Good communication key in doctor-patient relationship

Last week’s minor storm in surgical circles, now thankfully settled, prompted me to highlight the importance of communication or rather the lack of it between doctors and patients/ relatives as this is often not stressed upon enough.

Good communication is essential in all walks of life. In surgery, this is a sine quo non. Effective communication is one of the key factors in that hallowed concept - the doctorpatient relationship. A good doctor-patient relationship is a core element in the ethical practice of medicine. Other factors that influence doctor-patient relationship include trust, informed-consent, empathy and understanding and respecting professional boundaries.

Studies have revealed that good communication between doctors and patients leads to better patient compliance and a more satisfactory outcome to the consultation/treatment. Communication in surgical practice is deemed so important that post-graduate surgery exams, in which the writer is privileged to be an examiner, have a designated skills station designed to assess the communication skills of aspiring surgeons.

Communication is a two-way street with both the doctor and the patient contributing meaningfully to make the consultation/treatment fruitful. Mutual respect and the ability to manage expectations are important. In the present age of information, many patients and their families are well-informed. An ideal patient is one who has questions ready for his or her doctor. In addition, knowing the time constraints of many doctors, the questions should be concise and to the point.The patient should always ask the doctor “what happens next?’ Studies have shown that on average, doctors interrupt their patients by 18-23 seconds of the consultation! Such interruptions should ideally be politely resisted by the patient. However in countries such as ours, where doctors are regarded as deities, this is unlikely.

What makes a doctor an effective communicator? An effective communicator has respect for every patient regardless of their social status.The sick are in a very vulnerable position and being respectful goes a long way in comforting them. An ability to explain complex medical/surgical matters in simple layman’s terms is a much desired trait that not all possess. A physician must also be able to effectively manage patient expectations by explaining procedures, possible outcomes and also lay out the limitations of interventions.

It must be pointed out that communication in the privacy and comfort of a private hospital is not possible in the majority of cases.The harsh reality is the setting of a bustling general hospital in Sri Lanka or other developing countries. Here, many constraints impede effective doctor-patient communication.The lack of privacy, the sheer volume of patients and the relentless schedule of many consultants are a few such factors. The knowledgeable patient from a better social background is better placed to carry out medical instructions and contribute to an effective doctorpatient relationship. In the writer`s experience, however, a patient from a less privileged background,though not conversant with many aspects of his illness and sometimes unable to carry out clearly stated instructions is very often extremely grateful for whatever doctors do for them.Their implicit trust in their doctors is touching and that trust must never be betrayed. Whatever constraints there are on the doctor or whatever the social background of the patient, it is every doctor`s duty to attempt to communicate with the patient under his or her care.

Research has shown that physicians and surgeons have a tendency to overestimate their communication skills. One such study revealed that 75% of surgeons surveyed, felt they satisfactorily communicated with patients whereas only 21% of patients were satisfied with the communication. Many doctors are of the opinion that curing disease is good enough. However as William Osler puts it `the good physician heals the disease, the great physician heals the patient with the disease`. Effective communication goes a long way in achieving this goal.