Beyond informing patients to involving them

Communication depends on constant hard work and is easy to get wrong. Jeff Aronson has had his name mis-spelt Aaronson, Tronson, Bronson, and even Arson (p 124). He has learnt to ask patients how they pronounce and spell their names. Marshall Marinker found the wrong preposition used in a Franz Kafka quote in his editorial because of “BT (the telecommunications company), my diction, and the technical editor's hearing (p 150).” Timothy Beringer describes the panic he felt in his membership examination when faced with a boy “with a broad Dublin brogue which his rapid delivery made it almost impossible to follow (p 99).”

Ann Faulkner gives advice on communicating with patients, families, and other professionals in her contribution to the ABC of palliative care (p 130). How do you answer questions like: Is there a cure? Why me? How long have I got? Explore the question, recognise that many are rhetorical, and be prepared to admit that you don't know.

Failure to communicate well with patients often arises because of poor communication among professionals. Colleagues from different disciplines have problems defining roles, boundaries, and differing philosophies of care. “Integrated care pathways” are an attempt to respond to this problem (p 133). They are “structured multidisciplinary care plans which detail essential steps in the care of specific clinical problems.” Some 45 pathways have been published covering conditions like acute myocardial infarction and total hip replacement, but they have not been well evaluated.

An important step in communication is to move beyond supplying patients with information to involving them more in decision making. Tessa Richards quotes Angela Towle from British Columbia speaking at a recent meeting in London (p 85): “Assessing people's information needs, identifying treatment options and the evidence that underpins them, establishing preferences, and supporting people to make decisions is a discipline in its own right …. which goes well beyond the current teaching of communication skills.” Patients will increasingly be there throughout health services when important decisions are being made, and the British NHS has a strategy to encourage this development. In the long term it will be revolutionary, and Hazel Thornton describes how it is already happening with breast cancer research (p 148).

Doctors who sigh at such change may hanker after the autocratic power that doctors had in the old days. A 100 years ago the BMJ described an Ohio bill requiring those wanting to marry to pass a medical examination (p 117). A licence was forbidden to those suffering from “dipsomania, insanity, or tuberculosis.”