Communication
Skills in Health Care
Part
i
Amer Eltwati Ben Irhuma,*
"Communication
is not as 'add on' it is the heart of patient care"1
Abstract:
Training to be
a doctor involves the acquisition of knowledge, skills and appropriate
attitudes. The ability to communicate well with patients- to build up a
trusting relationship within which curing, relieving and comforting can take
place- is a great challenge that, as Sir Charles Fletcher pointed out and
should always be before us. Like many aspects of medical education,
it was assumed until fairly recently that students acquire good communication
skills and appropriate attitudes by a sort of osmosis – by observing and modelling
their bahaviour on that of their teachers. As we have already seen, however, this
may not produce doctors who are good communicators. It is now recognized that
the apprenticeship method is not sufficient and that formal training in
communication skills is necessary and effective. Medical schools have responded
by introducing communication skills as a formal and important part of the
curriculum and assessment. There is evidence from Magure's work that students
learn communication skills most effectively if the following conditions are
fulfilled:
·
Students are given written instructions about the information to be obtained
from training and the skills to be used.
·
The skills are demonstrated by the teacher.
·
Students are given opportunities to practice these skills with real or
simulated patients under controlled conditions.
·
Students are given feedback on their performance by audio or videotaped replay.
· Students are able to discuss
their performance and related issues with a tutor.
Remember that
learning to communicate well does not stop at the end of the undergraduate course.
We all need to develop and hone our communication skills with patients,
relatives and colleagues throughout our professional lives. This is now
recognized in the postgraduate examinations, where communication skills are now
formally assessed.
Key
words:
Communication, skills, interview, learning, practice.
Introduction:
The objective
of the series of articles in the subject is to help graduates to develop the
skills that will enable them to communicate effectively with patients and their
relatives and with their colleagues. The importance of good communication
between patients and those who care for them cannot be disputed. However,
patients' experience of the care they receive often fall short of the ideal.2
With the existing technological advances being made in clinical medicine, it is
easy to be swept along by the science of medicine and to forget the ancient aim
of the physician.: "To cure sometimes relieve often, comfort always".
The ability to
communicate well with patients- to build up a trusting relationship within
which curing, relieving and comforting can take place- is a great challenge
that, as Sir Charles Fletcher pointed out and should always be before us.3
What is
communication?
The word
'communicate' comes from the Latin 'to import, to share'. 'Communication' is
importing, conveying or exchanging ideas, knowledge, etc.4,5 Good
communication is essential in good medical care; it supports the building of
trust between doctor and patient and helps you provide clear and simple
information that improves health. This allows you and the patient to understand
each other and agree goals together which suit each individual patient.
Communication is much more than 'taking a history', it is an integral and
important part of looking after patients and is the only way they can be
involved effectively in their health care.6,7 Thus, the General
Medical Council in the UK has reinforced this in their latest recommendations
on undergraduate education: "Graduates must
Professor and Head Surgical Department, Dean,
Faculty of Medicine, Sebha University, Sebha, Libya.
be able to
communicate clearly, sensitively, and effectively with patients and their
relatives, and also colleagues from a variety of health and social care
professions".8
Good
doctor-patient communication.
Why is
communication important?
Good
communication provides 'better care for our patients'. There is considerable
evidence to show that doctors who communicate well with patients are more
likely to:
1. make an accurate, comprehensive
diagnosis. Good communication skills enable one to collect information about a
patients problem that is comprehensive, relevant and accurate.
2. detect emotional distress in
patients and respond appropriately.
3. have patients who are satisfied with
the care they have received and who are less anxious about their problems.
4. have patients who agree with and follow
the advice given.
There is also
good evidence that good communication can have a positive effect on the
patients' physical condition, for example, blood pressure. One study showed that
patients who had been allowed to express their concerns about their problem,
had a significantly greater reduction in their blood pressure than those who
had not been given this opportunity but had been treated similarly in other
respects.
What is good
communication?
A study carried
out some years ago by Dr. Peter Magure in Manchester indicated that patients
who had been interviewed by medical students were asked for their opinion of
the students' interviewing abilities.9
Patients
preferred interviewer who:
· were warm and sympathetic.
· were easy to talk to.
· introduced themselves.
· appeared self-confident.
·
listened to the patients and responded to their verbal cues.
·
asked questions that were easily understood and were precise .
· did not repeat themselves.
Unfortunately,
it is not difficult to find examples of poor doctor-patient communication. A
study in Florida compared patients' opinions of obstetricians who had had
malpractice claims made against them with those who had not been sued. It was
found that patients were most likely to complain about aspects of
patient-doctor communication rather than the technical aspects of care.10
The most frequent complaints about the doctors were that they:
· would not listen.
