Today I get to talk to Dr. Tim Gilligan. He’s the President of the Academy of Communication in Healthcare and an oncologist at Cleveland Clinic. And Dr. Gilligan gets right into how systems-level issues in health care actively push providers away from patients. He talks about how this can lead, sometimes directly, to worse patient care, and he talks about what he’s doing in the face of these everyday pressures.
Hi, everybody. This is 10 Minutes to Better Patient Communication from Health Communication Partners. Since 2017, we’ve been giving you inspiration and strategies to improve engagement, experience, and satisfaction. I’m Dr. Anne Marie Liebel, a researcher, consultant, and educator specializing in communication and education. This podcast digs to what we can take for granted about communication in our professional lives, especially in health care and public health, but increasingly across sectors, because communication touches everything. We’re here to learn, get inspired, and most importantly, make the difference we got into our jobs to make.
Now, I get to say this next part with a bit of pride: I originally met today’s guest while consulting at Cleveland Clinic. I was brought in to help support their communication initiatives. And to this day, it’s been some of my most meaningful consulting work. It had a big impact on me personally as well. So if your organization wants to improve how providers connect with patients or with each other, this is exactly the kind of work I love to do, and I’d be glad to talk with you about it. Visit healthcommunicationpartners .com and click on contact or find me on LinkedIn, Anne Marie Liebel.
Now, you already know, because you’re here, that good communication is the foundation of good care. You also are aware that there’s lots of ways the systems that we work in make that communication harder instead of easier. And that many of the structures designed to support clinicians and providers end up pulling you away from patients.
Across this series, we’ve often talked about ways that today’s healthcare system can work against active communication between teams, between patients and providers, and these systemic barriers lead to worse patient care and outcomes. And this isn’t an abstract issue either. It affects real people, every day, because when conversations get skipped or rushed, avoided all together, you get more mistakes. We erode trust and outcome suffer.
You know this. The research backs it up. And yet, you are trying hard to give the best care you can in spite of this. And so is our guest today.
He’s seen these challenges from the inside as a clinician and a caregiver. From the outside, as a parent. And he talks about individual and systems level issues in communication in health care, which is why I’m so excited to have Dr. Tim Gilligan on the show. In this conversation, oof, we get into a lot, so this one is also broken across two episodes because I want us to have a chance to dive in to the layers and layers that he talks about. So Dr. Gillian talks about one way systems get in between providers and patients. He talks about what he’s doing at an individual level to repair the patient -provider relationship through communication, while he’s still working for and hoping for systems-level change. Here’s Dr. Gilligan.
Anne Marie: I’m live with Dr. Tim Gilligan. Dr. Gilligan is president of the Academy of Communication in Healthcare, and he’s also a clinical oncologist at Cleveland Clinic and a soccer dad. Dr. Gilligan, welcome to the show.
Dr. Gilligan: Thank you so much for having me.
Anne Marie: I’m delighted to be able to be talking with you again. You and I got to cross paths a long time ago in the pre-COVID days. And so I’m delighted for us to be able to chat again. So please let me know, Tim, what is a problem or issue in patient communication that you have been facing?
Dr. Gilligan: I see two different levels of this that I’m really struggling with right now, both the systems level and an individual level. When I first started doing a lot of work training communication skills, I was really focused on teaching people skills, teaching myself skills, to have better conversations with patients. And what stands out to me now, when I am in the hospital, especially if I’m there, not as a doctor, but as a loved one visiting a friend or family member, what strikes me is there’s so many systems issues getting in the way of good communication that it’s important to me to talk about both of those.
Anne Marie: So what are you seeing? What is this kind of issue that you want to talk about that’s kind of got the individual level manifestations and the systems level manifestations?
Dr. Gilligan: So what strikes me is how little attention we’re paying, actually, to the patient. And it often feels like…
AM: Hmm [laughs]Sorry. Oh, wow, okay.
TG: We’re really paying attention to the chart. When I go into the hospital, what I see is people are taking care of the patient’s medical record. They’re making sure they do careful documentation. They do careful billing. They have all the problems listed. They notice whether the problem is a new problem or an old problem. And all the incentives in the system were built around taking great care of the patient’s chart, rather than taking great care of the patient.
