Communication gaps across the care pathway: Patient perspectives from a Patient Journey Mapping study of hand and wrist orthopaedic care
Through patient journey mapping of 19 individuals in the Netherlands, this study reveals that communication gaps and discontinuities across the hand and wrist orthopaedic care pathway—rather than individual encounters—significantly shape patient experiences, highlighting the need for improved referrals, expectation management, and inter-provider information exchange.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
When a hand or wrist hurts, the path to getting better is rarely a straight line. It is a journey that often involves visiting a family doctor, waiting for a specialist, undergoing tests, trying therapies, and perhaps having surgery. In the world of medicine, this sequence of steps is called a care pathway. For patients, the quality of this journey depends heavily on how well the different people involved—doctors, therapists, and nurses—talk to each other and to the patient. When these conversations break down, a person can feel lost, confused, and anxious, even if the medical treatment itself is technically correct. Researchers have long known that good communication leads to better health outcomes, but understanding exactly where the silence happens requires listening to the people walking the path.
A team of researchers in the Netherlands recently set out to map this journey from the patient's point of view. They focused specifically on hand and wrist care, a field where injuries can range from sudden fractures to long-term, aching conditions that develop over years. To do this, they interviewed nineteen people who had recently received treatment for these issues. Instead of just asking questions, the researchers and the patients sat down together with markers and large sheets of paper to draw out the entire story of the care they received. They traced every step, from the moment pain first appeared to the final recovery, noting not just what happened, but how the patients felt at each stage. This method, known as patient journey mapping, allowed the researchers to see the gaps in the system that a simple medical record might miss.
The study revealed that the most difficult parts of the journey were not usually the medical procedures themselves, but the moments where one person handed the patient over to another. The researchers found that the experience was shaped less by individual doctor visits and more by the breaks in the chain of communication between them. When a patient moved from a family doctor to a specialist, or from a surgeon to a physical therapist, information often failed to travel with them. Patients frequently found themselves acting as the messengers, carrying their own medical history, test results, and treatment plans from one office to the next. They had to repeat their stories over and over, sometimes to doctors who seemed unaware of why they had been referred in the first place.
This lack of coordination created a specific kind of frustration. One patient described how a surgeon sent them to a rheumatologist, but the rheumatologist had not read the referral letter and asked what the patient expected, unaware of a wrist infection the surgeon had already identified. Another patient spent six months with a hand therapist, only to find that the surgeon never received updates on their progress or strength. In these moments, the patient became the invisible glue holding the care together, a role they did not want and were not trained to fill. The study suggests that when providers do not share information, patients feel isolated and uncertain about what comes next.
The researchers also noticed that the needs of patients differed depending on whether their condition was sudden or long-lasting. Those with acute injuries, like a broken bone, wanted immediate reassurance and a clear plan for what would happen next. They needed to know the timeline and the steps. In contrast, patients with chronic conditions, who had been in pain for months or years, expressed a deep frustration when their concerns were dismissed by their family doctors. They wanted to feel heard and taken seriously, often feeling that their pain was minimized before they could even reach a specialist. For these patients, the journey was not just about fixing a problem, but about having their suffering acknowledged.
Trust played a massive role in how patients felt throughout the process. When doctors explained things clearly, listened with empathy, and involved the patient in decisions, the patients felt safe. They felt like partners in their own care. However, when consultations felt rushed or when doctors used complex language without checking for understanding, patients felt anxious and left behind. One patient recalled being told a surgery would be a "small operation," only to wake up and find a fifteen-centimeter scar, a shock that came from a mismatch in expectations. Another described the operating room as chaotic and overwhelming, with machines beeping and staff moving quickly, which heightened their fear because they felt unprepared for the environment.
The study also highlighted how patients tried to fill the information gaps on their own. Many turned to the internet to research their symptoms and treatment options, especially when they felt their doctors were not providing enough detail. While this helped some feel more informed, it also created new problems. Online information could be scary or exaggerated, leading to more worry. Furthermore, patients often wished for written materials to take home, noting that they received so much information during short appointments that they forgot the important details once they left the office.
Ultimately, the researchers concluded that improving hand and wrist care requires fixing the connections between the people providing the care. It is not enough for a surgeon to be skilled; the system must ensure that the family doctor, the surgeon, and the therapist are all on the same page. The study suggests that better coordination, clearer explanations, and a genuine effort to listen to patients would reduce the stress and confusion that currently plague the journey. By smoothing out the handoffs and ensuring that patients do not have to carry the burden of communication themselves, the medical system can make the path to recovery less about navigating a maze and more about healing.
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