Physician Outlook

Failure to Communicate

Practicing good medicine requires a healthy understanding of anatomy, physiology, pharmacology, pathology and all the other components of the medical discipline that can be translated into proper grammar using clear and concise language. However, technology has negatively impacted both our written and oral forms of communicating. Poor communication has become the new normal. There is a failure to communicate across our everyday life with human feeling, emotion, and empathy dissolving into emojis. Take a look at whatever method you use to communicate and what it might say about you and if it is the right message you want to send.


“What we’ve got here, is failure to communicate.”  That is arguably the most memorable line of dialogue from “Cool Hand Luke”, a 1967 film portraying life inside a prison and starring Paul Newman in the title role.  The line was a key message about life in the turbulent 1960’s.  Ironically (or perhaps tragically) I think the message is even more pertinent today than it was more than 50 years ago.  If I’m correct…if we are communicating more poorly now than we did a half century ago, maybe we should spend some time thinking about how communication works.


During my youth (which coincided with the release of “Cool Hand Luke”) learning how to read, write, and speak our native language was considered the most critical of all skills.  High school English teachers were ferocious in their demand for correctness in all details.  That expectation followed us everywhere.  When answering essay questions in any other subject (e.g., history or science), one would likely be penalized for errors in spelling or punctuation or sometimes, even syntax.  That expectation continued to follow me through undergraduate school.  But interestingly, I began to see some weakening of expectations when I entered medical school.  That was when testing began to move away from written answers to a game of multiple choice (or multiple guess) which could be graded by a computer.  That meant your “evaluator” had no interest in your communication skills.


Once I got through that first couple of years of medical school, however, both oral and written communication skills became critically important again.  Medical records, after all, are legal documents.  That meant medical histories, physical exams, progress notes, orders…all had to be written (or dictated) using clear and concise language.  Later on, during my surgical residency at Medical College of Georgia, the expectation of exemplary written and oral communication continued.  I watched uncomfortably as residents were chastised for misspellings in their progress notes or poor grammar in their dictated operative summaries.  I delighted when one particular professor congratulated me one morning during attending rounds for my correct spelling of ‘intussusception’ in a progress note.  The message was clear.  Practicing good medicine demands more than knowledge and understanding of anatomy, physiology, pharmacology, pathology and all the other components of the medical discipline.  It also requires skillful communication, both written and oral.


Over my four and a half decades in medical practice, I watched in dismay as the rudiments of communication have gradually decayed, not just in medical practice, but in virtually all areas of our lives.  The grammatical errors that I hear and see daily are too numerous to count.  They appear, not just in casual conversation, but can be spotted in prestigious newspapers and magazines daily, not to mention television and radio broadcasts and podcasts.  A working knowledge of what proper grammar sounds and looks like appears to have evaporated.  In fact, in many areas, we’ve abandoned language altogether, preferring to communicate with emojis.


To a large degree, this decline in the proper use of our language can be traced to our overall failure as a nation to invest in the education of our young.  But I think the greater damage to our communication skills lies in our willingness to forego communicating altogether, particularly in medical practice.  In the early 1990s, I thought the electronic medical record would revolutionize one of the most time-consuming tasks burdening healthcare.  Unfortunately, it did exactly that, but not in a good way.  Rather than capturing our observations, thoughts, plans, and intentions, it has forced us to click a series of checkboxes, with the intent of maximizing the financial return of the encounter but leaving no trace of what we actually saw, heard or did.  As a bonus, this electronic marvel will then create a “letter” to the referring physician that says basically nothing.  And perhaps most regrettably, all of this can be done without even making eye contact with the patient.  


If this assault on personal communication were confined (note the subjunctive mood) only to medical practice, I suspect that it would not be tolerated.  But, alas, it appears to have become the norm, even in everyday life.  The handwritten personal letter or thank you note is now a curiosity of the past.  Even email has fallen victim to the now-preferred text message (replete with emojis) for personal communication.  And vast quantities of human feeling, emotion, and empathy have evaporated in the process.


As I read over my words above, I realize that all of this can sound like the meaningless rant of a hopelessly out-of-date old man.  I admit that it might be exactly that.  For my part, I hope it will be interpreted as a call to action.  It would be delusional to think that electronic communication will be abandoned for paper and pen, and I am not, even for a moment, suggesting that it should be.  What I am suggesting is that we take a moment to realize that in whatever method we use to communicate, our recipients will form some kind of opinion about us.  We should take great care to be certain that the message we intended to send is the message that will be received.    


To read more of Dr. Randy Cook's blog "The Script Pad" go to Dr. Cook is also host of MD Coaches, LLC's weekly Rx for Success Podcast found at


MD Coaches, LLC is a company dedicated to developing and empowering physicians to realize a greater satisfaction in their roles. Understanding the challenges and operational concerns for both physicians and hospital administrators. MD Coaches utilizes experience and coaching skils to support their physician clients in establishing strategies for positive career progression.



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