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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The boy who lies: what the Daily Prophet can teach us about fake news

The students at Hogwarts are living in an echo chamber of secrets.

They can make objects levitate, conjure up spirit animals and harness the power of invisibility. But perhaps the strangest thing about the witches and wizards of the Harry Potter universe is that despite all their magic, they still rely on old-fashioned print media for their news.

Although the Daily Prophet bills itself as “the wizarding world’s beguiling broadsheet of choice”, the reality is that its readers have no choice at all. Wizards don’t have their own television network – the risk of muggles accidentally tuning in was deemed too high – they don’t generally use the internet, and rival publications are virtually non-existent. (No, Witch Weekly doesn’t count.)

JK Rowling clearly sought to satirise the press in her portrayal of the Prophet, particularly through its poisonous celebrity journalist Rita Skeeter and her tenuous relationship with the truth. And in doing so, the author highlighted a phenomenon that has since become embedded within the muggle political landscape – fake news, and how quickly it can spread.

In the run-up to the recent French presidential election, an Oxford University study found that up to a quarter of related political stories shared on Twitter were fake – or at least passing off “ideologically extreme” opinion as fact.

While they don’t have social media at Hogwarts – probably for the better, despite the countless Instagram opportunities that would come with living in an enchanted castle – made-up stories travel fast by word of mouth (or owl.) The students are so insulated from the outside world, the house system often immersing them in an echo chamber of their peers, they frequently have no way to fact-check rumours and form rational opinions about current events.

When the Ministry of Magic flatly refuses to believe that Voldemort has returned – and uses the Prophet to smear Harry and Dumbledore – most students and their parents have no choice but to believe it. “ALL IS WELL”, the Prophet’s front page proclaims, asking pointedly whether Harry is now “The boy who lies?”

While Harry eventually gets his side of the story published, it’s in The Quibbler – a somewhat niche magazine that’s not exactly light on conspiracy theories – and written by Skeeter. He is telling the truth – but how is anyone to really know, given both the questionable magazine and Skeeter’s track record?

After Voldemort’s followers take over the Ministry, the Prophet stops reporting deaths the Death Eaters are responsible for and starts printing more fake stories – including a claim that muggle-born wizards steal their magical powers from pure-bloods.

In response, Harry and his allies turn to their other meagre sources such as The Quibbler and Potterwatch, an underground pirate radio show that requires a password to listen – useful to some, but not exactly open and accessible journalism.

Rowling is clear that Harry’s celebrity makes it hard for him to fit in at Hogwarts, with fellow students often resenting his special status. Do so many believe the Prophet’s smear campaign because they were unconsciously (or actively) looking forward to his downfall?

We are certainly more likely to believe fake news when it confirms our personal biases, regardless of how intelligently or critically we think we look at the world. Could this explain why, at the start of last week, thousands of social media users gleefully retweeted a Daily Mail front page calling on Theresa May to step down that was blatantly a poorly-edited fake?

The non-stop Hogwarts rumour mill illustrates the damage that a dearth of reliable sources of information can cause to public debate. But at the other end of the scale, the saturation of news on the muggle internet means it can also be hugely challenging to separate fact from fiction.

No one is totally free from bias – even those people or sources whose opinions we share. In this world of alternative facts, it is crucial to remember that all stories are presented in a certain way for a reason – whether that’s to advance a political argument, reaffirm and promote the writer’s own worldview, or stop an inconvenient teenage wizard from interfering with the Ministry of Magic’s plans.

Now read the other articles included in the New Statesman’s Harry Potter Week.

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