He didn't let me speak!

Escrevi o artigo seguinte para o “PRIME International Email” de Setembro de 2009, enviado pela PRIME a várias centenas de estudantes e profissionais de saúde de todo o mundo. Tendo em conta que algumas visitas ao blogue são provenientes de países anglófonos, parece-me oportuna a sua divulgação online.

 

In one of my past consultations I’ve attended a woman complaining of leg pain. My examination didn´t show any signs of vascular disease. Knowing that she had consulted an orthopedic surgeon some days before I asked her if she had told him about these symptoms. Her answer amazed me: “No, he didn’t let me speak!”.

Effective communication is an essential element of whole-person and patient centred medical practice. It requires listening to patients with empathy, letting them speak, addressing their needs and concerns, and speaking to them openly and honestly in a way they could understand.

In my own specialty of vascular surgery most diagnosis are relatively straightforward and could be made in the first minutes of the consultation. However, sometimes it takes me over an hour to fulfill my duty and moral obligation of relating to patients not just as a (hopefully competent) technician but also as a counsellor and a friend.

I’ve realized that for some patients is not enough to speak slowly and repeat the message in a clear understandable way. It’s necessary to reinforce what we are trying to communicate. Now all my surgical patients receive an information sheet some weeks before their operation and another one before they leave the hospital after surgery. The benefits are enormous. My only regret is that I didn’t start doing this earlier in my career.

Good doctor-patient communication and respect for the patients concerns has been shown to improve both patient and physician satisfaction and reduce malpratice claims.

Lack of time and increased workload are some of the pressures health professionals face nowadays that disrupt communication. However, in spite of these pressures it’s important to remember that ultimately effective communication with patients is our responsibility as carers.

The report Tomorrow’s Doctors (General Medical Council, 2003) lists some examples of circumstances when communication is particularly hard, such as breaking bad news, dealing with difficult and violent patients, communicating with people with mental illness (including cases where patients have special difficulties in sharing how they feel and think), communicating with and treating patients with severe mental or physical disabilities, and helping vulnerable patients.

For most physicians these challenging situations are rare but improving communication skills is useful for the daily work of every professional. Communication and consultation skills can and should be learned, by training and practice. It is one of PRIME’s educational programmes. Some of the topics covered include: Good and bad consultations, patient and doctor centeredness, conflicting ideas, concerns and expectations, listening skills, methods of analysing the consultation, consultation models, and breaking bad news.

If you feel you need to brush up your communication abilities why don’t you attend one of the forthcoming PRIME conferences?

As the God-inspired wisdom of the Book of Proverbs reminds us, ‘Thoughtless words can wound as deeply as any sword, but wisely spoken words can heal’ (12:18). Speaking words that convey our care and compassion should be our aim in every clinical encounter.