The authors of the book Effective Communication Skills for Doctors, Teresa Parrott and Graham Crook, explore, together with Matt Green of the BPP University College’s School of Health, the art of clear communication in medicine and the steps that doctors can take to improve their communication with patients, family, and colleagues
Use clear language: Avoid jargon and tailor your language to your patients’ understanding and information needs.
Be conscious of your non-verbal communication: It is important to maintain eye contact—reading notes or looking at the computer screen may convey negative messages.
Negotiate an agenda: Ask patients what they need from the consultation, and explain what can be covered. Few doctors explain the purpose of the consultation or the time available, and less than one quarter negotiate over treatment.
Establish a dialogue: Determine whether your patient agrees with the diagnosis and management plan. Patients who disagree with the diagnosis probably won’t adhere to the treatment.
Be flexible in your consultation style: Tailor your approach to the individual patient. A more directive style may be appropriate for patients who want less involvement in decision making. A supportive style—listening attentively and asking questions about psychosocial issues—helps facilitate the disclosure of sensitive information.
Provide the information that patients want: Doctors tend to talk too much about drug treatment, whereas patients want to know about causes and the likely diagnosis and prognosis. They want more openness about side effects and advice on how to relieve pain and emotional distress and what they can do for themselves. Providing this information helps their symptoms, reduces distress, improves physiological status, reduces hospital stay and use of analgesia, and improves quality of life.
Reflect on the outcomes of your interactions with others: Why do some doctors work well and others not so well? Communication difficulties are one of the main reasons that patients complain about doctors. The most common criticism is not about the doctors’ competence but that they have failed to listen or to offer sufficient explanation.
Apologise when mistakes occur: Apologising and expressing regret at the suffering experienced by a patient is not an admission of liability. Ineffective communication is the single largest factor behind litigation by patients. Good communication, including effective apology, can avert or help end conflict, especially litigation. It never does any harm to apologise—for yourself or on behalf of colleagues.
Empathise and listen: Your relationship with the patient is vitally important. It facilitates therapeutic space in which patients can express their concerns and receive support and advice. Empathy is the ability to understand what another person is experiencing and to communicate that understanding to the person. As the patient begins to relate his or her story, it is necessary to silence our own internal talk, including the diagnostic reasoning process, which can interfere with our ability to listen.
Mindful practice: This is your ability to observe not only the patient but your own performance during the consultation. Mindful doctors can easily be identified by patients and colleagues—they are present, attentive, curious, and unhindered by preconception.
Establish rapport: Recognition and explicit acknowledgment of the emotional content in your patient’s story is particularly important in establishing rapport. Doctors often respond to emotional cues by offering premature reassurance, explaining away distress as normal, attending to physical aspects only, switching the topic, or “jollying” patients along.
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