Intended for healthcare professionals

Rapid response to:

Views & Reviews From the Frontline

Lost in translation

BMJ 2014; 348 doi: (Published 25 February 2014) Cite this as: BMJ 2014;348:g1749

Rapid Response:

Re: Lost in translation

Patient-doctor communication has almost certainly evolved since Elliot Mishler published “The discourse of medicine” during the mid-1980s. To summarise, Mishler (1984) found, through observational research, that doctors would principally communicate with patients in a manner that was medicine-centred. Fortunately medical communication has evolved in the last thirty years and this is certainly evidenced in preliminary unpublished findings from doctoral research which I am currently carrying out. Incidentally this observational research is concerned with how oncologists communicate with their patients about oral chemotherapy prescriptions.

While the voice of medicine retains a central importance in all dialogue with patients, it should be supplemented with the voice of the patient lifeworld. This holistic approach to medicine is already reflected in best medical practice legislation (pertaining to concordance, two-way communication, shared decision-making, advance care-planning etc.) The benefits of this approach are all too obvious and are likely to lead to an increase in patient well-being during any illness trajectory.

Naturally there is room for improvement, but the question to ponder is how far away is that pipe dream of consistent optimum two-way communication between any given healthcare professional and any given patient? The complexity of disease, the diversity of patient and the skills of the practitioner are massive pre-requisites to consider. There are no easy answers, largely because good communication means different things to different people. Some patient value excessive information-giving, some prefer their doctors to make decisions about treatment and others may not want to see their doctor at all. Add to the mix that doctors are now caring for more people at any one time than ever before, it seems that ‘perfect’ two-way communication is impossible – but considering Mishler (1984) once more, progress has been made.

To endorse a celebration of mediocre communication practices is not the intent of this letter. We all know from experience that provision of two-way communication can, and should, be improved in the future. Yet in a period of increased scrutiny, with regard healthcare practices, should there not be a period of reflection? Communication practices with patients have improved and frequently do seek to involve the patient in decision-making and information-giving. Doctors, nurses, pharmacists, physiotherapists and every facet of the interdisciplinary team should have some sense of pride based on the evolution of health communication so far. From professional, personal and academic experiences, disease-centred communication has declined. Admittedly there are still many, many steps to take on the journey to optimum communication practices. This journey may take many life-times to complete…or may never be realised, but as a professional interdisciplinary healthcare team we should continue to move forward because the change in healthcare communication practices has already begun.

Competing interests: No competing interests

27 February 2014
Gary Mitchell
Doctoral Researcher
Queen's University Belfast
School of Nursing and Midwifery