Dulcet tones of a surgeon's voice may have a hidden meaning
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7359.297/a (Published 10 August 2002) Cite this as: BMJ 2002;325:297
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Would an alternative hypothesis be also explanatory ? - that being
sued is a brutalising and demoralising experience for the doctor, and that
this experience fundamentally changes the attitude of doctors towards
their patients ?
Perhaps those with experience in this area could be asked to comment
?
Competing interests: No competing interests
I have not read the original article but one must wonder whether the
authors have controlled for the effect of being sued on the surgeons' tone
and behaviour.
I would hope that it is true that those surgeons who are concerned
and respond to patients concerns about their condition and treatment are
likely to choose better treatments and deliver them effectively to
patients who are better informed and have realistic expectations. I would
agree that those who fail to concern themselves with such matters might
also likely to fail to deliver a top class technical operation.
But I wonder about the effect of being sued on the ability of the
clinician to continue to deliver on all this. In the environment where we
pratice in Ireland, the risks of legal action by patients is ever present
and court awards enormous. Often these legal actions and the size of the
awards are determined by factors other than clinical performance of the
surgeon, but suing the clinician is widely regarded as th best way to
ensure a sucessful action.
The unfortunate clinician who finds thenselves at the receiving end
of such an action (particularly if this happens more than once or when the
clinician really is not to blame) might find it particularly difficult to
maintain a more sympathetic tone and are, perhaps, more likley to be
guarded and reserved?
Competing interests: No competing interests
I was surprised at the conclusions of the authors of the article in
Surgery.
They found that surgeons who sounded more dominant and less concerned
were sued more often than those who sounded less dominant and more
concerned. It is suggested that if surgeons can be trained to change their
tone of voice, they might avoid lawsuits. This is based on the assumption
that patients sue surgeons because of the way they sound.
This may be true. However, I find it slightly arrogant that the
authors appear not to have even considered the possibility that patients
are sueing these surgeons because of poor surgical performance.
It seems quite likely to me that the domineering and uncaring tone of
a surgeon's voice actually reflects that surgeon's personality. Is it not
possible that a surgeon who dominates the doctor-patient relationship and
doesn't listen to the needs and wishes of his patients is more likely to
perform an operation that the patient does not want? Maybe a surgeon who
cares less about the outcome for his patient is also less attentive than
he might be whilst operating.
Surgeons who sound domineering and uncaring may in fact give good
cause to be sued.
Yours
Chris Kirke
Competing interests: No competing interests
Reports suggest that litigations in the NHS are on the increase recently.
Most published cases in the media also indicate that patients would have
accepted a “good communication from doctors, receptionists, trust
chairpersons” and not pursued the cases further in court. From this study
it looks as if we are failing to train health professionals (it's not only
doctors who are to be blamed, often other professionals in the health service
are more rude and abrupt with patients, which builds frustration and anger
in patients) in an effective communication skills. To save a huge loss of
litigation against NHS we must invest in developing appropriate
communication skills in health professionals at all levels.
Competing interests: No competing interests
Communication training: it's all talk
Evidence that patients are less likely to trust medical practitioners
who lack communication skills is mounting. Such skills are also vital in
doctor-doctor scenarios and when negotiating a complex career pathway.
That’s why it was good news when Alan Milburn, in his introduction to
the 2001 Medical Education and Standards Board (now the Postgraduate
Medical Education and Training Board - the PMETB) consultation document,
wrote: “The education and training of doctors [must provide] doctors with
the clinical and communications skills called for in a modern health
service.”
This is a commendable aspirational statement, but where is the
substance? Unless provisions are made to include communication training in
the remit of courses the PMETB oversees, the NHS won't come good on its
commitment and is also likely to see an increasing number of claims made
against it.
Until the NHS builds an internal capability to conduct such training
as standard, it will have to be sourced from expert providers working
alongside the NHS. Further, and as evidence of its commitment to building
the non-clinical skills of doctors, such skills should be more formally
assessed at interviews and during appraisals.
Aside from communication training (which has at least been recognised
as necessary at the highest levels), the prospects of other, non-clinical,
training being provided to help doctors negotiate their careers and assist
their personal development looks slim. Let’s hope the PMETB isn’t a wasted
opportunity to get these important needs on the agenda.
Competing interests: No competing interests