Why bother explaining things to your patients? Carl Morris explains why proper communication is so important

Interviewer: "So why do you want to be a doctor?"

Student: "Well, I want to be able to help people." (Actually, it's because I'm good at sciences and I couldn't think of anything else to do/my parents told me to/I wanted to make sure I'd have a job after university.)

Interviewer: "What are the most important qualities for a doctor?"

Student: "Communication skills, empathy, diagnostic ability." (Erm, being good at exams/knowing the right consultants/memory of ER episodes.)

Communication operates on lots of different levels. One of the most useful skills that health professionals can learn is how to pick up unspoken messages.

Yet we medical students often seem to undervalue communication training - once we've got ourselves on to a course by saying the right thing at interview, that is. "Communication skills" training either induces yawns from those who know it all already, or terror from those who hate any kind of role play or video exercise.

We are more concerned with the "real work," such as memorising the causes of acute pancreatitis. Official assessments reinforce this. Time spent learning rare and obscure syndromes is rewarded with distinctions: "Well professor, an even less likely, but possible cause of the obesity is of course, Laurence-Moon-Biedl syndrome."

As far as I know, there is no medical school prize for empathy.

The old argument is wheeled out

With doctors under pressure from the media, there can be a kind of "anti-PC" backlash in the profession. The old argument gets wheeled out: better the rude doctor with the skills to save you, than the namby-pamby communicator who can't tell an aneurysm from an onion. I think you need both. You need to communicate well to know when and how your technical skills will be most appreciated.

There is plenty of evidence that communication skills directly influence "hard" outcomes, such as control of hypertension1 as well as general patient "satisfaction."²

The little things are important too. I expect most of us already know all the arguments about communication. We've all laughed at the hammed up examples of how not to do it on the training videos. Yet those videos are not that far from real life.

Two years ago, my friend Helen had hyperemesis gravidarum. This itself is an example of a highly specialised form of medical communication - that is, repeating the patient's symptoms back to them in Latin and calling it a diagnosis. Try it in English: "I see, so you're pregnant and you're vomiting excessively. Well I believe you have what we call" - pause for effect - "the excessive vomiting of pregnancy."

As Helen later pointed out, I was always "banging on" about the new curriculum, integrated clinical education, Tomorrow's Doctors, and so on. So she was a little surprised when the young doctor in question managed to fit an entire course on poor communication into one half hour consultation. Helen's job involved training others in effective communication and public relations, so she was able to spot a few shortcomings.

There was no eye contact

From unintroduced beginning to abrupt end there was no eye contact at all, just plenty of interruptions, note taking, and patronising comments. At one point, presumably in an attempt at rapport, the doctor waved her hand in the direction of Helen's family and said, "Is this circus with you then?" Later on, when Helen explained that she had some important concerns due to family history, Dr X raised her eyebrows, sighed with exasperation, and said pointedly, "I thought you were here about the hyperemesis."

Now Helen is a very forgiving soul, and has always wished Dr X the best of luck - in laboratory based research. No one got hurt or had any organs removed against their will, so by current standards, Dr X was doing well.

Perhaps I'm being a little unfair.

But just in case any of us are ever patients Helen wanted me to pass on a handy tip. She noticed in all her times in hospital that only one person introduced themselves by name. Doctors and nurses were adept at ignoring the lost looking outpatient, having mastered the "I've-got-something-muchmore- important-to-do" expression. So Helen learnt to approach people with a prepared speech: "My name is Helen- and I'm ... months pregnant." She said she found by using her own name and making staff see her as a person they would instantly become much warmer and more helpful. Suddenly they did have time.

This is of course the same technique you are advised to use when in a hostage situation.

Now there's a really useful role play!

Kurtz S, Silverman J, Draper J. Teaching and learning communication skills in medicine. Oxford: Radcliffe Medical Press Ltd, 1998.
Royal Pharmaceutical Society of Great Britain. Achieving shared goals in medicine taking-from compliance to concordance. London: Royal Pharmaceutical Society of Great Britain, 1997.