The art of communication during consultations

Rashid’s suggestion that consultations in primary care should be held standing up goes against basic communication skills, which require eye contact, full attention, and being at the same level.1

Other factors in the consultation interfere with good communication. Electronic patient records encourage doctors to sit behind the screen and to look at the keyboard and screen instead of having eye contact with the patient. Smart phones also distract us from listening to patients.

Doctors’ communication skills have been slow to improve. A landmark study in 1984 showed that doctors interrupted their patients after only 18 seconds.2 It took about 15 years to improve this figure by five seconds.3 As our patients grow older and have more complex combinations of diseases, active listening and priority setting become more important.4

Communication skills need to be improved greatly to meet the challenges of current medicine and reach our aims of patient centred care and shared decision making. However, we seem to be taking three steps forward and two steps backwards. This may improve our cardiovascular risk profile but is far from being patient friendly and efficient. There are many ways that doctors can walk and stand if we are creative—for example, while collecting patients and bringing them back to the office, and by testing exercise limits together. Advances in medicine have limited value if not provided within an ongoing trusting relationship with a professional, such as a GP, medical specialist, or practice nurse, who genuinely cares for the patient.4 Let’s sit down for this.