title: Disengaged: a qualitative study of communication and collaboration between physicians and other professions on general internal medicine wards.
abstract: BACKGROUND
  Poor interprofessional communication in hospital is deemed to cause significant patient harm. Although recognition of this issue is growing, protocols are being implemented to solve this problem without empirical research on the interprofessional communication interactions that directly underpin patient care. We report here the first large qualitative study of directly-observed talk amongst professions in general internal medicine wards, describing the content and usual conversation partners, with the aim of understanding the mechanisms by which current patterns of interprofessional communications may impact on patient care.
  
  
  METHODS
  Qualitative study with 155 hours of data-collection, including observation and one-on-one shadowing, ethnographic and semi-structured interviews with physicians, nurses, and allied health professionals in the General Internal Medicine (GIM) wards of two urban teaching hospitals in Canada. Data were coded and analysed thematically with a focus on collaborative interactions between health professionals in both interprofessional and intraprofessional contexts.
  
  
  RESULTS
  Physicians in GIM wards communicated with other professions mainly in structured rounds. Physicians' communications were terse, consisting of reports, requests for information, or patient-related orders. Non-physician observations were often overlooked and interprofessional discussion was rare. Intraprofessional interactions among allied health professions, and between nursing, as well as interprofessional interactions between nursing and allied health were frequent and deliberative in character, but very few such discussions involved physicians, whose deliberative interactions were almost entirely with other physicians.
  
  
  CONCLUSIONS
  Without interprofessional problem identification and discussion, physician decisions take place in isolation. While this might be suited to protocol-driven care for patients whose conditions were simple and courses predictable, it may fail complex patients in GIM who often need tailored, interprofessional decisions on their care.Interpersonal communication training to increase interprofessional deliberation may improve efficiency, patient-centredness and outcomes of care in hospitals. Also, electronic communications tools which reduce cognitive burden and facilitate the sharing of clinical observations and orders could help physicians to engage more in non-medical deliberation. Such interventions should take into account real-world power differentials between physicians and other health professions.
authors.affiliation: Centre for Studies in Family Medicine, London, ON, Canada. merrick.zwarenstein@ices.on.ca.
authors.forename: Merrick
authors.initials: M
authors.lastname: Zwarenstein
authors.forename: Kathleen
authors.initials: K
authors.lastname: Rice
authors.forename: Lesley
authors.initials: L
authors.lastname: Gotlib-Conn
authors.forename: Chris
authors.initials: C
authors.lastname: Kenaszchuk
authors.forename: Scott
authors.initials: S
authors.lastname: Reeves
mesh_terms: D003142:Communication; D003299:Cooperative Behavior; D006801:Humans; D007388:Internal Medicine; D007400:Interprofessional Relations; D010348:Patient Care Team / Q000458:organization & administration; D010820:Physicians / Q000458:organization & administration / Q000523:psychology; D036301:Qualitative Research