Twin Challenges: Collaboration and Communication

We pathologists have two important – and often overlooked – roles to fill: collaborator and communicator. Those roles are often conflated; after all, it’s difficult to have one without the other. Nevertheless, they are different aspects of our role as members of a health care team, and it’s vital for us to understand and actively engage in both.

The pathologist as a collaborator

Modern health care teams include not only groups of professionals working closely together on one site, such as a ward team, but also teams with a variety of perspectives and skills at multiple locations. It is therefore essential for us to be able to collaborate effectively with a multidisciplinary, multi-site team of health care professionals for the provision of optimal care, education, and scholarship.

What does that collaboration look like? We must know how to effectively consult other physicians and health care professionals. We can start by synthesizing any relevant information we have that our colleagues may not and presenting written and verbal reports on our findings and our proposals concerning further investigation needed for a patient. Our speaking and writing skills matter – it’s crucial to prepare and present reports in a concise and easily understandable form so that our non-pathologist colleagues can understand and make use of what we’re telling them. Each time we work on aspects of a case, we should record accurate, logical, comprehensive, and pertinent accounts – meaning that every examination, advanced analysis, diagnosis, and communication with clinicians should be filed, time- and date-stamped, and clearly attributable to us as the authors. And with medical records moving increasingly toward electronic models with patient access portals, we should make each note with the clear understanding that it may be read by the patient.

Once all of the information is on the table, we should enter discussions about diagnosis and treatment options with the other members of the team when appropriate. That means we must be able to recognize the limits of our personal and professional expertise and decide if and when other professionals’ contributions are needed to arrive at a final diagnosis in a case. And whether or not one is reached, we still need to communicate effectively with every member of the team to ensure a shared understanding of our patients’ problems and to foster continuity of care.

When we begin to see ourselves not only as individuals, but also as vital components of a larger healthcare system, our deep influence on patient care – at both a personal and a population level – becomes more obvious than ever. We don’t just weigh in on individual cases, although that is a key part of our work. We should also be cooperating with other professionals to make efficient use of resources by coordinating care, and contributing to the management of our patients at the interface with other specialties. We should be working with laboratory staff to implement efficient, high-quality diagnostic laboratory services and appropriate quality control. And we should be ensuring that our colleagues and collaborators can finish what we start: by demonstrating good handover practices and ensuring continuity of care when we go off-duty; by accurately summarizing the main points of pending cases; by providing pertinent information to the appropriate staff; and being ready with urgent additional information when necessary.

Clearly, it’s important for us to learn how best to work with our colleagues – both by expanding our collaborative skills and by exploring how we can invest in our roles on the multidisciplinary team. And the best way to keep tabs on how we’re doing is to seek feedback from colleagues on the quality of care our patients are receiving. We need to cope well with both positive and negative feedback – and we must be seen to reflect on and use that feedback to improve our skills. Indeed, welcoming any kind of feedback is key to ensuring that other medical professionals are comfortable telling us what we need to hear.

Full marks for collaboration

The collaborative pathologist contributes effectively to other interdisciplinary team activities beyond the scope of patient diagnosis and treatment. The tools in our arsenal? Effective teamwork skills, an awareness of our personal roles and responsibilities on the team, and leadership skills – along with the discernment to use them when, and only when, appropriate. How do we know when that is? All members of the team should be able to define their own tasks and competencies in relation to those of the others – not just the doctors, but also laboratory staff and other health care professionals.

We must treat all members of the health care team with respect regardless of similarities or differences. We need to understand the clinical setting in which we work and the interactions that occur within it, and shape our work effectively in light of that insight. Any personal agenda must be secondary to the goals of the medical team – and, of course, our patients.

We cannot be good collaborators if we don’t support our colleagues; therefore, we should assist laboratory staff with the design and implementation of new laboratory procedures, attend sign-out meetings, and accept directions from our expert colleagues. If we spot a potential problem in a complex case, it’s our job to take pre-emptive action – and to assist our co-workers in doing the same.

The best collaborative pathologists work effectively with colleagues and management to help create a culture where the improvement of quality and safety becomes a part of daily practice. The best collaborators also never stand still – we always seek improvement elsewhere.

How can we improve our collaborative skills?

• Connect with others to assess, plan, provide, and review tasks such as administrative responsibilities and education.
• Encourage an atmosphere of open communication and appropriate directed communication within your team, so that those we work with feel they can come to us with feedback, whether good or bad.
• Seek out opportunities to learn in cooperation with other health professionals – pathologists, certainly, but also others within and outside your institution. It is surprising how much we can learn from other disciplines!

The pathologist as a communicator

Communication skills are essential for our day-to-day function, as well as necessary for exchanging information with requesting physicians and other health care professionals – not to mention individual patients or patient groups. Furthermore, these abilities are critical for assessing key factors that affect the quality of care we provide.

To develop a productive professional relationship with others on the health care team, we must first understand that good communication is a core clinical skill for pathologists, and that effective pathologist-physician communication can foster physician satisfaction and improve clinical outcomes. To that end, we should ensure that we are always courteous and considerate to technical and medical staff, treating them as we ourselves wish to be treated. Nonverbal cues can be valuable ways to discern how others feel about how we communicate with them. And, of course, we must respect our patients equally – including their confidentiality, privacy, autonomy, and right to know about and understand their own conditions and care.

The main purpose of communication is a two-way exchange of information. No one medical professional is an expert on the entire patient – including the pathologist – so we must seek out the perspectives of our colleagues to see the whole picture. If appropriate, we can also look for information from other sources, such as the patient’s caregivers or the patient themselves. We will always take care to assess the potential impact of factors such as age, gender, and ethno-cultural background on our diagnostic reasoning. All of this should then help us explain to colleagues and other professionals our assessment of a case so that we can reach a common understanding on issues and problems and develop a shared plan of care. Because the other members of the care team are not pathologists, we should deliver information to them in a way that is understandable so that it encourages discussion and participation in decision-making. Above all, our goal should be to foster the highest quality of communication within the team, because it helps ensure that patients receive the best possible care.

That said, one can’t always schedule a meeting to discuss every patient with every member of the team – so what else can be done? In such cases, written records are our friends. We will provide clear, concise, and complete reports to requesting physicians (and follow up with a verbal conversation whenever we feel it is necessary). We will routinely and comprehensively record personally attributable accounts of all examinations conducted for each case and the decisions based on the results; also record any verbal information we give to other members of the team. Whenever possible, we will support our written reports with published data, computer-based information, or both. Although our summary reports should be easy to read and refer back to, the existence of a thorough base of supporting information may be helpful in the future. This advice may sound familiar – why? Because many of the attributes of a good communicator are also those of a good collaborator.

Overall, the key points any pathologist must remember are to practice respect, encourage feedback, and model good communication and collaboration to other members of the health care team. In this way, not only are we acting as an excellent expert resource for our colleagues, but we are also providing our patients with the service and care they deserve.