10 FYi • C ommunication


M E S S AG E


SENDING THE RIGHT


How doctors communicate with their patients is a common cause of complaints. Experts from the Maguire Communication Skills Training Unit off er some practical tips and advice


P


ATIENTS want to be treated by skilled and knowledgeable clinicians but this by itself is not suffi cient. Patients also want to be treated with humanity, dignity and respect; they want to be fully informed, supported and listened to so that they can make meaningful and informed choices about their care.


In 2012 the General Medical Council report, The State of


Medical Education, revealed there were proportionally more complaints about doctors than any other healthcare professional. Two of the top three complaints involved communication: ineff ective communication (including failure to respond to concerns, provide appropriate information and listen) and lack of respect (including rudeness, failure to respect the patient’s dignity and work in partnership). What steps can we take to deliver best practice?


Structuring the conversation Evidence suggests that one of the simplest things we can do is to structure our consultations. The aim is to gather all information and concerns, from the patient’s perspective, before we give any information. This aids the disclosure of concerns. As soon as we provide any information and advice to patients, patient disclosure is reduced and we hear fewer concerns. The Calgary-Cambridge consultation model is useful, as is the Maguire model (see box, right). Both allow the doctor to direct and optimise the fl ow of information between patient and doctor.


Working with cues To optimise either model of assessment, it is essential to be cue- focussed, as behind each cue may be a concern which needs to be identifi ed.


Defi nition of a Patient Cue A hint or clear expression of a negative emotion (verbal, vocal or non-verbal) which would need exploring to check for the presence of an underlying concern


Structure of an assessment interview (Maguire model)


Introductions Names and role Reason for the consultation Time boundary


Gathering information Background information History of the illness including patient’s perspective and concerns


Assessing current situation Current concerns Impact on life Coping responses View of the future


Information giving and plan of action Tailor information Share decision making Negotiate plan of action


Closing


Summarise Screen for further questions or concerns Check how patient is left feeling


Patients tend not to immediately and clearly disclose all their


concerns even if we ask them to, instead they hint at worries and concerns to determine if the healthcare professional is interested. An important skill is therefore the ability to recognise and


respond appropriately to patient cues. At each step in the model the doctor needs to recognise the patient’s cues and link their response to the cue. Communicating in this way about the issues


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