Time Out Before Talking: Communication as a Medical Procedure

Ideas and OpinionsJanuary 2021Time Out Before Talking: Communication as a Medical ProcedureJoshua R. Lakin, MD, James A. Tulsky, MD, and Rachelle E. Bernacki, MD, MSJoshua R. Lakin, MDDana-Farber Cancer Institute and Brigham and Women's Hospital, Boston Massachusetts (J.R.L., J.A.T., R.E.B.), James A. Tulsky, MDDana-Farber Cancer Institute and Brigham and Women's Hospital, Boston Massachusetts (J.R.L., J.A.T., R.E.B.), and Rachelle E. Bernacki, MD, MSDana-Farber Cancer Institute and Brigham and Women's Hospital, Boston Massachusetts (J.R.L., J.A.T., R.E.B.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-4223 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Medical procedures encompass a set of ordered actions, each requiring unique knowledge and skills, aimed at diagnosing, prognosticating, or treating illness. A medical procedure generally brings to mind invasive technical interventions, such as colonoscopy or appendectomy. However, clinician–patient communication, particularly when focused on a specific task—such as taking a medical history, delivering bad news, or discussing goals of care—also contains procedural elements and has been likened to procedures in the educational realm (1, 2). Considering communication interactions from a procedural lens may improve the specificity, intention, and impact of these ubiquitous interactions across clinical, educational, policy, and research domains. To ...References1. Kelley AS, Back AL, Arnold RM, et al. Geritalk: communication skills training for geriatric and palliative medicine fellows. J Am Geriatr Soc. 2012;60:332-7. PMID: 22211768 doi:10.1111/j.1532-5415.2011.03787.x CrossrefMedlineGoogle Scholar2. Lipkin M, Frankel RM, Beckman HB, et al. Performing the interview. In: Lipkin M, Putnam SM, Lazare A, et al, eds. The Medical Interview. Frontiers of Primary Care. Springer; 1995. Google Scholar3. Levinson W. Patient-centred communication: a sophisticated procedure Editorial. BMJ Qual Saf. 2011;20:823-5. PMID: 21856961 doi:10.1136/bmjqs-2011-000323 CrossrefMedlineGoogle Scholar4. Back AL, Arnold RM, Baile WF, et al. Approaching difficult communication tasks in oncology. CA Cancer J Clin. 2005 May-Jun;55:164-77. PMID: 15890639 CrossrefMedlineGoogle Scholar5. Baile WF, Buckman R, Lenzi R, et al. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5:302-11. PMID: 10964998 CrossrefMedlineGoogle Scholar6. Haynes AB, Weiser TG, Berry WR, et al; Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360:491-9. PMID: 19144931 doi:10.1056/NEJMsa0810119 CrossrefMedlineGoogle Scholar7. Zulman DM, Haverfield MC, Shaw JG, et al. Practices to foster physician presence and connection with patients in the clinical encounter. JAMA. 2020;323:70-81. PMID: 31910284 doi:10.1001/jama.2019.19003 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston Massachusetts (J.R.L., J.A.T., R.E.B.)Acknowledgment: The authors thank Dr. Wendy Levinson, MD, OC, for her thoughtful input on this work.Financial Support: This work is unfunded. Drs. Lakin and Bernacki are supported by the Cambia Sojourns Scholar Leadership Program.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-4223.Corresponding Author: Joshua R. Lakin, MD, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215; e-mail, email protectedorg.Current Author Addresses: Drs. Lakin, Tulsky, and Bernacki: Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215.Author Contributions: Conception and design: J.R. Lakin, J.A. Tulsky, R.E. Bernacki.Analysis and interpretation of the data: J.R. Lakin, J.A. Tulsky.Drafting of the article: J.R. Lakin, J.A. Tulsky.Critical revision for important intellectual content: J.R. Lakin, J.A. Tulsky, R.E. Bernacki.Final approval of the article: J.R. Lakin, J.A. Tulsky, R.E. Bernacki.Administrative, technical, or logistic support: J.R. Lakin.Collection and assembly of data: J.R. Lakin.This article was published at Annals.org on 8 September 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byClinician Self-Disclosure in Palliative Care: Describing a Taxonomy and Proposing a Communication ToolTopical Review: Teaching Serious News Delivery in Eye CarePrognostic Communication in the Era of Targeted Therapy and ImmunotherapyPrognostication in dementiaNavigating Difficult ConversationsTime-Limited Trials and Potentially Nonbeneficial Treatment in the ICU—Willing to Wait for ItSay No to This: Unilateral Do-Not-Resuscitate Orders for Patients with COVID-19 January 2021Volume 174, Issue 1Page: 96-97KeywordsAppendectomyColonoscopyEmotionsLumbar puncturePatient advocacySpecificitySurgeonsSurgeryTechniciansTracheostomy ePublished: 8 September 2020 Issue Published: January 2021 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...