Communication/Interpersonal Skills
Comunication / Interpersonal Skills (IPS as the ACGME calls it)
“What we have here is a failure to communicate”
from Cool Hand Luke
http://www.youtube.com/watch?v=SnO9Jyz82Ps
Examples of communication failures
Avianca Flight 52 http://en.wikipedia.org/wiki/Avianca_Flight_52
In 1990, the crew ineffectively told the JFK tower that they were running critically low on fuel. They crashed into Cove Neck, Long Island killing 65 of 159 passengers on board. The crew may have felt they declared an Emergency while the tower did not. Malcolm Gladwell speculates that the way different cultures deal with authority could also have played a part.
Relevance to medicine:
Sometimes we try to communicate issues to others. The other party just does not seem to understand the sense of importance. We must keep trying in order to make sure the right thing gets done.e.g. a radiology resident gives an intern the result of the head CT “large subdural hematoma” and advises the intern to call neurosurgery. He observes the intern adding the to do item to his clipboard. Our resident say, “NO, pick up the phone and call neurosurgery!” Medicine often has an authoritarian culture where the resident may try to tell the attending the equivalent of the “plane is running low on fuel” with results that could be disastrous for any given patient.
KAL 801 http://en.wikipedia.org/wiki/Korean_Air_Flight_801
In 1997, in poor weather, KAL crashed in Guam. In the lingo it had a “Controlled flight into terrain” meaning that the plain had no mechanical issues. Part of the problem is that the pilots had poor English skills. They learned that whenever the tower asked for clarification, all they had to do was say “Roger” and the tower would stop “bothering them”. This contributed to the bad outcome.
Relevance to medicine:
Sometimes, when giving instructions, the person receiving the instructions may be too ready to say the equivalent of “Roger” for a variety of reasons. It is important for the instruction giver to have an environment where it is encouraged to seek clarification.
Another “systems issue” with this flight is that usually the radio beacon is put at the end of the runway. The pilot can guide the plane to the beacon and land safely. In this case, the radio beacon was on Nimitz Hill 5600 meters from the runway. The pilot brought the plane down almost on top of the beacon which resulted in the crash.
Relevance to medicine:
Sometimes we assume that the set up or systems are the same where ever we go. This can lead to minor or major errors. For example, neuro may use 5 ml syringes for contrast and 10 ml syringes for saline flush, while interventional uses the opposite. When a resident moves from one service to another, this is a set up for confusion.
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References
(mentioned in Malcolm Gladwell’s book “Outliers”)
Malcolm Gladwell on Culture, Cockpit Communication, and Plane Crashes
Korean Air Tries to Fix a Dismal Safety Record
http://online.wsj.com/article/SB933090613281869060-search.htm