· would not give information.
· showed lack of concern or lack
of respect for the patient.
In countries
where patients are less likely to sue their doctors, patients still express
dissatisfaction about how doctors communicate and relate to them. A report of a
survey carried out in Britain includes a quote from a patient with breast
cancer: "They just told me I was going to have a mastectomy – No choice,
no explanation. They don't discuss much with patients. I would have preferred
they had explained more".11
Can
communication skills be learned?
Training to be
a doctor involves the acquisition of knowledge, skills and appropriate
attitudes. Like many aspects of medical education, it was assumed until fairly
recently that students acquire good communication skills and appropriate
attitudes by a sort of osmosis – by observing and modelling their bahaviour on
that of their teachers.
As we have
already seen, however, this may not produce doctors who are good communicators.
It is now recognized that the apprenticeship method is not sufficient and that
formal training in communication skills is necessary and effective. Medical
schools have responded by introducing communication skills as a formal and
important part of the curriculum and assessment.
How to develop
good communication skills?
The most
important point to realize is that you have the ability to communicate and that
you use this ability continually when relating to other people. Learning
communication skills is, therefore, for example, to take someone's blood
pressure – which you are unlikely to have done before coming to medical school.
The communication skills courses that are now part of the curriculum in all
medical schools aim to help you to hone your innate skills and develop specific
skills that enable you to communicate effectively with patients.
Communication
skills training will enable you to identify these skills and practice them with
your fellow students or simulated patients (often actor role-playing patients).
This is important for learning how to take a history from a patient, but even
more important for situations when communication may be particularly difficult
for both you and the patient for example when you have to tell a patient that
they have cancer, or when you need to take a sexual history. These situations
are never easy to cope with, but it does help if you have been able to practice
the necessary skills and explore your own feelings about these issues with
other students and a tutor in a supportive settings.
So, what is the
best way to learn the skills of effective communication? Clearly, this will
depend on your teachers' experience and opinions. However, there is evidence
from Magure's work that students learn communication skills most effectively if
the following conditions are fulfilled9:
·
Students are given written instructions about the information to be obtained
from training and the skills to be used.
·
The skills are demonstrated by the teacher.
·
Students are given opportunities to practice these skills with real or
simulated patients under controlled conditions.
·
Students are given feedback on their performance by audio or videotaped replay.
·
Students are able to discuss their performance and related issues with a tutor.
Finally, here
is a cautionary note. You may think that you have excellent communication
skills and will have no problems in dealing with patients. You might be tempted
to say: 'communication skills seminars are not for me – I don't need them'.
However, one study of medical students has shown that students who are the most
confident tend to be least competent in communicating with patients.
Life-long
Learning:
Remember that
learning to communicate well does not stop at the end of the undergraduate
course. We all need to develop and hone our communication skills with patients,
relatives and colleagues throughout our professional lives.8,11
This is now
recognized in the postgraduate examinations, where communication skills are now
formally assessed.
References:
1. Audit Commission. "What seems
to be the matter". Communication between hospitals and patients. HMSO,
London, 1993.
2. Lloyd M. & Bor R. Communication
skills for Medicine. Churchill Livingstone, London, 2004.
3. Fletcher CM. Communicaiton in
Medicine. Rock Carling monograph. Nuffield Provincial Hospital Trust, London,
1973.
4. Simpson M., Buckman R., Stewart M.
et a;. Doctor-patient communication. The Toronto consensus statement. B.M.J.,
1991; 303: 1385-1387.
5. Stedmans Medical terms and phrases.
A complete guide to Medical Language. Lippincott Williams and Wilkins. New
York, 2005.
6. Goldman L. & Ausullo D. Social
and ethical issues in medicine. Cecil Textbook of Medicine. Saunders, New York,
2004.
7. Douglas G., Nicol F. and Robertson
C. Macleod's clinical examination. Churchill-Livingstone, New York, 2005.
8. The General Medical Council.
Tomorrow's Doctors: Recommendations on undergraduate medical education. HMSO, London,
2002.
9. Magure P. Fairbavin S. and Fletcher
C. Consultation skills of young doctors: benefits of undergraduate feedback
training in interviewing. In: Stewart M., Roger D. (eds). Communicating with
medical patients. Sage Publication. California, 1989.
10. Hickson GB., Clayton EW. And Entman
SS. Obstetricians' malpractice experience and patients' satisfaction with care.
JAMA, 1994; 272: 1583-1587.
11. Rogers EM. Health Communication
Up-to-date-report. J. Health Comm. 1996; 1: 15-33.
ليست هناك تعليقات:
إرسال تعليق