Doctors and nurses must understand meaning of “communication”

EDITOR—In Kinmonth et al's randomised controlled trial of patient centred care of diabetes one group of health professionals (the intervention group) received training in patient centred care while the other (the comparison group) did not.1 Subsequently, scores on quality of communication with patients favoured the intervention group, but scores on patients' knowledge about their disease favoured the comparison group—to put it crudely, patients assigned to the intervention group were relatively happy but ignorant.

Sadly, the straightforward paradox of saying, in effect, “he communicates well but tells you nothing” is all but lost in the way that the word communication is used in medical education these days. Indeed, in a manner that many medical educators would find unexceptionable, Kinmonth et al gloss this term as meaning “the ability to tell the doctor or nurse personal or troubling things and feeling understood”—as if the transfer of information from professional to patient was something else. Where does this content free definition come from?

Perhaps the problem is that the whole communication skills movement arose from a perception that medicine (if not nursing) had insufficient empathy; the result—the common, lazy identification of empathy with patient centredness, and of both with communication—therefore has its own historical logic. But we cannot propagate a view of communication …