Myth: All doctors are naturally good communicators.

–GILLELA SAITEJASWI 

There I was standing at the corner listening to my 75-year-old granny carefully, who was not able to bend down but trying to explain her leg pains to the orthopedic doctor. And there he was peeping into his mobile phone now and then. I went through a mixture of emotions (anger, frustration, disappointment). Whenever this incident flashes in my mind, even NOW. There is only one question that daunts me: “Why didn’t he pay attention to her?”

The process of curing a patient requires a holistic approach that involves considerations beyond treating a disease. It warrants several skills in a doctor along with the technical expertise. Studies have shown that good communication skills in a doctor improve patient’s compliance and overall satisfaction. There are certain basic principles of practicing good communication. , listening to patient, empathy, and paying attention to the para verbal and non-verbal components of communication are the important ones that are often neglected (1). There is the “need of the hour” to train medical professionals in this important yet ignored aspect in clinical medicine (2,3). Extensive research has shown that no matter how knowledgeable the physician might be if he/she is not able to open good communication channels with the patient, he/she may be of no help in the latter. Despite this known fact and the fact that a patient-physician consultation is the most widely performed ‘procedure’ in a physician’s professional lifetime, effective communication with the patient is sadly lacking. Most complaints about doctors are related to issues of communication, not clinical competency (4)

Recently, the medical system has witnessed an increase in the incidences of conflict between doctors and patients or with their attendants (4) .There is enough evidence in the literature to suggest that poor communication between doctors and patients is an important attributing factor (5). The most important barrier is lack of insight due to inadequate knowledge and training in communication skills. Many a times, doctors do not give enough heed to the importance of keeping patients adequately informed. Good practices like detailed explanation by clinicians along with enduring listening to the patients or their families have been found to decrease such incidences (5).

Patient-Physician relationship

‘‘The patient will never care how much you know until they know how much you care.’’ (Terry Canale in his American Academy of Orthopedic Surgeons Vice Presidential Address). Effective doctor-patient communication is a central clinical function in building a therapeutic doctor-patient relationship, which is the heart and art of medicine. This is important in the delivery of high-quality health care. However, many doctors tend to overestimate their ability in communication. ‘‘Medicine is an art whose magic and creative ability have long been recognized as residing in the interpersonal aspects of the patient-physician relationship.’’ The 3 main goals of current doctor-patient communication are creating a good interpersonal relationship, facilitating the exchange of information, and including patients in decision making. Good doctor-patient communication has the potential to help regulate patients’ emotions, facilitate comprehension of medical information, and allow for better identification of patients’ needs, perceptions, and expectations. Patients reporting good communication with their doctors are more likely to be satisfied with their care, and especially to share pertinent information for accurate diagnosis of their problems, follow advice, and adhere to the prescribed treatment. A more patient-centered encounter results in the better patient as well as doctor satisfaction (6).It has been observed that communication skills tend to decline as medical students progress through their medical education, and over time doctors in training tend to lose their focus on holistic patient care.

What can be done?   

 Doctors are not born with excellent communication skills, as they have different innate talents. Instead, they can understand the theory of good doctor-patient communication, learn and practice these skills, and be capable of modifying their communication style if there are sufficient motivation and incentive for self-awareness, self-monitoring, and training [8]. The practice of good communication skills in the medical profession is integral for the development of a meaningful and trustworthy relationship between the doctors and patients and thus is beneficial to both of them. (1) The diagnostic capability of the doctor is greatly enhanced because of a better understanding of patient’s problems (2). Patient’s level of satisfaction is improved by better recognition and understanding of their ailment and the treatment available (7). Psychologist and former theater director Dr. Marjorie Melnick Heymann, takes communications skill development a bit deeper. Her Communication Through Theater approach for doctors stresses (8)                                                                                                                                      

Being Present – clearing the clutter of mental distractions such as “the previous patient,” schedule or time worries, and other distractions that can reduce the focus on the immediate communications task at hand;                                                                                                                                                                                                           

Active Listening – applying specific listening-for-understanding techniques that confirm their awareness; Learn to listen to the patients patiently. It is extremely important in creating a trustworthy doctor-patient relationship which is a prerequisite for therapeutic success. Be the first one to greet the patient. Establish eye contact and maintain it at reasonable intervals.  Listening is an active process because it involves not just hearing but also seeing and feeling what the patient is going through. It is a multidimensional act. Be careful not to interrupt him/her when he/she is expressing something. While concluding, one must ask the patient if he would like to add something more.                                                                                                                                                                                                                                         Active Empathy – processing information for a true awareness of the other person’s needs. Baile et al reported that patients often regard their doctors as one of their most important sources of psychological support. Empathy is one of the most powerful ways of providing this support to reduce patients’ feelings of isolation and validating their feelings or thoughts as normal and to be expected.

Hippocrates suggested that doctors may influence patients’ health. Formal training of the doctors in improving communication skills is necessary and has proven to improve overall outcomes. Listening is a habit that must be taught along with clinical studies and practiced by doctors before they enter the battleground. Clinical communication skills plays an indispensable role in the success of the physician-patient relationship and therefore the recovery of the patient.

REFERENCES:

  1. Ranjan P, Kumari A, Chakrawarty A. How can doctors improve their communication skills?. Journal of clinical and diagnostic research: JCDR. 2015;9(3):JE01.
  2. Maguire P, Fairbairn S, Fletcher C. Consultation skills of young doctors: I–Benefits of feedback training in interviewing as students persist. Br Med J (Clin Res Ed). 1986 Jun 14; 292(6535):1573-6.
  3.  S Chatterjee, N Choudhury. Medical communication skills training in the Indian setting: Need of the hour. Asian J Transfus Sci. 2011;5:8–10.
  4. AK Shukla, VS Yadav, N Kastury. Doctor-Patient Communication: An Important but Often Ignored Aspect in Clinical Medicine. JIACM. 2010;11:208–11. 
  5. Doctors strike: Latest News, Videos, Photos. Times of India [Internet]. 2014 Oct 6 [cited 2014 Oct 6].
  6. Virshup BB, Oppenberg AA, Coleman MM. Strategic risk management: reducing malpractice claims through more effective patient-doctor communication. Am J Med Qual. 1999 Jul-Aug; 14(4):153-9.
  7. Hagihara A, Tarumi K. Association between physicians’ communicative behaviors and judges’ decisions in lawsuits on negligent care. Health Policy. 2007 Oct; 83(2-3):213-22.
  8. Wanzer MB, Booth-Butterfield M, Gruber K. Perceptions of health care providers’ communication: relationships between patient-centered communication and satisfaction. Health Commun. 2004; 16(3):363-83.

About Author

GILLELA SAITEJASWI

GILLELA SAITEJASWI is a FINAL YEAR MBBS STUDENT studying at KAKATIYA MEDICAL COLLEGE. She actively takes part in various organizations. She is currently working as Local exchange officer for MSAI, and College Representative for Rotaract Club of Caduceus. She along with her team recently won best Innovation prize in a hackathon for decoding COVID organized by SAMSA. she likes to share my knowledge with the people around. She is a highly curious person by nature, keen towards learn new things and understanding them to their core.
 

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