Good communication: Why it's worth it

Poor communication is a barrier to the delivery of effective care. Sara Williams explores how to become a good communicator

Good doctors are good communicators – it’s that simple. An Ipsos MORI poll published in November 2005 confirmed that the top characteristic the public wished to comment on in relation to their doctor’s performance was their communication skills, followed by their technical ability, how much they involve patients in treatment decisions and whether they show their patients dignity and respect.¹

Understandably patients experience difficulties in assessing the technical competency of a doctor, so will frequently judge the quality of clinical competence by their experience or their interpersonal interactions with a doctor. Developing good communication skills will improve clinical effectiveness and reduce medicolegal risk.

Effective interpersonal skills are particularly important for locum GPs because they often have only one chance to make a good impression.

The GMC’s view

Over recent years the doctor–patient relationship has evolved, moving from a paternal to a partnership model. In its most recent edition of Good Medical Practice, the GMC says that doctors should “work in partnership with patients” by listening and responding to their concerns and preferences, giving them “the information they want and need in a way they can understand”, respecting their right to be involved in decisions about their treatment and care, and supporting them in their own efforts to “improve and maintain their health”.²

The GMC expects doctors to be effective communicators, so what if you are not?

How to communicate effectively

It is often said that body language speaks louder than words. Eighty per cent of communication is non-verbal, so it is crucial to the patient encounter. A mismatch between verbal and non-verbal communication can lead to a strained encounter for both doctors and their patients.

Being aware of your own body language is the first step in understanding how your body language is perceived. Maintaining eye contact demonstrates that you are listening and showing an interest; this is particularly important at the beginning and end of a consultation.

Turning away and facing a computer indicates disinterest, so the patient may not give information critical to the consultation. Interruptions, and cutting off a patient before they have finished, are not effective means of communication. Beckman found that the mean time taken for a doctor to interrupt a patient’s opening statement was 18 seconds.³

His research showed that patients rarely presented problems in order of clinical importance, so allowing patients to complete their opening statement led to a significant reduction in late-arising problems. The longer a doctor waits before interrupting, the more likely the patient will “get to the point” quicker, thus avoiding presenting the key issue at the end of the consultation, where the adherence to time constraints could appear heavy-handed.

Handling patients’ expectations

Part of communicating effectively is handling expectations. Patients will be dissatisfied if their expectations have not been met. Although these expectations may be unrealistic, eg, the doctor will have unlimited time and availability, they will solve all the issues at once and all treatments will be 100% effective, these expectations can be addressed if they are identified early on. So, once explored and respectfully corrected through effective communication, the patient will leave content with their treatment and more likely to comply with it.

When things go wrong

Despite the best intentions, some patients will remain dissatisfied and seek redress. In most cases this is not down to human error. MPS’s experience is that a breakdown in communication and patients’ dissatisfaction with a doctor’s manner and attitude frequently give rise to complaints and claims.

Research by Bunting suggests that there are two sets of factors which influence the decision to sue or seek redress: 

• Predisposing factors – rudeness, delays, inattentiveness, miscommunication, apathy, no communication. 
• Precipitating factors – adverse outcomes, iatrogenic injury, failure to provide adequate care, mistakes, incorrect care, systems errors.⁴

According to Bunting, precipitating factors are unlikely to lead to litigation in the absence of predisposing factors; yet the media tends to report on the former rather than predisposing factors. So good communication could save your professional skin; patients who feel informed about their condition and are involved in deciding the appropriate treatment are more likely to comply with it and less likely to complain when things go wrong.

However, should you receive a complaint, it is important to talk to an experienced colleague or your medical defence organisation, and it is vital to try to retain your professionalism. This is particularly pertinent for sessional GPs, so make sure that through the practice you: 

• Acknowledge the complaint 
• Find out the facts 
• Provide an explanation 
• Apologise where appropriate 
• Identify what can be done to prevent similar issues arising 
• Adopt those lessons into your future practice.

Communicating with colleagues

In today’s team-driven environment communication has to extend to a greater number of people, so there are more opportunities for it to fail. Communication between primary, secondary, voluntary and social care should be viewed not as a chain but as a communication net, where all members can contact each other. This requires all members to be aware of who is doing what and understand the part they play. This will inevitably involve sharing patient information, which is entirely appropriate as long as continuity of care is balanced with the need to maintain confidentiality.

In its new confidentiality guidance, the GMC says that most people understand and accept that information must be shared within the healthcare team in order to provide their care.⁵ But it is not always clear how that information will be used. So patients should be informed about disclosures for purposes other than what they would expect. If a patient objects to the disclosure, you should explain that you cannot refer them or otherwise arrange for their treatment without also disclosing that information.

Working as a locum GP, your colleagues should provide all the relevant details of the patients for whom you are responsible. Practices should have in place protocols for the transfer of relevant information between doctors. However, many do not cater for the nuances of working as a locum, so locums should have in place their own systems to ensure adequate clinical handover.

Overcoming hurdles

Locum GPs, unlike their permanent colleagues, face the unique challenge that they often only get one chance to make a good first impression. Patients will be unfamiliar with a new GP’s mannerisms and may be used to a particular GP, so they will be more likely to pick up on, and make an issue of, poor communication.

A well-organised locum chambers should provide laminated profiles of its members that reassure and inform patients about the GP they’re about to see, as well as working with the practices to apply consistent communications systems between its locum GP members and practices.

Be very stringent about documenting any advice given and record all of the patient’s concerns. Listen and respond accordingly; body language is key to effective communication – being comfortable in an unfamiliar setting can be challenging for a sessional GP, but don’t shy away from moving a computer if it is creating a situation where you are facing away from the patient and remove books that could act as a barrier. Be aware of all these things and communication will no longer be a barrier to effective patient care.

Tips for effective non-verbal communication

• Observe 
• Show respect 
• Be patient 
• Be self aware (posture, eye contact, first impression) 
• Be curious 
• Assess patients' moods 
• Show empathy.

References

1. Ipsos MORI, Health Professional Qualifications poll (November 2005) – www.ipsos-mori.com/researchpublications

2. GMC, Good Medical Practice (2006)

3. Beckman, HB, The effect of physician behaviour on the collection of data, Ann Intern Med (1984)

4. Bunting, R, et al, Practical risk management principles for physicians, Journal of Healthcare Risk Management (1998)

5. GMC, Confidentiality (2009) pars 25-29.