introduction

herni suprapti
Communication is not an add on

it is at the heart of patient care
Good communication is difficult :

few can master it without special tuition
and costant attention to its effectiveness
The aim of communication is
to help you to develop the skill that will
enable you to communicate effectively and
sensitively with
patients
their relatives
colleagues
patients experiences of the care they
receive often fall far short of the ideal
With the exciting technological advances
being made in clinical medicine and to
forget the ancient aim of the physician :

to
cure sometimes
relieve often
comfort always
latest recommendations on undergraduate
education

Graduates must 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.
What is communication ?

What does the word communication
mean to you?
Do some brainstorming, either by yourself
or in a group.
Write down all the words or phrases which
come to mind.

a definition of communication

the method of communication

the purpose of communication

the word communicate comes from the
Latin to impart, to share.

Communication is imparting, conveying
or exchanging ideas, knowledge, etc.
What is good communication ?
Patients preferred interviewers who
:
were warm and symphathetic
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
Why is good communication important ?
The short answer is

better care for our patients
doctors who communicate well with patients
are more likely to :

make an accurate, comprehensive diagnosis

Good communication skills enable one to collect
information about a patients problems that is
comprehensive, relevant and accurate.

It has been shown that doctors who have received
training in communication skills are more likely to
diagnose psychiatric morbidity in their patients than
those who had not been trained.
Cont
detect emotional distress in patients and
respond appropriately.
have patients who are satisfied with the
care they have received and who are less
anxious about their problems.
have patients who agree with and follow
the advice given.
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.
poor doctor-patient communication

patients were most likely to complain
about aspects of patient-doctor
communication rather than the technical
aspects of care.
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 dont discuss much with patients. I
would have preferred that they had
explained more.
Can communication skills be
learned ?


Training to be a doctor involves the
acquisition of
Knowledge
Skills
Appropriate attitudes
Like many aspects of medical education, it
was assumed until fairly recently that students
aquire good communication skills and
appropriate attitudes by a sort of osmosis by
observing and modelling their behaviour on
that of their teachers.

this may not produce doctors who are
good communicators.
It is now recognised 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 assessments.
What is the evidence for the effectiveness of
communication skills training ?
In the 1970s a series of studies was
carried out on medical students during
their fourth-year clerkship in psychiatry.
The study found that before training,
students experienced difficulties in
obtaining histories from patients.
The difficulties which were
highlighted included :
not obtaining all the necessary information
from the patient
forgetting to ask about the influence of the
patients problems on themselves and
their family
failing to notice and respond to verbal and
non-verbal cues from the patient
looking bored during the interview.
process studies
a control group & a feedback group
students in both groups were asked to
interview a patient and obtain a history of
the patients main problem within 15
minutes
The interviews were videotaped and the
students were asked to write up the
patients history.
process studies
The feedback group then interviewed two more patients
and were also videotaped.
However, on these occasions the students watched and
discussed their interviews with a tutor during a feedback
session, comparing it with an instructional handout.
Finally both the control group (who had had no training)
and these feedback group made a final videotaped
interview with a patient.
These interviews and the pre-training interviews were
then rated and given a score by a psychologist who was
blind to which group each student belonged.
What were the result ?
students who had received feedback training were
better at communicating with patients because
compared to the control group, they
obtained three times more relevant and
accurate information about the patients
presenting problem

they were given higher ratings by the
patients

other studies

students who receive training are better at
communicating with patients than
untrained students
Are the skills that there students acquired
through training retained, or are they lost
over a period of time ?
doctors who had feedback training as
students retained their skills :
They were more emphatic
They were more self-assured when
interviewing patients
They had better basic communication
skills, including the use of an open style of
questioning and responding to verbal cues
conclusions
communication skills can be learned, and
doctors who receive training retain the
skills
How to develop good communication
skills
to realise is
that you have the ability to communicate
and
that you use this ability continually when
relating to other people
communication skills courses
now part of the curriculum in all medical
schools

aim to help you to
hone your innate skills and
develop spesific skills
that enable you to communicate effectively with
patients
Communication skills training
will enable you to
identify these skills and
practise them

with your
fellow students or
simulated patients
(often actors role-playing patients).
learning how to take a history from patient

communication may be particularly difficult
for both you and the patient for example
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

practise the necessary skills and
explore your own feelings about these
issues with other students and a tutor in a
supportive setting.
what is the best way to learn the skills of
effective communication ?
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
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 dont need them.
One study of medical students has shown
that students who are the most confident
tend to be least competent in
communication with patients.

Life-long learning
Learning to communicate well does not
stop at the end of undergraduate course.

We all need to develop and hone our
communication skills with patients,
relatives and colleagues throughout our
professional lives.