The Mumbo Jumbo Fix A Survival Guide for Effective Doctor
Patient Nurse Communication
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The Mumbo Jumbo Fix
The Mumbo Jumbo Fix
A Survival Guide for Effective Doctor-Patient-Nurse Communication
Written and Illustrated by
Michael J. Grace, JD, CPHRM
Universal-Publishers
Irvine • Boca Raton
The Mumbo Jumbo Fix:
A Survival Guide for Effective Doctor-Patient-Nurse Communication
Copyright © 2021 Michael J. Grace. All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form
or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the
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Universal Publishers, Inc.
Irvine, California & Boca Raton, Florida • USA
www.Universal-Publishers.com
2021
ISBN: 978-1-62734-366-4 (pbk.)
ISBN: 978-1-62734-367-1 (ebk.)
Typeset by Medlar Publishing Solutions Pvt Ltd, India
Cover design by Jeremy Blanger
Library of Congress Cataloging-in-Publication Data
Names: Grace, Michael J., 1950-author.
Title: The mumbo jumbo fix : a survival guide for effective doctor-patient-nurse communication / written and illustrated by Michael J. Grace, JD,
CPHRM.
Description: Irvine : Universal Publishers, [2021] | Includes bibliographical references.
Identifiers: LCCN 2021039076 (print) | LCCN 2021039077 (ebook) | ISBN 9781627343664 (paperback) | ISBN 9781627343671
(ebook)
Subjects: LCSH: Communication in medicine. | Miscommunication. | Medical personnel and patient.
Classification: LCC R118 .G72 2021 (print) | LCC R118 (ebook) | DDC 610.69/6--dc23
LC record available at https://lccn.loc.gov/2021039076
LC ebook record available at https://lccn.loc.gov/2021039077
About the Author
Michael J. Grace, JD, CPHRM
Mike is a licensed attorney and is designated by the American Hospital Association as a certified
professional in healthcare risk management. He was a founding partner of Grace Hollis LLC, a San Diego
based law firm, where he specialized in the defense of healthcare providers. After twenty years as the firm’s
lead trial attorney, he “retired” to pursue a new chapter in life as the Risk Manager and Patient Safety Officer
at Desert Regional Medical Center, a large Southern California hospital. Currently he teaches communication
and law to nurses in the University of California, Riverside’s extension program.
His interest in communication and medicine was established at an early age. Mike was a high school
debater and forensic champion. He went to San Diego State University on a debate scholarship where he
majored in speech communication. He graduated with High Honors and went on to graduate school at the
University of California, Davis to pursue a master’s degree in the Department of Rhetoric. This was followed
by a year on a Rotary Fellowship at the University of Stockholm’s International Graduate School to study
mass communication.
Mike returned to California for law school at the University of San Diego where he achieved a juris
doctorate degree, followed by admission to the California and Nevada Bars. He quickly recognized he
wanted to spend his legal career in the exciting intersection of law and medicine. Mike currently holds an
“AV” rating from Martindale-Hubbell, the highest possible peer reviewed national attorney rating.
In private practice when not representing doctors, nurses and hospitals in the courtroom, Mike was
teaching them. As an expert on healthcare communication, Mike has been a frequent invited lecturer to scores
of healthcare groups throughout the State of California. He is passionate about his chosen field and enjoys
enthusiastically sharing his experience. As entertainer Steven Colbert recognizes: “You can’t really be
passionately moderate. It’s like wearing an ‘extra medium’—it doesn’t exist.”
After years in the courtroom defending healthcare providers, Mike jumped at the chance to work inside a
hospital system to improve communication and prevent medical errors. In his role of hospital administrative
officer, Mike had primary responsibility for investigating every incident of injury and “near miss” to determine
the root cause as well as institute and evaluate corrective actions plans to prevent future harm. This hospital
experience reinforced the lessons learned from decades of defense legal work—miscommunication among
doctors, nurses and patients was at the center of many problems within healthcare.
Mike lives in Palm Springs. When he’s not traveling, Mike enjoys reading, photography and painting. His
paintings have appeared in several art exhibitions in Southern California.
Mike would like to hear from you about your healthcare communication experiences. He can be reached
at
[email protected].
The gods too are fond of a joke.
—Aristotle
Table of Contents
Chapter 1: Where We Are
Chapter 2: We Once Knew It All
Chapter 3: The Importance of a Name
Chapter 4: Handshakes and Other Greetings
Chapter 5: A Communication Model
Chapter 6: Interruption
Chapter 7: Technical Talk
Chapter 8: Patient Barriers to Understanding
Chapter 9: It’s More About Listening
Chapter 10: Human Barriers to Active Listening
Chapter 11: Physical Barriers to Active Listening
Chapter 12: Nurse-Doctor Communication
Chapter 13: Communication Within Teams
Chapter 14: The Testimonial
Chapter 15: Patient Preparation for the Office Visit
Chapter 16: Patient Preparation for the Hospital Stay
Chapter 17: The Angry Patient
Chapter 18: The Quiet Patient
Chapter 19: The Unfocused Patient
Chapter 20: The Patient’s Family
Chapter 21: Legal Healthcare Documents
Chapter 22: The Patient Bill of Rights
Chapter 23: The Disabled Patient
Chapter 24: The Foreign Patient
Chapter 25: Informed Consent
Chapter 26: Conduct During Examinations
Chapter 27: Communicating in the Medical Record
Chapter 28: Confidentiality
Chapter 29: Sex Talk
Chapter 30: The Transgender and Non-Binary Patient
Chapter 31: The Elderly Patient
Chapter 32: The Seriously III Patient
Chapter 33: Telemedicine
Chapter 34: Doctor Disclosure and Apology
Chapter 35: Terminating the Relationship
References and Resources
Acknowledgements
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1
Where We Are
IN THIS CHAPTER
Patients learn miscommunication among healthcare participants—doctors, patients, and nurses—is
the cause of most medical errors but they have usually been excluded as a target audience from books
on the subject.
