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LETTER
Year : 2009  |  Volume : 55  |  Issue : 2  |  Page : 151-152

The value of communication


Imperial College London, United Kingdom

Date of Web Publication23-Jun-2009

Correspondence Address:
S K Krishna
Imperial College London
United Kingdom
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0022-3859.52854

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How to cite this article:
Krishna S K. The value of communication. J Postgrad Med 2009;55:151-2

How to cite this URL:
Krishna S K. The value of communication. J Postgrad Med [serial online] 2009 [cited 2019 Sep 23];55:151-2. Available from: http://www.jpgmonline.com/text.asp?2009/55/2/151/52854


Sir,

I read Kulkarni's short paper [1] with interest; it is reassuring to learn that this young student, at least, recognizes the value of effective communication. Kulkarni, however, rationalizes the argument for improved communication skills, by examining patient distress and future receptiveness, to students. Instead, I suggest that there is a rather more concrete reason for one to improve in this domain: Improved clinical outcomes!

  1. Good communication enables doctors to identify patients' problems more accurately. [2]
  2. Patients will thus better understand their own condition, treatment options, and prognosis.
  3. Informed patients are far more likely to be compliant with the prescribed therapy. [3]


Moreover, when communication skills are used effectively, a doctor's own wellbeing is improved. [4]

Even as Kulkarni suggests that these skills can largely be taught in the preceding week of lectures, I suggest that any solution requires greater student proactivity than can be achieved in large lecture theaters. Before unleashing students to the wards, it would be wise, as well as safer, to 'model' appropriate behaviors in a controlled environment. If resources permit, this is best achieved via a cohesive three-stage process, with each stage demanding progressively more student input.

  1. Teachers should demonstrate key communication skills in action - with audio or video recordings of real consultations. The participants should then discuss the impact of these skills on the patient and doctor.
  2. Having learnt the skills under supervision, an interactive demonstration could now be used. A facilitator conducts a consultation as he or she does in real life, but instead uses a simulated patient. The interviewer asks the group to suggest strategies that he or she should use to begin the consultation. Competing strategies are tried out for a few minutes, after which the interviewer asks for student's views and feelings about the strategies used. They are asked to predict the impact on the patient. Unlike audiotaped or videotaped feedback of real consultations, the 'patient' can also give feedback. This confirms or refutes the group's suggestions. This process is repeated, to work through a consultation, so that the group learns about the utility of key skills.
  3. Once these key skills have been demonstrated, the students can interact with a simulated patient. For a simulation exercise to be effective, students must be given feedback objectively by audiotape or videotape. [4]


Ideally, teaching groups should be limited to four or six participants, as this has been shown to create a sense of personal safety required for students to disclose relevant attitudes and feelings. Furthermore, this also allows more opportunity to practice key communication tasks. [6] The medical student who emerges from such a training program will not only be skilled for future patient interactions, but will also be undoubtedly 'safer' on the ward. As tactful, thoughtful students roam the wards - this can only be good, for us as well as for the patient.

 
 :: References Top

1.Kulkarni GV. The Student-patient relationship: A student's perspective on the grey areas. J Postgrad Med 2009;55:72  Back to cited text no. 1  [PUBMED]  Medknow Journal
2.Maguire P, Fairbairn S, Fletcher C. Consultation skills of young doctors: I--Benefits of feedback training in interviewing as students persist. BMJ 1986;292:1573-8.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Silverman J, Kurtz S, Draper J. Skills for communicating with patients. Oxford: Radcliffe Medical Press; 1998.  Back to cited text no. 3    
4.Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM. Mental health of hospital consultants: The effects of stress and satisfaction of work. Lancet 1995;16:724-8.  Back to cited text no. 4    
5.Maguire P, Roe T, Goldberg D, Jones S, Hyde C, O'Dowd T. The value of feedback in teaching interviewing skills to medical students. Psychol Med 1978;8:695-704.  Back to cited text no. 5    
6.Parle M, Maguire P, Heaven C. The development of a training model to improve health professionals' skills, self-efficacy and outcome expectancies when communicating with cancer patients. Soc Sci Med 1997;44:231-40.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]




 

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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow