One step at a time

Dr Jagdeesh Singh Dhaliwal, MPS Manager and Senior Medical Educator for the Asia-Pacific region, offers some thoughts on what it takes for doctors to improve their communication skills

Most colleagues will be aware from reading previous Casebook articles that poor communication contributes to approximately 70% of clinical negligence claims against doctors.

Nevertheless, communication issues continue to surface, with depressing regularity, with each new series of claims and complaints assisted by MPS.

Doctors clearly do not communicate poorly on purpose. As a group, we have a strong ethical drive of wanting to do the best for the patient and this is combined with a pragmatic desire to avoid being sued.

Why do communication failures persist?

A report by the British Medical Association’s (BMA) Board of Education has highlighted key barriers to effective communication.¹ Several of these barriers link to personal traits and attitudes.

Such barriers include:

• Negative attitudes towards communication. Doctors give it a low priority, preferring to focus on treating an illness rather than the patient’s overall needs.
• A lack of inclination to communicate with a patient, especially when a doctor doesn’t have a lot of time, is dealing with an uncomfortable subject or is lacking in confidence. 
• Doctors having personality differences compared to their patients. Research in the UK suggests that doctors may differ significantly to adult population norms in the areas of personality related to preferred mode of understanding. This opens up the possibility of misunderstandings in communication between doctors and patients.
• Undervaluing the importance of communications: doctors may not appreciate the importance of keeping patients informed. This may reflect a wider imbalance in the doctor–patient relationship.
• A lack of understanding of the communication process, such as the need to provide information in language that a patient understands, or listening to a patient’s views, to encourage two-way communications.
• A lack of knowledge or training in communication skills, especially in non-verbal communication, such as body language.

The same report recommended that more communication skills training programmes should be developed for doctors. MPS Educational Services offers members a number of three-hour workshops that aim to support doctors’ communication skills.

Small interactive workshops, like those offered by MPS, have been shown to be effective in changing doctors’ behaviours.² And after attending a workshop, 80% of participants say they will change their practice.

As doctors, we know from our own experiences of supporting patients with behaviour change, such as quitting smoking or addressing weight problems, that good intentions on their own often aren’t enough.

Overcoming barriers, especially when they are related to attitudes or personal traits, requires support, reflection and reinforcement.

It is for this reason that MPS offers members a series of communication skills workshops. The workshops each focus on a different area of communication. This was another recommendation of the BMA’s Board of Medical Education.

Different techniques and skills are provided for each area but all the workshops share key themes.

Starting with Mastering Your Risk and working through Mastering Adverse Outcomes, Mastering Professional Interactions, Mastering Difficult Interactions with Patients and the new Mastering Shared Decision-Making, the workshops build upon one another.

They each offer participants the chance to rehearse communication techniques, while revisiting key ideas and refreshing skills. Each workshop also encourages doctors to reflect on their own actions and behaviours.

The aim is that over time, by gradually helping members challenge and change their attitudes towards communications, the workshop will ultimately produce a step change in their communication skills. This will lead to a reduction in risk for the doctor and an improved patient experience.

References

1. BMA Board of Medical Education, Communication Skills Education for Doctors: an Update (November 2004)
2. The King’s Fund, Interventions that Change Clinician Behaviour: Mapping the Literature, London: NICE (2007)