How to talk to doctors--a guide for effective communication.

BACKGROUND: Nurses and doctors undertake segregated and distinct preparation for clinical practice, yet are expected to communicate effectively with each other in the workplace. Most healthcare facilities have policies relating to written communication, but guidelines for verbal communication, which is used most in times of uncertainty and urgency, are generally less regulated. Poor communication and communication overload are shown to have a direct correlation with patient outcomes, adverse events and stressors among healthcare professionals. We suggest a guide for more effective verbal communication between nurses and doctors. METHODS: We perform an integrated review of the extensive literature that identifies specific problems that contribute to ineffective communication between a doctor and nurse. We discuss these in five themes in the modern clinical context including intensification of workload, workforce mobility, differing perceptions, language use and heuristics. To combat these, we provide a four point practical guide to arm the nurse clinician with effective tools to ensure a satisfactory exchange of information in the context of patient advocacy. CONCLUSIONS: The guide assists in overcoming the discussed barriers by creating a premise for fostering communication, understanding each clinician's information needs in a mutually respectful manner, especially in the context of uncertainty. We recommend that a shared mental model regarding communication in health be adopted at tertiary institutions offering pre-registration nursing and medical training and techniques and be woven into respective curriculum design.

Google governance: increasing the effectiveness of critical care physicians through the use of an online usergroup.

AIMS: The aim of this study was to describe the use of an online user group to enhance communication and productivity by critical care specialists. METHODS: In this article, we provide a description of the first 6 months of use of an online user group by senior retrieval physicians. RESULTS: Initially developed as a communication and online discussion tool, our online user group evolved to include a number of other utilities that support clinical governance. These included a repository for useful files, educational presentations, online rostering and "portfolio pages", updating aspects of an individual specialist's non-clinical activity. Its applications continue to evolve in number and utility. Participating physicians perceive an increase in organisational efficiency. CONCLUSIONS: An online user group such as Google Groups may provide powerful support to an organisation's clinical governance. We recommend this tool to other services with limited administrative personnel.

Advances in the management of traumatic anterior and atraumatic multidirectional shoulder instability.

Dislocation of the shoulder is a common and often disabling injury to an athlete. Most shoulder dislocations are traumatic in origin, occur in the anterior direction and result in stretching and detachment of the anterior capsule and labrum. The most frequent adverse sequel of shoulder dislocation is recurrence--an event that occurs most commonly in active individuals and less frequently with age. In the past, many operative procedures failed to address the anatomical disruptions of shoulder instability. Recently, an enhanced understanding of shoulder instability pathoanatomy and significant technological advances have resulted in surgical procedures for shoulder instability that are less interventional and have focused on restoring disrupted static constraints.

Shoulder instability. Diagnosis and management.

BACKGROUND: The shoulder is the most commonly dislocated joint in the body. The most frequent complication of shoulder dislocation is recurrence, occurring most often in young athletes. OBJECTIVE: To summarise the functional anatomy of the shoulder joint, the structures damaged following shoulder dislocation and the methods to evaluate and treat shoulder instability. DISCUSSION: Clinical history is effective for diagnosing obvious shoulder instability. The O'Brien's sign (for superior labral lesions), the sulcus sign (for capsular laxity) and the apprehension sign (for anterior instability) are helpful clinical tests for more subtle instabilities. Labral disruptions and capsular laxity can often be restored by minimally invasive (arthroscopic) methods. Rehabilitation aims to enhance the dynamic muscular and proprioceptive restraints to shoulder instability.