and follow-up. Thematic analysis was conducted drawing on multimodal data collected in the form of observational fieldnotes and document artefacts produced by participants. Results The forum identified major challenges which pose immediate risks to patient safety. Participants recommended priorities for addressing issues relating to: (i) the governance of test result management processes; (ii) integration of health care processes through the utilisation of effective digital health solutions; and (iii) involving patients as key partners in the decision-making and care process. Conclusions Stakeholder groups diverged slightly in their priorities. Consumers highlighted the lack of patient involvement in the test result management process but were less concerned about standardisation of reports and critical result thresholds than pathologists. The forum foregrounded the need for a systems approach, capable of identifying and addressing interconnections and multiple factors that contribute to poor test result follow-up, with a strong emphasis on enhancing the contribution of patients.

Delivering safe and effective test-result communication, management and follow-up: a mixed-methods study protocol

Introduction The failure to follow-up pathology and medical imaging test results poses patient-safety risks which threaten the effectiveness, quality and safety of patient care. The objective of this project is to: (1) improve the effectiveness and safety of test-result management through the establishment of clear governance processes of communication, responsibility and accountability; (2) harness health information technology (IT) to inform and monitor test-result management; (3) enhance the contribution of consumers to the establishment of safe and effective test-result management systems. Methods and analysis This convergent mixed-methods project triangulates three multistage studies at seven adult hospitals and one paediatric hospital in Australia. Study 1 adopts qualitative research approaches including semistructured interviews, focus groups and ethnographic observations to gain a better understanding of test-result communication and management practices in hospitals, and to identify patient-safety risks which require quality-improvement interventions. Study 2 analyses linked sets of routinely collected healthcare data to examine critical test-result thresholds and test-result notification processes. A controlled before-and-after study across three emergency departments will measure the impact of interventions (including the use of IT) developed to improve the safety and quality of test-result communication and management processes. Study 3 adopts a consumer-driven approach, including semistructured interviews, and the convening of consumer-reference groups and community forums. The qualitative data will identify mechanisms to enhance the role of consumers in test-management governance processes, and inform the direction of the research and the interpretation of findings. Ethics and dissemination Ethical approval has been granted by the South Eastern Sydney Local Health District Human Research Ethics Committee and Macquarie University. Findings will be disseminated in academic, industry and consumer journals, newsletters and conferences.

Assessing Data Integration and Quality for the Evaluation of Point-of-Care Testing Across Rural and Remote Emergency Departments in Australia.

In Australia, New South Wales Health Pathologys implementation of managed Point-of-Care Testing (PoCT) services across rural and remote emergency departments (EDs) has the potential to significantly improve access to results for certain types of pathology laboratory tests and help to deliver timely patient care. The aim of this study was to assess the quality of the datasets, including the integration of PoCT results into clinical systems, as a precursor to the application of an evaluation framework for monitoring the delivery of PoCT services and their impact on patient care. Three datasets, including laboratory, ED presentations and hospital admissions data were extracted from the relevant clinical information systems. Each dataset was assessed on six dimensions: completeness, uniqueness, timeliness, validity, accuracy, and consistency. Data incompleteness was the largest problem. Assessing the PoCT data integration and data quality is a precondition for the evaluation of PoCT and for monitoring and improving service delivery.

Talking their way to success: communicative competence for international medical graduates in transition

In a long overdue review of transitional programmes, Kehoe et al. focused on how programmes can aid international medical graduates (IMGs) in their transition to a new host country. They defined a successful transition in terms of outcomes related to adjusting to new work environments, cultures and interactions. They have shown that among the myriad of available interventions, the most successful interventions ‘offer a developed programme, targeting individual needs of IMGs within a supportive learning environment [and] offer ongoing support from both peers and supervisors; during and following implementation’.