Intended for healthcare professionals

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Editor's Choice

Good communication is key to good care

BMJ 2018; 361 doi: (Published 19 April 2018) Cite this as: BMJ 2018;361:k1704

Rapid Response:

Direct verbal communication is good, only if it is not interruptive and hostile

These recent articles lament the lack of direct verbal communication between colleagues in the NHS nowadays.<1><2> Let us step back and ponder why direct communication has declined. First, we are often interrupted when attempting proper SBAR (situation, background, assessment, recommendation) handover.<3> It is ironic why we are taught SBAR in school and life support courses -- in reality, people cut you off when you are still talking about the situation, and do not always care about your assessment and recommendation. We may have to rely on written referral forms to ensure all pertinent information is given.

Secondly, handover hostility is a barrier to direct verbal communication.<4> Some colleagues could be reluctant to make direct referrals to avoid embarrassment. For example, my general practice colleagues find it unpleasant when a hospital junior declines their telephone referrals, and even criticise their assessment. Similarly, hospital seniors usually delegate their juniors to make referrals. Some bad referrals could be like, “This patient needs a review. I don’t know why, but that is what I’m handed over.” Written referral forms are meant to ensure referrers have performed all basic assessment before asking for help. These forms are not simply a way to avoid more work, but a system to prevent inappropriate referrals and protect healthcare funding.

I learnt some tricks to avoid interruption and hostility during handover, such as asking my questions at the end,<3> and writing down my thoughts and the information given. A previous instructor of mine would stand in the middle of the lecture hall in silence until the class quieted down – this is a good strategy against those who repeatedly interrupt during handover. I also feel for those who must interrupt because the referrers give too much irrelevant information during busy handover. One good solution is to politely tell the referrers you are running out of time and would like to have a more concise presentation. Communication is often a two-way street.

1. Cook S. Good communication is key to good care. BMJ. 2018;361:k1704.
2. McCartney M. Margaret McCartney: Let’s start talking to colleagues. BMJ. 2018;361:k1602.
3. Fletcher B. Listening: a neglected aspect of safe handover. BMJ. 2017;359:j5200.
4. Al-Rais A. Why we should avoid handover hostility. BMJ. 2017;356:j1272.

Competing interests: I have been paid for working as a medical doctor, but not writing this letter.

24 April 2018
Eugene Y.H. Yeung
Medical Doctor
Royal Lancaster Infirmary
Ashton Road, Lancaster, LA1 4RP, UK