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It's good to talk ...

Dr Raj Persaud
Consultant Psychiatrist
The Maudsley Hospital,
Raj Persaud is author of The Motivated Mind, published by Bantam Press, priced £12.99.

Doctors tend to see contact with patients as either aimed at getting information out of the ill or imparting advice to them. They therefore ignore a vital purpose to communication - to initiate and enhance the relationship with their patients. One review of the literature found that less than 5% of doctors' comments in medical consultations were friendly or sociable! Nurses are often better at these social elements of the consultation than doctors, but they can also often improve their communication skills.
A recent study found that the chief concerns of patients were not elicited in 25% of medical consultations. In another study, 40% of cancer specialists were found to believe that patients preferred not to know too much about their condition, even if the patients said otherwise.
There are many reasons why communicating with patients is stressful. It normally occurs under very constrained circumstances. Sick people are not usually able to converse as easily as when they are well, and are often hampered by strong emotions, such as fear of a particular diagnosis or procedure. Research evidence also indicates that the responsibility for good interaction between parties tends to be seen by patients as lying much more heavily on doctors' and nurses' shoulders. So nurses often find themselves held to blame when a consultation is not progressing smoothly, despite the problem, from the nurse's perspective, being as much to do with the patient.
One reason for the massive recent rise of public interest in alternative and complementary therapies might be that patients find those practitioners speak a language that is more easily understood by them than the unintelligible gobbledygook of the scientifically trained doctor or nurse!
The evidence is that the nurse-patient conversation is not some hurdle to be rapidly got out of the way before the important business of diagnosis and treatment. Instead, communication lies at the heart of the nurse-patient relationship - it is the key to making a correct diagnosis and prescribing a successful treatment that will be adhered to. For example, there is recent evidence that immune responses, such as natural killer cell activity, are significantly enhanced in cancer patients who perceive their doctors and nurses as being supportive.
One way of improving your communication skills is to focus on them as a separate ability to be developed alongside your clinical abilities. Break down patient communication competence into seven separate skills:

  1. Greeting the patient - it is important to introduce yourself and acknowledge continuity of the relationship (use the patient's preferred name or refer to something in the patient's life or a previous visit).
  2. Beginning the interview - mention the purpose of the interview and the amount of time available.
  3. Eliciting a full account of the patient's problems - ask clear questions and elicit any worries.
  4. Receiving the patient's communication - check what the patient means and don't use technical words.
  5. Offering a full account of the patient's problems - have you elicited all the patient's concerns about treatment?
  6. Check the patient understands - get the patient to repeat back to you what your advice was.
  7. Ending the interview - give a summary and check whether the patient wants to add anything.

After each consultation or clinic take a few moments to re-examine what went well in terms of communication and what could be improved, and analyse why you were better at certain times than others. With practice it is possible to perform all seven skills seamlessly and rapidly, so good communication means more effective use of clinical time.
Seeing communicating with patients as an important skill may take up more time in the short term, but in the longer term better patient communication will lead to improved job satisfaction for you. This is because nursing is primarily, despite whatever scientific advances are round the corner, a people profession.