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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PMQs review: Angela Eagle cheers Labour MPs against an improved George Osborne

The shadow first secretary of state revelled in the Tories' splits. 

For months, Labour MPs have despaired at their party's failure to exploit the Tories' visceral EU divisions. But at today's PMQs, Angela Eagle gave them cause for cheer. Facing George Osborne in her capacity as shadow first secretary of state (David Cameron is attending the G7 in Japan), she brandished Iain Duncan Smith's description of him as "Pinocchio". "Who does the Chancellor think the public shoud listen to," she dryly remarked, "his former cabinet colleague or the leader of Britain's trade unions?" Eagle later roused the House by noting the scarcity of Brexiters on the frontbench. Her questions were too broad to pin Osborne down, and she struggled to match the impact of her first performance - but it was a more than adequate outing.

After recent reversals, the Chancellor delivered a ruthlessly efficient, if somewhat charmless, performance. When Eagle punched his Google bruise (following the police raid on the company's French offices), Osborne shot back: "She seems to forget that she was the Exchequer Secretary in the last government, so perhaps when she stands up she can tells us whether she ever raised with the Inland Revenue the tax affairs of Google?" 

He riled Labour MPs by describing the party as anti-Trident (though not yet announced, Corbyn will grant a free vote), a mark of how the Conservative leadership intends to use the issue to reunify the party post-referendum. "We look forward to the vote on Trident and he should get on with it," Eagle sharply retorted at the start of the session. But Osborne inevitably had more ammunition: "While she's sitting here, the leader od the Labour Party is sitting at home wondering whether to impeach the former leader of the Labour Party for war crimes." He compared Labour MPs to prisoners on "day release". And he gleefully quoted from Jon Cruddas's inquiry: "In their own report this week, Labour's Future, surprisingly long, they say 'they are becoming increasingly irrelevant to the working people of Britain."

The muted response from the Tory benches demonstrated how badly the EU vote has severed the party. But Osborne will be satisfied to have avoided any gaffes or hostages to fortunes. His performance today, his best to date at PMQs, was a reminder of why he is down but not yet out. 

George Eaton is political editor of the New Statesman.