Thoughts on clinical handover

"This patient has the problem?of being severely interesting"

Not surprisingly, doctors, nurses and paramedics talk to each other a lot about patients - in particular at point of handover. This has long been recognized as a danger point in the patient care pathway - with failures of communication frequently documented in SAC1 investigations and the Coroner's court. Collectively we've been working on it for at least the last 15 years.

I take and give patient handovers for a living and have noted a wide variation in the skills of my colleagues - with almost no opportunity for feedback other than positive feedback (and that's not really needed in the first place for those who are doing it well.

Health jurisdictions give us a framework called ISOBAR but I don't see it used all that much.

Here's what I think is missing: the art of storytelling

Read a good book or watch a good movie - noting that your definition of both will likely vary to mine, but stick with me here.

Like at the start of a James Bond movie when our hero gets introduced to his newest DB5 by Agent Q at MI6. That vehicle is then metaphorically put in a cupboard to be brought out a later date in the movie, but when it is the audience is all "I wonder which weapon is going to be used in which order".

It's also important to understand that, when talking to clinicians from different specialties, their attention span varies. In the case of Emergency Medicine it's about 10 seconds. Sometimes shorter. So that opening line needs to be punchy.

The best opening lines I have heard of late:

"This patient has the problem?of being severely interesting"

and

I have a patient with a high clinical suspicion for life threatening problem X

Which might be subarachnoid haemorrhage, thoracic aortic dissection and so on.

It's also important to state the confidence in the diagnosis being handed over - clinical diagnosis, imaging proven; and it's important to know what is likely to happen to them at the receiving end - observation vs a life saving procedure.

But who am I kidding?

- a surprising number of my colleagues find it hard to give me their name and simply answer the phone with "hello"

- a smaller number have not actually met the patient they are looking after and are reading from notes that are not necessarily contemporaneous

- there are other examples

Let's not forget these are smart people

- I know that a lot of clinical individuals get training in how to speak with patients, be empathetic and so on - and that is awesome

- how much training are they getting in how to talk to other doctors I wonder? And can that be taught - I'm sure it can!

Focus on storytelling as a core skill of clinical medicine

- recognize that it is a creative process

- tailor to your audience of one or more

- seek and be open to feedback

And of course there is a flipside to this - how to take a good handover

- my take aways:

- practice active listening

- establish rapport

- realize you're the audience for a story rather than someone filling in a form

My name is Paul Bailey. I receive and give handovers for a living, using that information to manage risk. I used to be the Medical Director of the largest ambulance service in the world. In another life I was a jellyfish hunter. Like or comment on this post if you found it interesting, follow me on Twitter @waambedic, or drop me an InMail if you want to continue the conversation.