What is said, meant, heard: Practitioner-patient understanding during delivery of diagnoses in the emergency department.

Abstract

Effective communication between patients and practitioners is essential for patient satisfaction, adherence to the medical plan, and improved health outcomes. Delivering a diagnosis is a necessary component of patient care in the emergency department; however, these conversations can have risk for misunderstandings. This study investigated patient understanding of a new diagnosis in the emergency department and factors that modified this understanding. Patients and practitioners completed surveys following delivery of a new diagnosis, and descriptions of the diagnosis by both parties were compared and graded for agreement by three external physicians. We examined whether the severity of diagnosis or adhering to a communication framework class influenced patient-practitioner agreement on the new diagnosis. Among 196 encounters, 83.7 % described the same diagnosis given by their practitioner (patient-practitioner agreement). Patient-practitioner agreement was correlated with the patient's full understanding of their diagnosis (r = .17). Patient and practitioner-rated medical severity were inversely related (ρ=-.39). Practitioner-rated illness severity was related to difficulty receiving the diagnosis (ρ=-.38), difficulty delivering the diagnosis (ρ=.18), and adherence to a communication protocol (ρ=-.16). Multivariable Poisson regressions showed significantly increased practitioner-patient agreement on the new diagnosis when the patient self-reported full understanding of the diagnosis (RR=1.18, p < .05), and significantly decreased practitioner-patient agreement within certain diagnostic classes, specifically cardiac (RR=.71, p < .05) and gastrointestinal (RR=.77, p < .05) relative to musculoskeletal diagnoses. Most patients correctly described a new diagnosis given in the emergency department. However, in cases with misunderstanding, patients were significantly less likely to correctly describe a new diagnosis when they received cardiac and gastrointestinal diagnoses and when they reported anything less than full understanding.