Effective Communication

This is rather an extreme example of how things can sometimes go wrong in effective communication within the medical fraternity. But another lesson I was taught by my first registrar has also stayed with me; and although it initially may appear to be rather harsh, there is some truth in it. He told me that “all patients are liars”. I suspect that what he was really saying was that in some instances you mustn’t take what people say literally, or put your own interpretation on what others have said. Never the less, I have to admit that some groups of patients, such as drug addicts, do need special care and attention when communicating with them.
There are many reasons why the level of communication can break down between doctor and patient.

One of the biggest changes in medicine in the last 20 years has been the change that has occurred in general practice. Nowadays, the vast majority of GPs are part-timers, and those who are full time tend to be male and in their late 50s and will be retiring in the next few years. What this means is that it has become much more difficult to have ‘your own’ GP and for a relationship to develop whereby easy communication thrives, time is one of the essential ingredients. This can become more difficult if you are seeing a different doctor on each visit. The other tragic change in the style of general practice is the almost total loss of the ‘home visit’.

Over the decades I can remember many occasions when family members have rung me to say that they are very concerned about their ageing parents. Often it would have come as a bit of a surprise! The reason? Many of these older patients, particularly the women, see going to the doctor as a bit of an outing and get all dressed up in their best clothes and put on a smiling face! Most never complain about the downside of ageing, despite creaking joints, failing eyesight and diminishing hearing!

Over the years I have found that keeping up a routine of home visits has allowed me a privileged insight into how many of our older citizens live, and in a great many cases, it’s not always a reassuring sight! Poor lighting, loose carpets, steps up and steps down, food left out on surfaces, electric cables running across the floor and medicines in all sorts of containers and many just left lying where they dropped! And if GPs don’t do home visits, they’ll never know any of this. So the GPs have some work to do to lift the level of good communication and understanding of their patients. Patients too must play their part; after all it is their health, which is of prime concern at each medical consultation.

Try and describe in your own language what is concerning you. Often it may help to write it down. Also, there may be several things that concern you – the famous list which makes many GPs quake in their boots!! – And you should be aware that if that’s the case, then it may take several visits to actually go through the whole list. Always try and start with the one problem that is really concerning you – again GPs really get toey after having been through a long consultation, (usually with a full waiting room), when the departing patient says at the door something like “oh, and I nearly forgot, is it important if you bleed from the bowel?”.

Finally the practice of good medicine depends on trust. Patients have to be able to share their most intimate secrets with their doctors, knowing that the information will be sacrosanct. To doctors, this is a part of their creed, though sadly this can sometimes be forgotten, but to someone sick for the first time it can be a difficult thing for them to open up to a total stranger.

All of us need to be aware that medicine is first and foremost a caring profession, and if we focus on being caring people, then free and effective communication gets easier and easier.