The late business management expert, Peter Drucker, wrote
that information is data given relevance and purpose. Although he wrote about a
different industry, this concept is useful for us in clinical medicine.
We can apply this concept in our communication with
others in the clinical realm. How exactly can we do that? I’ll show you three,
related concepts with an example for each.
The three concepts are
1.
Putting
data into a context
2.
Leading
with our assessment
3.
Taking
the listener’s perspective
We have to put data
into a context. Without context,
without a bigger picture, an isolated fact your receive has little meaning,
less actionable information.
You could write:
The patient is a 3 year
old with a fever of 39 degrees Celcius.
Without the context, this bit of
data means little. With a little bit more, well-selected data, you can have a
clear picture of what is going on.
The
patient is a 3 year old with a fever of 39 degrees Celcius. He is drowsy, has
poor capillary refill, and sunken eyes.
In contrast
The
patient is a 3 year old with a fever of 39 degrees Celcius. He is alert,
smiling, and drinking juice vigorously.
I’ve only added 3 new facts with
each sentence and the clinical picture is very different for each scenario. The
first child sounds like he’s potentially very sick. The second child sounds
like he’s got mild illness. A little context makes a huge difference to your
audience’s understanding of the situation.
We can lead with
our assessment, with our conclusion. Sometimes giving our conclusion first,
then putting our data into that context is most efficient for communication.
You could tell a colleague:
The
patient is a 48 year old female with frontal headache, constant in nature,
worse with moving her head, associated with dizziness and nausea. No vomiting.
Cranial nerves 2-12 are intact, 5/5 strength in all 4 extremities, normal gait.
Neck supple. Bilateral sinus tenderness, and moderate amount of purulent mucous
in bilateral nares. I think it’s a sinus headache.
Alternatively,
when you lead with your conclusion:
I
think this patient has a sinus headache. She’s a 48 year old female with frontal headache,
constant in nature, worse with moving hear head, associated with dizziness and
nausea. No vomiting. Cranial nerves 2-12 are intact, 5/5 strength in all 4
extremities, normal gait. Neck supple. Bilateral sinus tenderness, and moderate
amount of purulent mucous in bilateral nares.
True, in the classic teaching in medicine, you shouldn’t
trust anyone else’s evaluation and you should re-evaluate the patient yourself.
However, when you lead with your conclusion your audience at least have an idea
of what you are trying to communicate. Give your listener the context of your
conclusion, which they can go and test for themselves. You don’t leave the
other person to figure out what you’re to tell them until the end and then have
them mentally go back and try to see if all the facts you told them fit.
Instead, you’re telling them, “This is my conclusion, here’s an opportunity to
reference that conclusion against the pertinent facts I’ve collected.”
Another example is that we take the listener’s perspective. We have to consider what is useful
for them. In clinical medicine we talk to different people who have different
roles to play in the patient’s care. Take a moment and ask yourself, “What is
my listener’s role in this patient’s care? What do they need to know?”
A nurse brings a patient to the
general, inpatient unit and tells the hospitalist, “The new patient with the recurrent seizures
just came from the ER.” Supposed the nurse stops and looks at the
hospitalist for instructions.
Most likely the hospitalist
needs information before their next action. The nurse gave facts not actionable
information. Should the hospitalist stay
in their chair and continue the work in front of them? Should they get up and
see this new patient immediately? Who
knows? Adding a little extra information helps tremendously.
Here’s a
little extra data with actionable information:
“The
new patient with the recurrent seizures just came from the ER. He got a lot of
valium downstairs and is a little groggy, but seems pretty stable.”
Alternatively…
“The
new patient with the recurrent seizures just came from the ER. He got a lot of
valium downstairs and looks like he’s having problems breathing.”
The patient in the second
description probably needs an urgent assessment, the one in the first likely
can wait. Now the hospitalist knows what actions to take, and a few extra
seconds worth of speaking gave that information.
Sadly I think many of us in clinical practice see some
kind of poor communication at work on a regular basis. The above are just three
examples, but with paying a little bit of attention, I think most clinicians
could list several more.
Take these lessons into account whenever you communicate
with someone else clinically. As we’ve seen, you can do this both in writing
and speaking. Make the data into
information, make it relevant and useful.
If you’re interested in further discussion of information
vs data in the clinical realm, please keep an eye out for my upcoming book, A
Guide to Clinical Decision Making.
