Communication between Doctors and Patients: Are We Listening Enough?
Medicine is an art which has since long been recognized for its magic and creative ability, residing in the interpersonal aspects of patient-physician relationship. Communication is to control, motivate, interact and provide information. In addition, communication helps to provide feedback and is considered to be the essence of the basic functions in everyday life. In medical profession communication has its own importance.
Communication(from Latin commūnicāre, meaning “to share” ) is defined as “any act by which one person gives to or receives from another person, information about that person’s needs, desires, perceptions, knowledge, or effective states”. Communication may be intentional or unintentional, may involve conventional or unconventional signals, may take linguistic or non-linguistic forms, and may occur through spoken or other modes. Communication skills are deemed as a crucial component of clinical practice as they are instrumental in accurate diagnosis as well as in convincing the patient to follow medical advice. A doctor’s communication and interpersonal skills encompass the ability to gather information in order to facilitate accurate diagnosis, counsel appropriately, give therapeutic instructions, and establish caring relationships with patients.
These are the core clinical skills in the practice of medicine, with the ultimate goal of achieving the best outcome and patient satisfaction, which are essential for the effective delivery of health care. Basic communication skills in isolation are insufficient to create and sustain a successful therapeutic doctor-patient relationship, which consists of shared perceptions and feelings regarding the nature of the problem, goals of treatment, and psychosocial support. Interpersonal skills built on this basic communication skill. Appropriate communication integrates both patient- and doctor-centered approaches.
Kaufmann constructed the Attitudes towards Medical Communication Scale with 41 items and used it in a cross-sectional study on 203 students in their first, second and fourth year respectively. This study, which was published in 2001, showed that the female students had more positive attitudes than male students, and that first and second year students had more positive attitudes than fourth year students. In 2001 de Valck presented a questionnaire measuring students’ attitudes towards full disclosure versus non-disclosure in breaking bad news. Following one cohort of students for three years (53 students responded in all three years) they found that students became more in favour of non-disclosure as they progressed through medical school.
In 2002 Rees, Sheard and Davies published the Communication Skills Attitudes Scale (CSAS), which measures students’ attitude towards learning communication skills during medical school. This scale has been used and validated in three different studies in the UK involving from 216 to 490 students and one involving 123 students in Nepal,until spring 2006. Although mostly cross-sectional, these studies report that female students have more positive attitudes than males and that students in their early years of medical school have more positive attitudes than students later in medical school. In addition, students exhibit less positive attitudes towards learning such skills.
Research has shown that good communication skills can improve the patient-physician relationship and are related to positive health outcomes for patients, including better compliance, satisfaction with care and benefits to physical and psychological health as well. Doctors received their training in English, discussed patient related issues with their seniors in English, but were expected to converse in the official language, Urdu or one of the other several regional languages, while discussing problems with patients. The basic building block of good communication is the feeling that every human being is unique and of value. What is the single thing doctors could do to improve their communication skills with patients? It’s the need of the hour that we should start finding an answer to this question.
Should higher authorities include communication skill courses in the curricula of undergraduates? These are some of the answers we are looking forward to. To look into the patients’ eyes: With the advent of modern technology, I worry that we are losing the ability to look our patients in the eyes, to listen intently to their fears and concerns and to provide the support and care that is so necessary for a relationship that promotes healing. I have always thought that the conversations with patients have the potential to be therapeutic or harmful.
We can promote the kind of communication that help our patients to be better able to make difficult choices, to be more confident in pursuing the strategies they choose and to be more likely to achieve the results that they desire. And we need to avoid the kind of communication that alienates patients from the health-care system, inhibits them from honestly disclosing how they feel and what they need, interferes with their ability to make the choices that best fit them and reduces the likelihood that they will get desirable outcomes. And the loss of respect for the power of connecting with patients is not the fault of doctors, but seems to be a byproduct of the medical environment that we have created and the behaviors that we reward and also somehow it is the fault of not teaching the skills during the undergraduate level. Doctors also lose when relationships are a casualty of the production mentality that focuses intently on relative value unit, the currency of medical output, rather than the results achieved with patients—including the nature of the relationships.
Doctors, medical schools, hospitals and health-care systems need to find ways to foster an environment where everything we do starts with looking in our patients’ eyes and really knowing them. The goal of good communication should be getting the best outcomes for patients. Seen in that light, the key for doctors improving their communication with patients is the quality of their communication with fellow clinicians as well. That’s because good medicine is a team sport.
Even the best surgeon can watch her patient die of an infection, accident or error because of a communication gap among the team of professionals. Sorry to say, these deadly mistakes are commonplace and often the rule rather than an exception in many hospitals. An estimated one in four patients admitted to a hospital in America will suffer some form of unintended harm, and more than 500 people die from hospital mishaps every day. Moreover, an estimated 80% of serious medical errors involve miscommunication between caregivers when patients are transferred or handed off to them.
Good team communication is life or death for patients. Unfortunately, though health care is changing rapidly, traditional medical education focuses on teaching physicians to function solo, learning the details of diagnosing and intervening, but not so much on the complexities of engaging disparate groups of clinicians, including non-physicians. The good news is that now we see new models of medical education which involve practical experience for students working with a variety of disciplines alongside their patients, focusing on the art and science of good teamwork—but it’s all very new, and much more is needed.
Listen More, Talk Less: Doctors need to listen more and talk less. When meeting with patients, doctors shouldn’t interrupt or dominate the conversation. Instead, doctors should ask open-ended questions to encourage each patient to describe his or her feelings and concerns about their illness. When doctors take the time to listen, the treatment decisions and care plans that they develop will better reflect their patients’ wishes; in turn, those plans are more likely to be followed by patients.
Toward the end of a visit, it’s important for doctors to carefully listen for any patient questions or concerns and to check for any misunderstandings or confusion. Studies show that up to 80% of the medical information patients receive is forgotten immediately and nearly half of the information retained is incorrect. To ensure that each patient understands and remembers important information about their treatment, their doctor can ask him or her to describe the plan in their own words, a strategy known as the teach-back method.
In my practice, we have several ways by which we try to enhance good doctor-patient communication:
1. Every patient is given sufficient time to explain their problem and symptoms.
2. We ask the patient to come in with a written list of questions, so they don’t get nervous and forget to ask something important.
3. We give the patient a record of all test results, in writing.
4. We make a heart diagram together, so the patient understands how his or her own heart works. When doctors give patients the chance to really communicate how they feel, patients become their own health-care advocates and everything that happens becomes part of the patient’s record. A good bedside manner is typically one that reassures and comforts the patients while remaining honest about a diagnosis. Vocal tones, body language, openness, presence, and concealment of attitude may all affect bedside manner.
Poor bedside manner leaves the patient feeling unsatisfied, worried, frightened, or alone. Bedside manner becomes difficult when a healthcare professional must explain an unfavorable diagnosis to the patient, while keeping the patient from being alarmed. It is the need of the hour that we should work on the doctor patient communication and relationship with the patient so that it can create an appropriate environment between the two for the betterment of the health.
About the Author: Iqra Yasin is a 2nd year MBBS student at Dow Medical College, Pakistan. She can be reached at [email protected]
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