Wednesday, 15 August 2012

Communication problems

A few years ago I taught a communication module to medical students at the Royal Free Hospital Medical School. I dont think it was entirely my lack as a teacher that resulted in many a disinterested student yawn. They just didn't seem to think it was that interesting, relevant or helpful. OK it's  not as sexy as cardiology or bone marrow transplants. But I say, let them wait until they've been practicing for a few years-they'll hopefully get to realise just how crucial a skill it is.

Indeed the medical defence organisations often tell us that where good communcation exists between doctors and patients, there is likely to be a much higher threshold before lodging formal complaints. In fact I would go so far to say that even when a doctor has made a really quite significant error, if there has been good rapport between patient and doctor, a complaint is much less likely.

Consider the  problem of back pain in general practice. I guess a daily consultation for most of us. How difficult it is, with multpile opinions on best ways of managing and investigating, and all to fit into 10 minutes, (including the 1-2 minutes it can take the patient to get form the waiting room amnd seated in the consulting room!).

A helpful study from Manchester in 2011 in the  January edition of the International Musculoskeletal Medicine jounal had an interesting article about the differences in perception between patients and GPs when back pain is the presenting problem. For a variety of different aspects (need for XR, referral to specialist, need for examination etc) patients and doctors were asked grade the activity from essential to potentially harmful.

Need for Xray?  60% of patients thought so but only 3% of GPs.
Referral to specialist?  57% of patients thought a good move, but less than 1% of GPs.
Need for examination? 90% of patients thought so as against 70% of GPs.
Allowing nature to take its course? Valued by 43% of patients but 83% of GPs.

It's a well worn adage in GP training that in every consultation one should address ICE issues.

I...what are the patient's ideas about their problem? E.g. caused by diet, aggravated by drugs, made worse by sun etc
C...what are the patient's concerns about their problem? Could it be cancer? Will it get better on its own? Is it the same as what my dad had? etc
E...what is the patient expecting? Antibiotics? A referral to a specialist? An examination? A 'sick' certificate? etc

Failure in communication is part of the reason my medical defence fees have gone up form £40 per annum when I qualified to more than £5000 per annum now! It's worth working at.
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