Communication is key

20 November 2019 | Avant media

As you embark on your medical career it’s important to recognise that good commutation is at the heart of the doctor-patient relationship. Avant’s claims data shows 37% of all complaints against doctors about their professional conduct have communication as a factor.

Final year medical student Emma Hardwick, winner of The Sulway Harris Prize for Excellence in Clinical Communication, demonstrated how good communication skills are paramount. Below is Emma’s inspiring submission, highlighting the significance of adapting your communication style for each patient.

Mr PB was a 77 year-old maths professor, expert court witness, dog walker and man with Asperger syndrome whom I encountered as I was preparing for my final Long Case Exam. Mr PB initially presented to Ryde Hospital four weeks earlier with acute severe epigastric pain. He was managed conservatively for two days at Ryde Hospital for acute pancreatitis, however Mr PB deteriorated and was transferred to Royal North Shore Hospital Intensive Care Unit with multiorgan failure.

When I spoke to Mr PB on the wards, he was lying in his bed with all the curtains drawn. There were few personal belongings; no cards, flowers or a sign that he had visitors or family, despite the length of his admission. Throughout my conversation Mr PB became quite tearful and emotional. He told me that while he had been in ICU, he had the last rites read and thought he was going to die. He spoke about his young primary school students who were gifted in maths whom he taught at a local university. He was upset because they would not know where he was or have anyone to challenge them in maths. He was upset because of all the people who were dependent on him for an income in a business he owned and ran. He was tearful about the dogs he walked who he knew wouldn’t be getting walked and would be cooped up inside.

Mr PB was terrified, isolated and completely vulnerable. He spent much of the conversation looking up at the ceiling making little eye contact. I had an overwhelming sense that this man was trapped in his own head and had no one to connect with.

Communication is not just about what is said, it is a nuanced interplay of body language, tone, expression, emphasis and even what is not said. At its core, communication is founded upon connection.

As I near the end of four years as a medical student, I have increasingly been reflecting on how I have grown both personally and professionally over this time. Thinking back to my first and second year, I would not have found myself having a conversation like I had with Mr PB. My focus then was on developing skills in structured history taking, limiting my question repertoire to the presenting complaint and past medical history. Now my approach is different, I have endeavoured to take a step aside from this structure and focus on the patient

in front of me. Identifying what is important to them and what they are trying to tell me is key in not only developing rapport, but also being able to address their concerns.

Furthermore, in our conversations with patients it is important to identify the purpose of that particular conversation or communication; whether that be answering their questions, understanding their perspective, or simply giving a patient our time and someone who is listening to them.

As a medical student, there was very little I could do to ‘solve’ Mr PB’s concerns. However, I know that by sitting next to his bed for over an hour, listening to him and understanding who he was and what was important to him, it was invaluable for myself in what I learnt. Further, I hope this gave Mr PB a sense of validation and a moment of connection in what is a very isolating and lonely environment.

I deeply value communication because of all that it can achieve, above and beyond the answers from a blood test or CT scan. I know that I will always grow and develop and continue to learn from others on how they express themselves and respond to different situations. I hope to continually build a repertoire of communication skills and approaches which I can draw upon. Also, as I become a more experienced doctor I can integrate this into my daily patient encounters, gradually becoming better at tailoring certain approaches to each patient. As we enter an era of personalised medicine, particularly in specialties like oncology, I believe this needs to reflect not only our individualising of treatment approaches, but also our patient-doctor communication.

The efficiency and success of our health system is founded on communication. A health system with limitless resources is no more equipped in improving patient outcome than one which considers the development of communication skills to be as integral as procedural or diagnostic skills. Our measures of success in the health system are usually based on cost and statistics of morbidity and mortality. What if we were to expand these measures of success to also include patient experience? Perhaps this shift in focus would encourage us as practitioners in the system to adjust our approach to day-to-day patient encounters and connect with the person behind the medical record number. Our ability to engage with patients, develop rapport, respond to their concerns and explain information is arguably the most critical responsibility our work brings. Dr Ranjana Srivastava’s essay ‘Dying for a Chat’ (2012) explores the breakdown in patient-doctor communication reflecting a de-emphasis of this invaluable skill as part of our training as students and doctors. Our health system needs to address the disconnect between the current principles of ‘patient-centred care’ and ‘shared decision making’, and the simultaneous devaluing of communication. Like many other skills in medicine, learning and applying the nuances of communication requires continual exposure, practice, feedback and reflection.

Communication empowers patients to navigate our otherwise complex and often isolating health system. As I move from being a medical student to junior doctor, I hope that my value of communication will allow me to connect with my patients and best address their concerns. I am incredibly privileged to have encountered patients like Mr PB. Listening to their stories and reflecting on their perspectives has helped me to grow in my understanding of communication and its foundations in connection.

Useful resources:

The right way to break bad news

Connecting with patients

Communication breakdown – how do you fare?

Examination anxiety: avoiding harassment claims

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