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Gretchen Fuller: Shaping Conversations to Improve Health Care

Oct. 23, 2020

This news feature is part of Dell Med's Voices, a series of profiles that highlight the people of Dell Med as they work to improve health with a unique focus on our community.

Gretchen Fuller, M.D.

Gretchen Fuller, M.D., is in her final year of the Pediatric Emergency Medicine Fellowship at Dell Medical School — and she’s a trained interpersonal communicator who recently co-authored an article about the communication challenges posed by COVID-19. Her aim? Improve the experiences of patients, families, providers and staff using her communication training.

Q&A

Why is your work focused on interpersonal communication?

In medicine, interpersonal communication is the procedure we use the most often, but it’s not a skill we approach with the same lifelong learning mentality as we do clinical medical knowledge. Often, feedback is only provided when a lack of communication skill has become egregious.

It was not until I attended a relationship-centered communication workshop provided by the Academy of Communication in Healthcare that I realized how effectively these skills could be taught. After personally using these skills with patients and colleagues, I was incredibly impressed by how slight tweaks to common dialogue could entirely transform a conversation, deepen connections and bring increased meaning to work.

What kinds of dialogue tweaks can be most impactful?

Emotions are powerful tools in conversation. Explicitly discussing emotions helps foster connections and makes people feel heard. Health care providers can acknowledge emotions with comments like, “I’m hearing you say that this is really frustrating,” or by legitimizing feelings by saying, “Anyone in your shoes may feel that same way.”

I recommend that health care providers ensure they are communicating in ways patients can understand. This may involve doing an audio check to make sure a patient can understand you through your mask and face shield. Providers can also engage in what’s known as “teach-back,” where they ask patients to repeat back what they’ve understood from a conversation.

What needs to happen to create this change in communication tactics, and what are you doing to bring about this shift?

Patients need excellent clinical care and they need caring. Effective interpersonal communication has a proven association with improved clinical care outcomes. We need to rework how we assess communication between patients and providers to ensure we are teaching and incentivizing behavior that meaningfully improves health care.

As a certified facilitator in relationship-centered communication and faculty-in-training at the ACH, I collaborate with inspiring individuals across the country to give workshops on topics ranging from fundamental communication skills for health care staff to more advanced topics like conflict engagement.

At Dell Children’s Medical Center of Central Texas, I'm conducting a research study on the effect of interpersonal communication training on pediatric patient and caregiver perceptions of physician empathy in the emergency department. With funds from a generous donation from a family at Dell Children’s, a multidisciplinary team of hospital leaders will be trained in relationship-centered communication in the spring.

The New York Times asks readers to tell their “Tiny Love Stories” in just 100 words. What’s yours?

A teen boy is in critical condition after a brain bleed from an arteriovenous malformation, requiring part of his skull to be removed. His father trudges out of the pediatric intensive care unit with a weekend bag slung over his shoulder. This is the first time he’s leaving the hospital in several days, heading home to sleep in his own bed and see his two daughters while his wife takes watch over their son. I stop him in the hall, acknowledging that this is a big deal and emotionally challenging. He begins weeping and I give him a hug.

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