Doctor-patient communication

A few weeks ago, a newlywed couple went to one of Kampala’s well-established private hospitals to have their first baby. As it were, the mother was delivered by a Caesarean section and discharged after three days. Shortly after the discharge, the mother developed abdominal distention and her condition deteriorated. She was rushed back to the hospital and immediately taken to theatre. She came out of the theatre with an opening through her abdomen to enable her pass out stool. Whatever the doctors found in the patient’s abdomen, they did not say; neither to the patient nor her spouse.

The patient’s previous discharge notes were taken away from her. As if to add insult to injury, the couple was given yet another hefty bill to clear. That was when hell broke loose. The couple demanded to know what went wrong and whether it was not really the fault of the surgeons who operated on the patient the first time that resulted in this second operation. It is more than likely that the surgeons injured the mother’s intestines in the course of the first operation. But the bottom line is that there was very poor communication between the health workers and the patient.

The importance of effective communication for good medical practice cannot be over emphasised. It is at the heart of every medical procedure, including listening to the complaints of the patient, seeking consent for the various processes and explaining to the patient his or her sickness. Good communication skills help the doctor establish rapport with the patient and help win the trust and confidence of the patient. This is vital for the diagnosis and effective management of the patient’s problems.
Once the doctor wins the trust and confidence of the patient, then the patient will provide the doctor with crucial information for correct diagnosis. Good communication will also improve patient compliance, as it helps the patient adhere to the medical advice given. It is no wonder that effective communication improves the quality of health care.

Such communication decreases the likelihood of complaints and legal action if adverse events occur. Breakdowns in communication are the most common basis for patient dissatisfaction. Doctors are often perceived by the patients as poor communicators or appear to be unapproachable or are unwilling to respond to the questions or concerns of the patients. Even the tone of the doctor and the body language can be a big turn-off for the patient. Patients often fault doctors in the following areas;

• Not listening or not appearing to listen attentively enough to their problems. The doctor appears disinterested as the patient narrates his or her complaints.
• Not providing adequate explanations to the patients. Doctors sometimes have the wrong attitude; “I am the doctor, I know it all.”
• Failure to demonstrate humaneness and understanding. Doctors must have an attitude that must convey to the patient respect, sensitivity and empathy.
• Spending very short time with the patient and appearing to be in a hurry. This is not helped by the fact that in reality, doctors are overwhelmed by patient numbers.
• A doctor’s behaviour during a consultation may uphold or destroy a patient’s confidence. A doctor must be absolutely sober during consultations. And telephone disruptions or other distractions during a consultation are not helpful.

Effective communication is a clinical skill that must be taught and practiced and also seen in the role models. It is a skill that is perfected over the years. One of the biggest obstacles to learning effective communication skills is the fact that the doctors do not appreciate its importance and there are perhaps few role models. Communication skills are not really taught in the medical schools and there is therefore lack of insight into communication deficiencies.

Patients’ needs
Patients need a comfortable and secure environment that reassures them of their privacy to communicate effectively with the doctor. A good sitting arrangement and how to receive a patient will enhance their confidence. Doctors must put the patient at ease and comfortable at the start of the consultation. A doctor should maintain appropriate eye contact, be attentive and be an active listener. A prudent doctor should avoid early interruptions but know when to tactfully guide the patient. The doctor’s posture, gestures and body language, constitute a major element of the non-verbal communication. Doctors should know how to cope with language barriers. They should avoid medical jargons and use simple language that is easily understood by the patient. They must also avoid judging or criticising the actions or behaviour of the patients according to their own personal standards or beliefs.

Doctors should be frank and open when admitting uncertainty and, especially, when an unexpected or adverse outcome occurs. The patient should be told as early as possible that something wrong has happened. This is part of open disclosure. Care must be taken not to imply or promise outcomes that cannot be delivered.

Dr Sylvester Onzivua is a Consultant Forensic Pathologist.

editorial@ug.nationmedia.com