'Is this the gullet?'
In what circumstances would you expect to ask this question? In your first anatomy class? When trying your hand at interpreting x-rays? Playing Operation?
Any or all of the above are acceptable. But absolutely, definitely not when you are referring to a patient with oesophageal cancer. In her hearing. Just before as she is about to go in for surgery.
As well as being an MDU medico-legal adviser, I am a consultant anaesthetist. Several years ago, I was preparing this particular patient for surgery in the anaesthetic room when two medical students charged in, laughing and jostling each other. One of our heroic duo saw the patient being helped on to the operating table and asked me... you've guessed it...'Is this the gullet? We're here to observe.'
So wrong. On so many levels.
First, the patient was seriously ill, frail and scared. She was about to undergo a serious operation to remove a life-threatening tumour.
Tip 1 - remember empathy: never talk about a patient in the third person when they are in the same room, or in such a disparaging way.
Second, the first words the students should have uttered were their names, as they introduced themselves to the anaesthetic team. Then they should have asked if they could observe.
Tip 2 - remember to ask: it is always a good idea to communicate with the doctors you are working with or wish to shadow. Do not assume you can just barge in and observe - ask permission!
Third, they should then have spoken to the patient directly, asking her if she minded them watching the procedure.
Tip 3 - remember manners: the patient has the final say in whether you can watch her operation.
Start communicating now
Good communication is an essential skill to learn. About 30% of all complaints against MDU medical members involve poor communication.
Ideally, you want to start your career at least knowing the basics of communication as soon as you enter the wards as an F1. Learn how to communicate effectively now with your colleagues, peers and patients, and practise your skills regularly.
I am proud of the care I provide and want my patients to know my name. As a patient, I believe that it is the little things like this that make the biggest difference
What makes a good communicator?
With patients First and foremost a good communicator listens. Eye contact is how we know that someone is listening to us, so rather than looking at the computer screen when the patient is describing symptoms to you, look at the patient. Give them your undivided attention.
The good communicator will then show the patient that they have been listening by 'reflecting' the patients own words. For example, if the patient talks about 'pins and needles' in their arm, call it pins and needles too, not paraesthesia. This helps build trust and rapport between the patient and the doctor and can lead to a more satisfying consultation.
If this is accompanied by 'matching', then the patient is likely to be put at ease. Matching involves reflecting the patient's body language, breathing, tone and volume of their voice.
With relatives Good communication with relatives is also vitally important. Remember, though, that your duty of confidentiality is to the patient if asked to discuss matters with their relatives.
With colleagues If communication between colleagues is absent, delayed or misleading, this may be unethical practice. Some styles of communication may even be harmful - so ask if you do not understand something or if you feel that something is wrong (e.g. you notice that the surgeon is about to operate on the wrong site). Do not feel that you are too junior to speak up if you are aware that something is about to go wrong.
On social media Take care with social media. Do not criticise your colleagues or place of work on Facebook, Twitter or any other social networking site. And do not breach your patients' confidentiality while using these forms of communication. It may be possible to work out who the patient is if you have an extended exchange about that patient's symptoms.
The 6 principles of good communication:
- Listen, do not interrupt
- Ask questions
- Pay attention to body language - yours and the other person's
- Manage expectations appropriately
- Gain compliance
- Be respectful
You may be aware of Dr Kate Granger's #hellomynameis campaign. Dr Granger is a doctor and, sadly, a terminally ill cancer patient. Her experiences as a patient led her to start a social media campaign that asks healthcare workers to consider the needs of their patients for a few minutes and to introduce themselves with 'Hello, my name is...'.
In a Guardian interview Dr Granger said: 'The ingenuity of this idea is its simplicity. It costs nothing and takes only seconds, but it improves patient experience. It is the first step to discovering what matters to that individual and to putting their concerns first. I am proud of the care I provide and want my patients to know my name. As a patient, I believe that it is the little things like this that make the biggest difference.'
Read our interview with Dr Granger in the MDU Journal
Take time to consider how you communicate with your patients, fellow students, healthcare staff and your family.
Think about what changes you may need to put in place.
Look up Dr Granger's Twitter feed (@GrangerKate) - it is inspirational with some amazing advice on communication skills.