COMMUNICATE TO CARE & CURE!

Volume 4 Issue 11 Nov 2014

Communication Skills is a vital component of a Doctor- patient relationship, not only in a field of psychiatry but in all fields related to patient care. However, there is no process whereby communication skills are taught to the teachers, the clinicians as a formal teaching, creating a communication gap in the doctor – patient relationship. No doubt, there is a rise in patients pressing litigations on the treating doctor’s in today’s scenario.

It is observed in clinical practice that during formal history taking only half of the complaints and concerns of patients are likely to be elicited. Often doctors obtain little information about patients’ perceptions of their problems or about the physical, emotional, and social impact of the problems through the structured case record sheet. Also, when doctors provide information to patients they do so in an inflexible way and tend to ignore what individual patients wish to know. They pay little attention to check how well patients have understood what they have been told.

Doctors may be reluctant to depart from a strictly medical model, and adopt a more negotiating and partnership style to deal with psychosocial issues due to certain reasons: Enquiring about the social and emotional impact of patients’ problems on the patient and family can unleash distress that they feel being inadequately trained, cannot handle. They fear, it will increase patients’ distress, take up too much time, and threaten their own emotional survival. Consequently, they respond to emotional cues with strategies that block further disclosure.

The Various blocking behaviors used by a clinician are, offering advice & reassurance before the main problem have been identified, explaining away distress as normal, attending to physical aspects only, switching the topic and “Jollying” patients along. Lack of appropriate communication skills leads to poor patient compliance, inappropriate diagnosis, and importantly, increased litigations & violence towards doctors.

On the other hand, when doctors use communication skills effectively, both they and their patients benefit. Firstly by enabling the doctor identify their patients’ problems more accurately. Secondly, their patients are more satisfied with their care and can better understand their advices, investigations, and treatment options. Thirdly, patients are more likely to adhere to treatment and to follow advice on behaviour change, helping holistic recovery of them. Fourthly, patients’ distress and their vulnerability to anxiety and depression are lessened. Finally and importantly, doctors’ own wellbeing is improved.

How to improve communication skills?.. Current evidence suggests that a doctor, who attends the workshops or courses to improve his or her skills and then has an opportunity to receive feedback about how he or she communicates in real consultations, will learn most and be able to implement the communication skills in routine clinical practice. They will feel more confident about how they are communicating and obtain more validation from patients. A good clinician will wish to continue their learning over time by self – assessment (recording their own interviews and reflecting on them) or attending further training in such skills and benefit self and their patients.
It is the need of the hour to take up workshops on Communication Skills for clinicians as a part of the continuing medical education.