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

 

A doctor examines a patient. Photograph: Getty Images
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5 things Labour has blamed for the Copeland by-election defeat

Other than Labour, of course. 

In the early hours of Friday morning, Labour activists in Copeland received a crushing blow, when they lost a long-held constituency to the Tories

As the news sank in, everyone from the leadership down began sharing their views on what went wrong. 

Some Labour MPs who had done the door knock rounds acknowledged voters felt the party was divided, and were confused about its leadership.

But others had more imaginative reasons for defeat:

1. Tony Blair

Shadow Chancellor John McDonnell told Radio 4’s Today programme that: “I don’t think it’s about individuals”. But he then laid into Tony Blair, saying: “We can’t have a circumstance again where a week before the by-election a former leader of the party attacks the party itself.”

2. Marginal seats

In a flurry of tweets, shadow Justice secretary Richard Burgon wanted everyone to know that Copeland was a marginal seat and always had been since it was created in 1983.

Which might be true, but most commentators were rather more struck by the fact Labour MPs had managed to overcome that marginality and represent the area for eighty years. 

3. The nuclear industry

In response to the defeat, Corbyn loyalist Paul Flynn tweeted: “Copeland MP is pro-nuclear right winger. No change there.” He added that Copeland was a “unique pro-nuclear seat”. 

In fact, when The New Statesman visited Copeland, we found residents far more concerned about the jobs the nuclear industry provides than any evangelical fervour for splitting atoms.

4. The political establishment

Addressing journalists the day after the defeat, Corbyn said voters were “let down by the political establishment”. So let down, they voted for the party of government.

He also blamed the “corporate controlled media”. 

5. Brexit

Corbyn's erstwhile rival Owen Smith tweeted that the defeat was "more evidence of the electoral foolhardiness of Labour chasing Brexiteers down the rabbit hole". It's certainly the case that Brexit hasn't been kind to Labour's share of the vote in Remain-voting by-elections like Richmond. But more than 56 per cent of Cumbrians voted Leave, and in Copeland the percentage was the highest, at 62 per cent. That's an awful lot of Brexiteers not to chase...

I'm a mole, innit.