For healthcare professionals only

Observations Out of Hours

Let us know how we are doing

BMJ 2010; 341 doi: (Published 19 August 2010) Cite this as: BMJ 2010;341:c4490

Challenges to Physicians' Communication

Mr Christopher Martin convincingly argues in favour of collecting
appropriate feedback, a powerful source for improving communication.

It is not enough to receive feedback from representative group of
patients. A non representative patient may offer valuable inputs. A few
years ago, I distributed an article titled "Medical x-ray examinations: a
note of caution", to many members of the administrative staff in a large
research organization.

Everyone appreciated the article. A few proposed the need to avoid
scientific jargon if that is possible. While describing the biological
effects of radiation, I explained the small potential for developing
cancer as a late effect of medical x-ray exposure. One of the respondents
was very upset. His niece had a few x-ray tests done a day before. He told
me that if he knew about the cancer-inducing potential of x-ray exposure,
he would not have agreed to the x-ray tests.

I modified the text substantially to assert that a patient should not
refuse a medically needed x-ray test. Feedback from a single respondent
influenced me because the adverse effect of avoiding a clinically
recommended x-ray may far exceed the tiny probability for induction of

A physician has to be constantly alert. A wrong word or even the
slightest gesture indicating a mild degree of indifference may put off a

Once I took my five year old son to a well equipped hospital. He had
a fairly large boil in his eye lid. I described his condition to the

"We have to cut it", the unsmiling, thoughtless physician who was
visibly impatient decreed. My son ran out of the room. He declared that he
will never again come with me to any hospital. The boil healed slowly;
some antibiotic cream helped.

Last week I suffered from severe earache. The consultant diagnosed
that it is due to impacted wax. The junior doctor who attended to me was
very considerate; may be a brief explanation on the procedure to be
followed may have been helpful and reassuring. One ear got cleared easily.
The wax in the other ear was stubborn. It was hurting badly.

Further procedure was postponed.” We will not hurt you", a senior
doctor who was stern but considerate, assured me. The stubborn wax needs
some softening! I am yet to read the material on "ear wax removal", I
collected from the website of the US National Institutes of Health.

The challenges to communication between physicians and patients may
be more demanding if the patients belonged to an elitist closed group.
Partly because of the patients' expectations.Some of them may be more
knowledgeable than their physicians.

If a hospital is located in a township in which thousands of persons
serviced by the hospital stay, then all bad news will spread faster than
wildfire; good news seldom gets any coverage.

Communication under stress will be ineffective. If communication to a
patient has to be effective it has to be delivered with compassion. It
will be satisfactory only if the patients trust their physicians.

Advancement in technology particularly medical imaging technologies
is an instance in point. These technologies advance with unbelievably
astonishing speed; the clinical uses lag disappointingly behind. More
often, there is no scientific indication that these technologies are
beneficial. Under those conditions, specialist doctors with clear
conscience will find it very difficult to communicate with knowledgeable

K.S.Parthasarathy Ph.D

Competing interests:
None declared

Competing interests: No competing interests

23 August 2010
Parthasarathy K S
Raja Ramanna Fellow
Department of Atomic Energy Mumbai 400001