Monday, 18 February 2008

"Not The End Of The World"

Today we had an all day communication skills session. Sounds like a real barrel of laughs eh? Even more so when it’s about terminal cancer and dying! There was an interesting start to the morning, as an icebreaker exercise (despite being in the same groups in previous sessions and having spent the last 2 and a half years together) we had to pretend to be QVC presenters in pairs. This provoked much eye-rolling, not only by me but most of my colleagues and there were understandably no volunteers so I volunteered the tutor to go first. To be fair, he did, and he showed it how it should be done. So, in turns we spend 5 minutes trying to sell ridiculous objects that the tutor had brought along ranging from a Cliff Richard CD to 2 self-help books on parenting. To start with I thought this exercise was pointless and ridiculous but when it came to my turn I was actually quite enthusiastic, unlike my partner who looked like she’d rather be dancing naked on the town hall steps. Our ‘item’ was an original artwork (a collage concoction put together by the tutor’s daughter I think). I actually had fun trying to sell this fantastic piece to my audience who were at the ready with their phones and credit cards. It was mentioned that perhaps medicine is the wrong career for me and that I perhaps have a future with QVC.

Anyway, from there, the day got more depressing as it went on. The case ran all day with a series of simulated patient sessions. By early afternoon the ‘patient’ had taken a turn for the worse and didn’t have long left. I was lucky in some ways when my scenario came round. The patient’s son had come from London and wanted to talk to me, the F1, about his father’s condition. This made it fairly easy from my point of view as all I had to do was not tell him anything because of patient confidentiality, of course I had to tell the son this and empathise at the same time. All in all, it was quite successful despite me refusing to tell him anything – I think we had quite a nice SP (simulated patient), others might have shouted at me. I felt a bit sorry for the poor chap who drew the short straw and had to tell the son that the patient had died – the SP was very good and promptly broke down there in-front of him. “Not the end of the world” was perhaps not the best phrase for him to use.

I can never really decide what I think about communications skills. I really like the simulated patient aspect and actually learnt quite a few tips today. We had a pretty good tutor who didn’t drag things out too much and was quite concise. The simulated patient sessions are very useful experience indeed and in a sadistic sort of way I enjoy doing them myself (not quite enough to volunteer openly though). I think they’ll come in useful in reality when we face some of these situations in the real world. I just hope I remember some of the tips I learnt. My feedback was generally good and the tutor was surprised when it was announced that I wanted to be a surgeon. Apparently surgeons are generally lacking in the communication skills department.

The sessions can be quite voyeuristic as you’re sat there looking into the lions den, watching as one student acts out a scenario being critiqued by all those around. Sometimes it goes well, others, things can go a little wrong. It’s rather obvious who’re going to be the best communicators come August and it’s not always the ones you expect. I was pleasantly surprised, if not shocked, at how good some people were and nobody was really bad. I wonder, will those with better communication skills be the better doctors?


Disillusioned said...

I don't know how you define "better doctors" - I'd have thought good communication skills were an essential quality (one of many) to being a good doctor. I am sure to a certain extent it depends what type of doctor you are (good communication skills being central, for example to those working in psychiatry; arguably less central to those working in surgery) but I still feel communication is an essential skill for all doctors to develop. And I say that having been on the other end of both good and less than good communication!

dr_dyb said...

Good communication skills is important - it makes the patient feel at ease and more relaxed which in turn help your build a rapport more quickly, the rapport is important because they need to trust you in order to tell you things, which are personal to them slightly embarrassing, and that they maybe haven't told anyone else. This has payback if/when you come to discharge a patient and you know more about their social situation and can help to get suitable support in place for their discharge.

In the community it is also important because if you build rapport quickly, and the patent gives you the information you have more time to discus the substantive issue and possible management and still complete the consultation within the 10 minute window!

Empathy is one of the few ways you can show you care about a patient.
The style of your Comms skills sounds quite odd, but it could just be that i am used to ours which is part of our vocation clinical and communications skills thread which runs through all 5 years, and involves numerous short consultations.

The Shrink said...

Communication is, obviously, key to what we do as medics.

Whether it's getting information, explaining, advising, convenying info to colleagues, our world is all about communication.

Breaking bad news, usually, isn't instant. If someone's got uncurable pain/cancer/unwanted pregnancy or whatever, usually the communication is a process. So breaking bad news is part of that process, not one one off event.

If we're honest with our patients, breaking bad news can become a straightforward and easy part of our work. In part it may be because in psychiatry we're particularly communication focussed but even when I was a GP and when I worked in a hospice I found breaking bad news to be pretty straight forward and not a daunting or difficult task. As we're doing investigations we're honest, so after history/examination we're formulating "It may be infection, it may be inflammation, it may be something more serious." We send for baseline investigations, as results come back excluding stuff we're honest, "it could still be something simple, but we need to look for serious causes of this." On sending them for diagnostic confirmation, since it is confirmation, I'm honest and would say something like, "I'm prepared to be surprised, but it's likely that this is something serious so we're doing blah." Depending on the patient, vocabulary changes. Some need to hear words like "sinister" early on, some only want to hear "cancer" when it's certain, but the process of preparing them for the honest truth of it is best done as a process and not as a one off consultation.

RTAs and the like aside, most of our bad news is a longer term process which, with experience, you'll find your own style for. Done well, it's satisfying and a job well done. But don't sweat it, you need to cut your teeth before you can really get the skills.

PhD scientist said...

Have personally been the patient of some surgeons with, erm "patchy" communication skills.

What the patients want, with reason, is skilled surgeons who are also good communicators. That is certainly the kind of surgeon medics recommend to friends and family "Oh yes, Mr X, he's an excellent surgeon AND he talks to his patients"

While a shit-hot surgeon who is a rotten communicator is preferable to the reverse for actually doing surgery, the problems I have heard of usually arose when it wasn't clear-cut that surgery was really the right course of action. Under those circumstances, the communication skills must be the key to sorting out if surgery is what the patient needs / wants - a classic example would be disc surgery for back pain.

If I have a bugbear with the surgeons I and my family have encountered as patients, it is that a few too many of them for comfort gave out a sense of being focussed on "Are you a candidate for my surgical list? Answer Y or N"