Miscommunication between clinicians and patients in hospitals can have serious consequences, an issue that is the focus of a unique research project being led by linguists and nursing academics from the University of Technology, Sydney.

If you have ever had trouble understanding the language of a medical practitioner, you are not alone. A NSW health report, in 2005, identified ineffective communication as the major cause of critical incidents in hospitals.

To improve this situation, professors of linguistics Diana Slade and Hermine Scheeres from the Faculty of Education and professor of mental health nursing Jane Stein-Parbury from the Faculty of Nursing, Midwifery and Health are leading research to identify and analyse communication between clinicians and patients in hospital emergency departments.

A UTS-funded pilot study, carried out in a major Sydney Hospital emergency unit, led to a three-year Australian Research Council Linkage grant starting this year. The project also involves UTS expert in health communication professor Rick Iedema and professor of linguistics from Macquarie University, Christian Matthiessen.

Industry partners include three area health services, South Eastern Sydney Illawarra, Northern Sydney Central Coast, and Australian Capital Territory, as well as the NSW Adult Migrant English Service (AMES).

The emergency department journeys of 90 patients in five different hospitals will be captured through taping their communication with clinicians. The tapes will be analysed linguistically for causes of breakdowns as well as examples of successes in communication. The context of the communication will be explored through ethnographic inquiry.

The pilot study found the causes of miscommunication to be complex. "There's a tendency to think of communication as common sense. But when you look closely at the interactions, it goes way beyond broad communication principles," says Scheeres. "In the pilot, very often the patient would turn to us and say something like, did you understand that? There were ongoing indications that there were gaps in terms of the types of explanations being given by doctors in particular."

These gaps included hospital staff not explaining the consultation process to patients. "A junior doctor asks all these questions, and they can do this for the entire length of the consultation, then they go out and a more senior doctor comes in and asks another whole series of questions. But at no stage do they explain that this is part of the process. So that can be very confusing and quite bewildering, especially if you are stressed and anxious," says Slade.

Another issue is the use of particular language. "Even though you might go in as an intelligent, articulate, literate person, the kind of language that sometimes comes back at you is either hospital system language or medical technical language, both of which might be unfamiliar to you," says Scheeres.

A mismatch between what patients want to tell medical staff and what the practitioner wants to know was also found. "People want to tell their story," says Scheeres. Patients want to put themselves inside the medical case but sometimes clinicians only show interest in the details of the case, seeming to ignore the person" says Stein-Parbury. Recognising that the patient has a life outside of their illness is one key to effective communication, says Stein-Parbury. "People don't manage illnesses; they manage a life in relation to an illness. One of major reasons that people do not comply with their treatment is that they don't understand what to do," says Stein Parbury.

Once the research is complete, training materials for effective communication, especially for the growing number of clinicians from language backgrounds other than English, will be developed in partnership with the NSW AMES.

"I think this project will show how nurses and doctors are busy trying to make the system work, yet feel frustrated" says Stein-Parbury. "Clinicians feel pressured and this is having an impact on the patient's experience."