Good doctors are good communicators – it’s that simple. This article examines how building your communication skills at medical school will stand you in good stead as a doctor.
The more traditional “communication skills” teaching has focused on the doctor–patient relationship, yet communication between colleagues in hospital and primary care settings is equally important.
Developing both your teamwork and communication skills at medical school will stand you in good stead as a doctor. The Singapore Medical Council’s Ethical Code and Ethical Guidelines states that doctors “must communicate with other team members as necessary for the team to provide the best care possible and must ensure that the care you provide does not exceed your capabilities … if the care you are asked to provide is beyond your capability, you must inform your team leader” (Section A5). Communicating well within a team demands more than merely listening and passing on messages. Doctors must work within their competence, seeking advice and assistance from senior clinical colleagues where appropriate.
The consequences of poor communication
Although there are often many factors leading to adverse outcomes, it is undoubtedly the case that poor communication and inadequate handovers can result in inappropriate prescriptions, incorrect diagnoses and patients lost to follow-up. These have clear potential for patient harm, and an associated impact on the team arising from complaints, claims and disciplinary investigations.
On occasion, doctors may need to act to protect patients from potential harm caused by inadequate systems or procedures, or as a result of a colleague’s behaviour, performance or health. Medical Protection recognises that this is never an easy decision. If you need advice on the appropriate action to take, you should usually raise this with your educational supervisor, and you can always access expert medicolegal advice via our advice line.
The importance of good handovers
Good handovers are essential to provide good continuous care, maintain patient safety and avoid errors. After every handover, all members of the team should have the same understanding of what has been done and the priorities going forward.
However, the lack of consistent processes, the absence of best practice guidelines and the limited use of protocols mean that handovers are fraught with risk. Poor handovers create discontinuities in care that can lead to adverse events (and subsequent litigation), such as inaccurate clinical assessment and diagnosis, delays in diagnosis, medication errors, inconsistent or incorrect interpretation of results, etc.
You must be satisfied that suitable arrangements have been made for your patients’ medical care when you are off duty. These arrangements should include effective handover procedures, involving clear communication with your colleagues.
The effectiveness of handovers will depend on the accuracy and completeness of the information, and whether it is received clearly and understood by the recipient.
• Begin with a short briefing – “situational awareness”
• Facilitate a structured team discussion
• Establish and develop contingency plans – “what to do if…”
• Encourage questions from the team – there are no “stupid questions”
As a minimum, ensure the following is imparted:
• Patient name and and age
• Date of admission
• Location (ward and bed)
• Responsible consultant
• Current diagnosis
• Results of significant or pending investigations
• Patient condition
• Urgency/frequency of review required
• Management plan, including “what if…”
• Resuscitation plan (if appropriate)
• Senior contact detail/availability
• Operational issues, e.g. availability of ICU beds, patients likely to be transferred
• Outstanding tasks.
Jean, a medical student, was on her elective abroad. She had always wanted to pursue a career in emergency medicine, and had arranged a placement in the trauma unit at a major hospital. Before leaving Singapore, she had read up on advanced trauma life support techniques and had spent time in her local emergency department.
One evening whilst on call, a number of patients were brought to the department following a road traffic accident involving a minibus and a lorry. Four patients were multiply injured, requiring immediate resuscitation. The two registrars in the department led the assessment of the patients. Jean was one of three medical students in the department and assisted in the management of one young female, obtaining venous access and taking blood.
After the initial assessment of the patient, it became clear that she would require a chest drain. The ward doctor asked Jean if she would insert the drain whilst he continued to attend to other patients. Jean had never performed a chest drain but had seen it done once before. She agreed to perform the drain, not wanting to pass up the opportunity.
After making a skin incision with a scalpel, Jean struggled to insert the drain. She applied more and more pressure, but was unable to force the drain through the chest wall. She tried to cut through the intercostal musculature with the scalpel, inadvertently causing the patient to bleed. Fortunately, the nurse recognised that Jean was out of her depth, and called the ward doctor urgently.
Having witnessed these events, another medical student expressed concern to her supervisor.
An elective period is often a hugely rewarding experience, and students will often find themselves practising medicine in a very different setting to that of their university’s teaching hospitals.
Whilst it can be tempting to gain new clinical experiences, and other healthcare staff may be grateful for your assistance, your patients’ safety must always be your primary concern. Working within your competence, or training within an appropriate environment supported by senior colleagues, will ensure maximum benefit for both you and your patients.
Remember that Medical Protection offers free elective protection and has a team of medicolegal consultants dedicated to assisting our members around the world. Jean could have requested support from Medical Protection even though she was not working in Singapore at the time.
To talk to us about electives, advice on good communication or to discuss any issues you might be facing, email us or call our student support and advice line on 0800 952 0442.