Nurses familiar with hospital education initiatives will recognize a continuing need for improved
communication among all healthcare participants.
Doctors’ ability to communicate effectively remains elusive despite the best of intentions, formal
training, and clinical experience.
“He doesn’t listen.” “She didn’t tell me.” “I thought I understood.”
“How many times do I have to say it?”
“Half the time I don’t know what he’s talking about.”
“Why doesn’t she just get to the point?”
As a hospital Risk Manager and Patient Safety Officer, every day I encountered the effects of linguistic
mumbo jumbo within the healthcare system—meaningless, confusing, and ineffective communication among
doctors, patients, and nurses. As a trial attorney defending healthcare providers, I regularly saw firsthand the
legal consequences and harm of poor communication among healthcare participants. And as a speech
communication major in undergraduate and graduate school and as a healthcare educator, I discovered there
are evidence-based best practices which add value and clarity to any professional interpersonal exchange.
How did we get here? We talk at, over, and past one another when there are easily adopted and effective
strategies for these essential interactions.
The Joint Commission, the accrediting organization for most American hospitals and healthcare
organizations, has long focused on the link between effective communication and patient safety. Its sentinel
event data identified communication as a root cause for almost two-thirds of the reported serious harm events
between 2004 and 2016.1 Ineffective communication continues to be among the top three root causes for
serious adverse events along with leadership and human factors.2
It’s not that medical and nursing schools ignore communication. On the contrary, all clinical programs
teach the centrality of the effective exchange of information. Both for optimal patient outcomes and provider
job satisfaction. Yet despite mandatory coursework and the best of intentions, healthcare providers graduate
with improved but only average communication competence. Apparently, communication skills are getting
lost in the press of mastering the growing mountain of required clinical skills. Nor does clinical experience
improve communication; bad habits become ingrained and excellent interpersonal skills remain elusive.3
Hospitals and other large healthcare delivery systems know communication is vitally important. An
alphabet soup of “easily remembered” mnemonic tools are regularly rolled out in an effort to boost patient
satisfaction scores. But posters plastered on institutional walls touting “patient centered” communication
become wallpaper. Consciously or subconsciously harried healthcare workers muddle on as they’ve always
done trying to gather and relate critical healthcare information as rapidly as possible in a time pressurized
environment.
Nor has self interest improved effective doctor-patient-nurse communication. Medical malpractice claims
data show the failure of a physician to communicate with the patient or other providers is one of the most
common and costly reasons for the initiation of litigation. A major study released in 2016 representing one-
third of the total insurance market estimated communication failures in U.S. hospitals and medical practices
were responsible for 1,774 deaths and $1.7 billion in malpractice costs over the prior five years.4
Often the patient who sues is merely looking for understanding of an unexpected outcome.
Unfortunately, many doctors shy away from addressing such problems out of ignorance, inertia or fear even
when there may be a straight forward and medically sound explanation. So, patients pursue answers through
the court system. Or as frequently happens, the physician did relate the proposed treatment’s risks and
benefits in an appropriate and timely fashion, but the message was not fully understood in the moment. And
often the physician fails adequately to document the conversation. Again, the result is a lawsuit.
There is already much written on this vital subject of healthcare communication, usually in the form of
academic studies and scholarly treatises. Hardly an approachable format for time-strapped professionals and
busy lay people already overwhelmed with other concerns. The Mumbo Jumbo Fix: A Survival Guide for Effective
Doctor-Patient-Nurse Communication is based on the author’s extensive real-world experience as a medical
malpractice trial lawyer, hospital administrative officer, and healthcare educator. It is intended as an accessible
treatment of easily digestible bites of important information—practical strategies which can be read in any
order as suits the reader’s appetite.
Most books in the field take a siloed approach to fixing miscommunication within the healthcare
industry. They typically focus on either doctors or nurses and largely ignore patient education. Yet all three
groups—doctors, nurses, and patients—are its essential participants. Emphasizing only one group to the
exclusion of the others is similar to family counseling where the therapist never brings the individual family
members together as a group. Is it any surprise that miscommunication remains a major cause of medical
errors? The Mumbo Jumbo Fix is literally the first healthcare communication book to get everyone on the same
page!
1The Joint Commission, “JC sentinel event data, root causes by event type 2004–2013,” 2014 Oct 1,
https://www.jointcommission.org/assets
2Cooke,
M., “TeamSTEPPS for health care risk managers: Improving teamwork and communication,” ASHRM Journal of Healthcare Risk
Management, 2016; 36(3): 35,36
3Gilligan,
C., Brubacher, S., Powell, M., “Assessing the training needs of medical students in patient information gathering,” BMC Medical
Education, 2020; 20:61
4
CRICO Strategies, “Malpractice risk in communication failures,” 2015 Annual Benchmarking Report, Boston, MA: The Risk Management
Foundation of the Harvard Medical Institutions, Inc., 2015
