Case Study: TIC Not Tick!
Ms. Brown is a 79-year-old patient in a small gastroenterology clinic. The clinic hired a young gastroenterologist (GE), who took over the care of patients from a doctor who had just retired. It is the custom in the clinic for the nurses to put a sticky note on top of the chart with the name of the patient, the examining room where the patient would be placed, and the reason for the visit. In the case of Ms. Brown, the nurse put “TICK” as the reason for the visit. The young GE thought it was strange that she was seeing someone for a tick bite, but she went ahead to the room. During examination, the doctor asked the patient, “Were you given antibiotics?” The patient responded, “For what?” The doctor said, “For the tick bite?” The patient yelled back, “What tick bite? I am here for diverticulitis!” (A common abbreviation for diverticulitis is “TIC.”)
Discussion Questions
- What was the communication problem in this case? At the personal level? At the clinic level?
- What could have each of the team members involved in this case have done to prevent this communication problem?
- Besides the specific Sub-competencies for Interprofessional Communication, which other specific Sub-competencies could improve the care in this situation?
- The communication problem here stemmed from an error in the transmission of information. At the personal level, the nurse’s abbreviation error led to the miscommunication. At the clinic level, there might have been an oversight in standardizing communication practices or ensuring clarity in notations.
- The nurse could have used a clearer and more standardized abbreviation or notation system. Instead of “TICK,” they could have written “DIV” for diverticulitis or spelled out the reason for the visit in full. The new doctor could have double-checked with the patient or cross-verified the reason for the visit before assuming the purpose based solely on the note.
- Beyond Interprofessional Communication sub-competencies, enhancing Cultural Competence could help. Understanding abbreviations or notations specific to the clinic or patient population is crucial. Additionally, employing Systems-Based Practice sub-competencies like creating standardized communication protocols within the clinic could prevent such errors by ensuring everyone uses a universally understood notation system. Patient-Centered Care sub-competencies also play a role, emphasizing the importance of confirming patient concerns and reasons for visits directly with the patient to avoid misunderstandings.
Improving communication channels, standardizing notation systems, and fostering a culture of double-checking information could collectively prevent similar communication breakdowns in the future.