Intended for healthcare professionals


Patient centred care of diabetes in general practice

BMJ 1999; 318 doi: (Published 12 June 1999) Cite this as: BMJ 1999;318:1621

Doctors and nurses must understand meaning of “communication”

  1. John Skelton (, Senior lecturer in communication skills
  1. Department of Primary Care and General Practice, Medical School, University of Birmingham, Birmingham B15 2TT
  2. Department of General Practice and Primary Health Care, University of Leicester, Leicester General Infirmary, Leicester LE5 4PW
  3. School of Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ
  4. aGeneral Practice and Primary Care Research Unit, Institute of Public Health, Cambridge CB2 2SR
  5. Department of Psychology, Royal Holloway, University of London, Egham, Surrey TW20 0EX
  6. School of Health and Related Research, Northern General Hospital, Sheffield S5 7AU On behalf of the Diabetes Care from Diagnosis Research Team

    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 …

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