Most people have a furious itch to talk about themselves and are restrained only by the disinclination of others to listen. Reserve is an artificial quality that is developed in most of us as a result of innumerable rebuffs. The doctor is discreet. It is his business to listen and no details are too intimate for his ears. W SOMERSET MAUGHAM (1874–1965), THE SUMMING UP
In the art of medicine there are three factors—the disease, the patient and the doctor … It is not easy for the ordinary people to understand why they are ill or why they get better or worse, but if it is explained by someone else, it can seem quite a simple matter—if the doctor fails to make himself understood he may miss the truth of the illness.1
Francis Macnab, Doctor of Divinity and patient, wrote: ‘The style of the doctor, the communication of the doctor and the person of the doctor at the level of primary contact and primary care can be crucial in a person’s life.’2
Much of the art of general practice lies in the ability to communicate. Listening is generally regarded as the most important skill.
Research continues to focus the ‘blame’ for communication breakdown on the doctor, ignoring the role of the patient.3
Communication can be defined as ‘the successful passing of a message from one person to another’.
There are five basic elements in the communication process:
Important principles facilitating the communication process are:
the rapport between the people involved
the time factor, facilitated by devoting more time
the message, which needs to be clear, correct, concise, unambiguous and in context
the attitudes of both the communicator and the recipient
These elements and principles can be seen emerging in various phases through the consultation, as illustrated in FIGURE 3.1.
The sequence of communication in the consultation
Reproduced with permission from Macy Initiative on Health Communication, New York University School of Medicine.
Communication in the consultation3,4
Communication in the consultation can be considered in the following sequence:
The doctor requires appropriate communication skills for complete diagnosis (physical, emotional and social) and competent management. It is important to be aware of the patient’s cultural background and educational level, and allow for these factors. The majority of interaction between doctor and patient occurs in the traditional consultation. This involves both verbal and non-verbal communication.