AM: Ouch. Ouch. Wow. How has this shown up in your experience?
TG: So I had a good friend who had a serious illness in the hospital not that long ago, and I spent a lot of time at his bedside. And one thing that was striking to me was how rarely doctors came into the room and actually did a physical exam. And there were significant changes happening in his physical exam that those of us who were his, who loved him and were visiting him, we could see it and he would tell us about it. And I was mystified as to why the physicians involved in his care didn’t seem to be picking up on changes that I thought, as a physician, to me were very important changes. I literally got to the point of writing down questions that I told him he had to ask his medical team because they weren’t getting answered. And I think what was happening was they were looking at his chart and not seeing these things manifest in his lab values or his imaging, so they weren’t aware of them.
AM: Wow, wow. But you could tell by looking at him, by observing him as a clinician, you could see something is going on here, even though it’s not being reflected in the chart.
TG: Yeah.
AM: Wow, wow.
TG: And I don’t necessarily blame the individuals.
AM: no.
TG: I see they’re doing what they’re being incentivized to do. This is what they’re told to do. I get dinged if I don’t say whether a problem is a new problem or an old problem, whether it was present on admission. But I don’t get dinged if I don’t go into the room, and don’t examine the patient. Like, no one’s actually noticing that. So people are noticing what’s noticed, and they’re paying attention to that. I’m not totally justifying it, but we have a system that’s strongly incentivizing behaviors that are not in the patient’s best interests. And a lot of it has to do with money at the end of the day. I also just want to say, hospitals are not doing well. Half the hospitals in the US, I saw recent data, I can’t tell you from which year but not that long ago, half the hospitals in the US are losing money. So it’s not like hospitals are greedy, trying to maximize profits, they’re trying to stay afloat.
And all the incentives in the system were built around taking great care of the patient’s chart, rather than taking great care of the patient.
Dr. Tim Gilligan
AM: Yeah
TG: Our system is broken, that hospitals are struggling so much, and yet private companies, pharmaceutical companies and device makers and private health insurance companies, they’re making billions and billions in profits, while hospitals are struggling and then care suffers.
AM: Yeah, it feels like I see every day, like notices of another hospital closing or threatening to close, close to closing, laying off hundreds of staff again, things like that. So how have you been facing this issue as a clinician or as a caregiver? You’ve got the systems level, all that you’re really wisely drawing our attention to: so many different kinds of pressures that, whether we notice them or not, are nudging toward this kind of paying better attention to the chart than to the patient. And then you’ve had the individual level, what you told, the story of your friend. you’re like: “here’s questions to ask your medical team.” How else are you dealing with these issues as a person?
TG: So I think it’s a really important question because the system is not going to change anytime soon. I think we have to fight for a better system and I’m hopeful that it will. In the meantime, we have the system that we have, and we have patients who need us to take great care of them. And so then I ask myself, well, given the limitations of the system, what can I do today? And seeing what my friend went through was a real reminder to me of the importance that I need to go into the room. And I need to make sure that patients feel like I’m paying attention to them, and I know what’s going on, and I’m seeing how their condition is changing over time. And so I think for me, while I wait for a better system, while I try to work for a better system, I can also think about seeing my patients, and listening to my patients, and hopefully they feel that I’m fully present with them when I’m there. And making sure I’m not spending too much time at the computer and the chart, at the expense of being present with them.
Now, Dr Gilligan talks about so many important interrelated issues, it was difficult for me to come up with a title for this episode that could capture them all. You’ll have to tune in next time and hear part two of our conversation because Dr. Gillian tells a story about why it’s still worth it, despite all of these pressures, to reconnect with patients through communication because of the impact it has on outcomes and even on clinician well -being and professional satisfaction.
This has been 10 Minutes to Better Patient Communication from Health Communication Partners. Audio engineering and music by Joe Liebel, additional music from Alexis Rounds. Minutes to Better Patient Communication from Health Communication Partners. LLC. Find us at health communication partners .com.