Improving doctor-patient communication
BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7149.1922 (Published 27 June 1998) Cite this as: BMJ 1998;316:1922All rapid responses
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Dear Editor,
DOCTOR- PATIENT COMMUNICATION
As a General Practioner working daily in areas of diagnostic uncertainty, I continually find that my communication skills are as, if not at times more important than my clinical skills. Your leading article on improving (1)doctor - patient communication is a timely reminder of the increasing need for specific training in this area. Recent authors have addressed this by defining a core skills curriculum and teaching programme for both undergraduate and
(2)postgraduate education.
However at a time when doctors are being increasingly burdened by information overload, it is important that we focus on those key skills which give the best return for time invested. As far back as 1972 Mehrabian showed that non- verbal communication was the prime channel for conveying information about beliefs (3) attitudes and emotions. In areas where verbal and non- verbal communication are not aligned it is invariably the non- verbal element that conveys the meaning of the exchange. Put simply, its not what you say its HOW you say it that counts. Until recently these skills have either not been taught at all or at best covered only superficially.
So where and how are we to acquire these skills? I have personally found the field of Neuro-linguistic (4)
Programming (NLP) to be highly valuable in this regard. NLP has modelled HOW effective communicators actually do what they do, both verbally and non- verbally. It has constructed models of the processes involved which are
easily assimilated in an accelerated learning format. The four fundamentals of NLP are a hepful framework in all consultations. First establish rapport, then set an outcome orientationand develop the sensory acuity skills to read non-verbal behaviour patterns. Behavioural flexibility is essential as no two patients problems or circumstances are equally alike.(5)
In summary we need to start thinking about how to package our information both verbally and
non- verbally in a way that suits our patients individual information processing patterns. The results will be better satisfied patients AND doctors.
Yours sincerely,
Lewis Walker
No conflict of interest. Full time GP principal
Ref (1) Meryn,S. Improving doctor - patient communication. BMJ 1998;316:1922 (27 June)
(2) Silverman J, Kurtz S, Draper J. Skills for Communicating with Patients. Radcliffe Medical Press.1998
(3) Mehrabian A. Non- verbal communication. Chicago IL: Aldine Atherton. 1972
(4) McDermott I, O'Connor J. Neuro-Linguistic Programming and Health. London: Thorsons. 1996
(5) Charvet S.R. Words that Change Minds. Dubuque, Iowa: Kendall / Hunt. 1995
Competing interests: No competing interests
As a general practioner I find that its not simply the words that convey the meaning in a consultation. The non-verbal patterns, which include voice tone, pitch, timbre and tempo, together with symmetry and asymmetry of posture and breathing patterns are vital for a complete understanding of the communication process.
Paying particular attention to incongruencies, where the verbal and non-verbal aspects are not aligned, can yield valuable information about patients underlying concerns, beliefs, emotions and expectations. This is the kind of information which gets to the real roots of problems and facilitates their resolution.
Unfortunately, although these skills are easily learned, they are generally either not taught or only addressed superficially in the medical curriculum. I have acquired them in communication courses outwith Medicine. I believe that they need to be incorporated within core clinical communication skills training.
Competing interests: No competing interests
Communication is as important as clinical acumen in patient care. Unfortunately, with the advances in modern medicine communication has taken a back seat. One of the important factors for the increasing popularity of alternative medicine is that patient communication is stressed upon in these forms of medical practise. It is hoped that ,as the authors have suggested patient communication in medical care regains its lost importance.
Competing interests: No competing interests
Improving doctor-patient communication
While Professor Meryn is right to identify the need for improvements in doctors’ ability to communicate with patients, his proposal that communication skills should be included as a mandatory element of the medical school curriculum offers only a partial solution.
However accomplished a communicator a doctor may be, three factors conspire to inhibit effective communication with patients. The first is time; typically doctors are able to spend only seven minutes with an NHS patient. The second is fallible short-term memory; it is widely accepted that few patients remember more than the first and last things doctors tell them. The third is generalism; GPs - the doctors most people see - are, by definition, generalists, and what they do not know they cannot communicate.
National patient organisations are a resource much under-utilized by doctors. In addition to the research they fund and their educational roles, they provide an excellent service of specialist information, advice and support. They make available as much time as may be needed. They offer written information as well as helpline support. And they have detailed knowledge of the conditions in which they specialize and of the treatment and management of them. For the vast majority of them, the quality and consistency of the information they provide is assured by a medical or scientific committee consisting of respected health professionals, all expert in their fields.
There is substantial research evidence to show the clinical benefits of membership of patient organisations. Doctors who do not already do so could help the patients and ease their own burdens significantly by directing patients and carers to appropriate patient supports groups.
Competing interests: No competing interests