Dr M K Mam
Communication between doctor and a patient is a very important component of patient care. It involves effective interaction with patients, family, other physicians and health care providers.Medical profession earlier was very well recognized for 3 Ts i.e. Talk , Touch and Treat.Talk means a compassionate talking and listening, whereas ‘touch’means a compassionate touch involving a good clinical examination of the patient.In earlier times doctors certainly gave maximum importance to talk and touch.It is a fact that a compassionate talk and touch gave most of the respect and appreciation to the medical profession In due course of time 4th Ti.e.tests came up and now we also have 5th T i.e. technology. Somehow or the other, nowadays with commercialization of the profession most of us ,most of the timework only on tests, technology and the treatment and just ignore the most important talk and touch.Certainly there has been a progressive deterioration of effective doctor-patient communication. Good communication skills in the doctors are important in the delivery of safe, high quality and effective patient care. Doctor-patient communication is very well addressed in western countries where communication skill development and training has been included in medical curriculum of medical training programs. In our country medical graduates are generally not given any specific training in communication skills. Somehow or other there is an informal learning as some basic communication skills are imbibed consciously or subconsciously from ward rounds, faculty feedback and observing peers and seniors. Despite being an important part of treatment it is somehow been neglected. Large number of studies have shown that many patients are not satisfied with the consultation and that doctors fail many a time in adequately communicating with the patients and providing adequate information to their patients.
Importance of good doctor-patient communication: Being a good doctor requires not only knowledge and technical skills, but also effective communication skills.It is not only the right of the patient to know about his sickness and the treatment he will receive but also the moral duty of the treating doctor to communicate to the patient his disease, the treatment he is to receive, the complications and alternative treatments if any. It has long been recognized that difficulties in the effective delivery of health care can arise from problems in communication between patient and provider rather than from any failing in the technical aspects of medical care.Good doctor-patient communication is important and has multiple impacts on various aspects of health outcomes.
a) Improvement in health care outcomes
There are numerous studies to show that improving communication skills in doctors results in marked improvement in healthcare outcome.Improved communication has been shown to empower patients for better recuperation after surgery.
b) Improved patient satisfaction
Effective doctor-patient communication plays an important role in patient satisfaction with health care services. Patient’s level of satisfaction is improved by better recognition and understanding of their ailment and the treatment available. When carried out properly, doctor-patient communication has shown to have a therapeutic effect equivalent to drugs and it also decreases the dissatisfaction amongst the patient.
c) Improved compliance with the treatment
Low compliance with prescribed medical interventions is an important problem in medical practice and it is associated with substantial medical cost including increased hospital admissions Studies suggest that effective communication fosters understanding and increases patient’s compliance to the advices given by the doctor.
d) Improved health, functional
and emotional status:
Effective communication has a positive impact on patient’s psychology, mental health, tolerance power and quality of life.
e) Reduces medical malpractice risk
There is growing level of mistrust among the public for the medical profession as one hears of cases of negligence, misconduct, and unethical practices leading to legal suits.Recently there has been an increase in the number of complaints against the doctors and the malpractice claims for doctors. There also has been an increase in the incidences of conflict between doctors and patients or their attendants. Studies show that communication problems have been the most common factor in the initiation of malpractice suits. There are also studies to show that effective communication between doctor and patient decreases malpractice risk and is associated with fewer malpractice claims.
f) Establishing doctor-patient relationship
Doctor patient relation is probably the most sacred relation in mankind. It has always been and will be the core of the medical profession and relies on the trust and faith of the patient in the doctor. Communication skills are Important when establishing doctor-patient relationship. Improper communication with the patient often leads to dissatisfaction among patients, loss of faith on the doctor and in many cases violence. It has been very well reported that imparting communication skill training to doctors helps in improving doctor-patient relationship.
Barriers to good communications
Lack of adequate knowledge and training in communication skills is an important barrier. The patient populations in our outpatient clinics are diverse and there is a significant variation in their spoken language, culture, educational and social background and this gives a tough time to doctors and all thesefactors act as a barrier. It is important that doctor must be careful not to be judgmental or scolding because this may rapidly close down communication. During the conversation, doctor must use simple words and phrases that are understood by everybody as use of medical jargon – technical terms , which are not understood by majority of people act as a barrier. Noise, inappropriate medium and then the distractions as often is the case in overcrowded outpatient clinics of most of our state run institutions, does create a barrier for effective communication. Assumptions and misconceptions are also not in favor of an effective communication. It has also been reported that human failings like stress, tiredness or lack of time, arrogance and telephone calls are important barriers to good communication.
Recent trends :There has been lot of technological advances in the modes of communication used by the people in modern society like e-mail, the internet and mobile phone etc. Electronic forms of communication are beneficial as they allow rapid exchange of healthcare information, however caution has to be exercised.It should not be allowed to interrupt or supersede verbal and nonverbal communication, which are central to the development of trust in patient-doctor relationship.It is important that with all the technological advances,we do not lose sight of the physical, psychological, social, and spiritual totality of the patient .
Training doctors: Not many doctors are naturally blessed to have good communication skills. Doctors need to be trained in communication and this has to be included as an important topic in medical education . As it is, medical graduates in our country are not trained sufficiently in communication skills resulting in gaps in doctor-patient communication. Inculcating habits of good communications skill during formative years will help the medical students and future practitioners. For already practicing doctors, short trainings can be organized to stress the importance of communication and to impart some skills in communication.Literature suggests that good communication skill is an art which can be acquired or improved by putting conscious efforts in day to day practice.
Summary: Communication between doctor and a patient is certainly a very important component of patient care and is somehow not given due importance in our country.Good doctor-patient communication has multiple positive impacts on various aspects of health outcomes which include improved care health outcomes, improved patient satisfaction, improved doctor- patient relationship, decrease in malpractice risks and litigations. With all thegrowing level of mistrust among the people for the medical profession, increase innumber of complaints, malpractice claims for doctors andincidences of conflict between doctors and patients, good doctor-patient communication is certainly becoming even more important. It is high time that we train medical graduates, postgraduates and all health care providers in communication skills.
(The author is former Vice Principal, Prof. & Head of Orthopedics,