Why do doctors struggle to communicate with their patients?

Many doctors turn their nose up at the art of communication, viewing it as potentially soft medicine.

Last month, the GMC reported that the number of complaints regarding doctors have increased by 23 per cent with complaints received focusing primarily on how doctors interact with their patients. Allegations about communication in particular have increased by 69 per cent with a lack of respect rising to 45 per cent. Dr Niall Dickson, Chief Executive of the GMC, commented that:

"the rise in complaints did not necessarily mean worse care and that the evidence was actually about rising levels of satisfaction with medical care across the country."

Katherine Murphy, Chief Executive of the Patients Association, reported that

"the huge rise in complaints in relation to communication and a lack of respect are of particular concern. Patients are not receiving the compassion, dignity and respect which they deserve."

For several years, medical schools across the UK have taken steps to help train future doctors enhance their communication skills. Throughout their training, students are expected to undertake role play sessions to help simulate situations they may face in the future either on the wards or in the GP setting. These can include anything from breaking bad news to communicating with an angry patient or explaining a procedure such as endoscopy. At the time, I can admit to doubting its relevance. However, looking back, those sessions certainly helped me to improve my patient interaction and appreciate what being a patient may actually feel like.

And of course don’t just take my word as gospel. A study by Dr Debra Nestel and Dr Tanya Tierney at Imperial College looked at the merit of role play during students’ first year at medical school. The scenario utilised centered on a "patient" who had come to see their GP following sustaining a wound to their hand in the garden. The patient is instructed to act worried about the wound using non verbal and verbal clues. And as the wound occurred following contact with a nail, the patient may as a result need a tetanus injection, and is instructed to act frightened of injections. Students are then assessed on their overall ability to assess why the patient has come to the GP and their ability to assess the patient’s ideas, concerns and expectations (ICE). The results of their research found that role play was an effective means of learning communication skills with over 96 per cent of students reporting it as helpful.

Of course role play is just one example of improving one’s communication skills. Dr Alan McDevitt, chair of the BMA Scottish GP committee, recently reported that his mother’s influence in persuading him to get his first job selling cream door to door aged 11 helped him to learn a lot of communication skills.

However despite some success stories, the current evidence suggests that doctors on the whole are failing to demonstrate their bravura in real life.

Dr Clare Gerada, chair of the Royal College of General Practitioners commented that:

"a number of factors could be responsible for the increase in complaints including over-worked and stressed doctors failing to communicate well and a growing culture of complaining."

She went on to say that:

"‘We must always be kind and compassionate. In the end, being kind and compassionate is what is important about being a doctor and what patients want."

Many doctors turn their nose up at the art of communication, viewing it as potentially soft medicine. And speaking with colleagues the general consensus is that patients surely want a doctor who simply knows their stuff, regardless of how they communicate. It seems however the inability of doctors to communicate well is not only being discussed among adults – its transition to the animated world surely serves to emphasise Oliver Goldsmith’s mind set: "People seldom improve when they have no other model but themselves to copy."

Neel Sharma is a medical doctor and Honorary Clinical Lecturer at the Centre for Medical Education, Barts and the London School of Medicine and Dentistry

 

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If Seumas Milne leaves Jeremy Corbyn, he'll do it on his own terms

The Corbynista comms chief has been keeping a diary. 

It’s been a departure long rumoured: Seumas Milne to leave post as Jeremy Corbyn’s director of communications and strategy to return to the Guardian.

With his loan deal set to expire on 20 October, speculation is mounting that he will quit the leader’s office. 

Although Milne is a key part of the set-up – at times of crisis, Corbyn likes to surround himself with long-time associates, of whom Milne is one – he has enemies within the inner circle as well. As I wrote at the start of the coup, there is a feeling among Corbyn’s allies in the trade unions and Momentum that the leader’s offfice “fucked the first year and had to be rescued”, with Milne taking much of the blame. 

Senior figures in Momentum are keen for him to be replaced, while the TSSA, whose general secretary, Manuel Cortes, is one of Corbyn’s most reliable allies, is said to be keen for their man Sam Tarry to take post in the leader’s office on a semi-permanent basis. (Tarry won the respect of many generally hostile journalists when he served as campaign chief on the Corbyn re-election bid.) There have already been personnel changes at the behest of Corbyn-allied trade unions, with a designated speechwriter being brought in.

But Milne has seen off the attempt to remove him, with one source saying his critics had been “outplayed, again” and that any new hires will be designed to bolster, rather than replace Milne as comms chief. 

Milne, however, has found the last year a trial. I am reliably informed that he has been keeping a diary and is keen for the full story of the year to come out. With his place secure, he could leave “with his head held high”, rather than being forced out by his enemies and made a scapegoat for failures elsewhere, as friends fear he has been. The contents of the diary would also allow him to return in triumph to The Guardian rather than slinking back. 

So whether he decides to remain in the Corbyn camp or walk away, the Milne effect on Team Corbyn is set to endure.

 

Stephen Bush is special correspondent at the New Statesman. He usually writes about politics.