Time Out Before Talking: Communication as a Medical Procedure
Authors: Joshua R. Lakin, James A. Tulsky, Rachelle E. Bernacki
Journal: Annals of Internal Medicine (2020)

Ideas and OpinionsJanuary 2021Time Out Before Talking: Communication as a Medical ProcedureJoshua R. Lakin, MD, James A. Tulsky, MD, and Rachelle E. Bernacki, MD, MSJoshua R. Lakin, MDDana-Farber Cancer Institute and Brigham and Women's Hospital, Boston Massachusetts (J.R.L., J.A.T., R.E.B.), James A. Tulsky, MDDana-Farber Cancer Institute and Brigham and Women's Hospital, Boston Massachusetts (J.R.L., J.A.T., R.E.B.), and Rachelle E. Bernacki, MD, MSDana-Farber Cancer Institute and Brigham and Women's Hospital, Boston Massachusetts (J.R.L., J.A.T., R.E.B.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-4223 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Medical procedures encompass a set of ordered actions, each requiring unique knowledge and skills, aimed at diagnosing, prognosticating, or treating illness. A medical procedure generally brings to mind invasive technical interventions, such as colonoscopy or appendectomy. However, clinician–patient communication, particularly when focused on a specific task—such as taking a medical history, delivering bad news, or discussing goals of care—also contains procedural elements and has been likened to procedures in the educational realm (1, 2). Considering communication interactions from a procedural lens may improve the specificity, intention, and impact of these ubiquitous interactions across clinical, educational, policy, and research domains. To ...References1. Kelley AS, Back AL, Arnold RM, et al. Geritalk: communication skills training for geriatric and palliative medicine fellows. J Am Geriatr Soc. 2012;60:332-7. [PMID: 22211768] doi:10.1111/j.1532-5415.2011.03787.x CrossrefMedlineGoogle Scholar2. Lipkin M, Frankel RM, Beckman HB, et al. Performing the interview. In: Lipkin M, Putnam SM, Lazare A, et al, eds. The Medical Interview. Frontiers of Primary Care. Springer; 1995. Google Scholar3. Levinson W. Patient-centred communication: a sophisticated procedure [Editorial]. BMJ Qual Saf. 2011;20:823-5. [PMID: 21856961] doi:10.1136/bmjqs-2011-000323 CrossrefMedlineGoogle Scholar4. Back AL, Arnold RM, Baile WF, et al. Approaching difficult communication tasks in oncology. CA Cancer J Clin. 2005 May-Jun;55:164-77. [PMID: 15890639] CrossrefMedlineGoogle Scholar5. Baile WF, Buckman R, Lenzi R, et al. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5:302-11. [PMID: 10964998] CrossrefMedlineGoogle Scholar6. Haynes AB, Weiser TG, Berry WR, et al; Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360:491-9. [PMID: 19144931] doi:10.1056/NEJMsa0810119 CrossrefMedlineGoogle Scholar7. Zulman DM, Haverfield MC, Shaw JG, et al. Practices to foster physician presence and connection with patients in the clinical encounter. JAMA. 2020;323:70-81. [PMID: 31910284] doi:10.1001/jama.2019.19003 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston Massachusetts (J.R.L., J.A.T., R.E.B.)Acknowledgment: The authors thank Dr. Wendy Levinson, MD, OC, for her thoughtful input on this work.Financial Support: This work is unfunded. Drs. Lakin and Bernacki are supported by the Cambia Sojourns Scholar Leadership Program.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-4223.Corresponding Author: Joshua R. Lakin, MD, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215; e-mail, [email protected]org.Current Author Addresses: Drs. Lakin, Tulsky, and Bernacki: Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215.Author Contributions: Conception and design: J.R. Lakin, J.A. Tulsky, R.E. Bernacki.Analysis and interpretation of the data: J.R. Lakin, J.A. Tulsky.Drafting of the article: J.R. Lakin, J.A. Tulsky.Critical revision for important intellectual content: J.R. Lakin, J.A. Tulsky, R.E. Bernacki.Final approval of the article: J.R. Lakin, J.A. Tulsky, R.E. Bernacki.Administrative, technical, or logistic support: J.R. Lakin.Collection and assembly of data: J.R. Lakin.This article was published at Annals.org on 8 September 2020. 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