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General Practice

Randomised controlled trial of patient centred care of diabetes in general practice: impact on current wellbeing and future disease risk

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7167.1202 (Published 31 October 1998) Cite this as: BMJ 1998;317:1202

Rapid Response:

Understanding Communication

Dear Sir,

Professor Kinmonth and her colleagues report [1], with the elegance
of methodology and discussion customary from that quarter, a randomised
controlled trial of patient-centred care of diabetes. One group of health
professionals (intervention group) received training in "patient-centred
care", the other (comparison group) did not. Subsequently, scores on
quality of communication with patients favoured the former, but scores on
patient knowledge about their disease favoured the latter. Crudely put,
it is as if 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 the
word "communication" is used in medical education these days. Indeed,
Kinmonth et al gloss this vexed term, in a manner many medical educators
would find unexceptionable, as "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, so that the result, the common,lazy identification of empathy
with patient-centredenss, and of both with communication, has its own
historical logic. But we cannot propogate a view of communication that
suggests - in Oprah's ghastly jargon - that just to be there is enough.

We need a more grown-up and integrated view of what is at stake. Put
simply, health professionals have expertise: if they didn't, patients
wouldn't visit them. It is hardly patient-centred to act as if things
were otherwise, nor rational to deny that it is knowledge people seek to
communicate.

Yours sincerely

John Skelton
Senior Lecturer in Communication Skills

[1]Kinmonth AL, Woodcock A, Griffin S, Spiegal N, Campbell MJ on
behalf of the Diabetes Care from Diagnosis Research Team. Randomised
controlled trial of patient centred care of diabetes in general practice:
impact on current wellbeing and future disease risk. BMJ 1998;317:1202-
1208.

Competing interests: No competing interests

06 November 1998
John R Skelton
Senior Lecturer in Communication Skills
Department of Primary Care and General Practice, Medical School, University of Birmingham, B15 2TT