The MDU has developed new guidance for doctors embarking on their first consultant post. In the second of a series of articles guiding you through the more common non-clinical challenges you might face, Dr Sally Old, MDU medico-legal adviser looks at the challenges of communicating well with patients and relatives.
Communication challenges
Any doctor who has ever experienced hospital care from the other side of the fence - as a patient - will appreciate the importance of good communication. A doctor who explains your condition, the possible treatments, their risks, benefits and any alternatives and who answers your questions clearly and honestly, is likely to instil you with confidence and trust.
But effective communication is not always straightforward in a modern hospital environment. Care is often provided by teams of doctors and other healthcare professionals, working in shift patterns and there is the potential for communication to suffer as a result.
Patient privacy
Ensuring privacy in open wards can be difficult, especially where visitors are present and curtains are the only barrier to a conversation being overheard by people in neighbouring beds. If you need to discuss a sensitive issue, you might want to consider finding a private area or office. If you are breaking bad news, try to avoid interruptions, for example, by handing your bleep to a colleague for a few minutes and turning off your mobile phone.
Patients with special needs
Special consideration needs to be given to patients with specific communication needs, for example, patients who do not speak English, people with a hearing problem, patients who lack capacity and children.
For patients who don’t speak English, you may require an interpreter. Sometimes a family member can act as a translator, but this may not always be appropriate. For example, a family member may be reluctant to tell the patient complex information about their illness. It may be necessary to use a professional interpreter for key discussions, such as when discussing the risks and benefits of treatment or giving information about the prognosis of a serious illness.
If talking to a person with a hearing problem, it may help to use a quieter office or private area to avoid the background noise of a busy ward.
People with impaired capacity should be given all practicable assistance to understand and contribute to decisions about their care. They might need the help of a trained advocate or family member.
When dealing with children, care needs to be taken to explain things in an appropriate way. Older children with sufficient maturity will be able to take decisions about some aspects of their medical care.
Communicating with relatives
Appropriate communication with the patient’s family, friends and other carers is also important. The patient’s nearest and dearest often provide invaluable reassurance and support to their loved one and they will want to be kept informed so that they can understand how best to help.
However, any information provided to a family member must be within the context of the duty of confidentiality owed to the patient. Often patients will appreciate you speaking to their relatives and updating them of events, but don’t assume this is always the case. The GMC’s Confidentiality (2009) guidance now includes a section entitled ‘sharing information with a patient’s partner, carers, relatives or friends’.
The GMC says it is important to establish early on what information the patient would want to be shared, in what circumstances and with whom.
The basic principle is that you should only disclose confidential information about a competent adult patient if they consent for you to do so. This means you should seek permission from the patient to speak to their relatives. The patient will need to know what you intend to discuss with their family before they can give informed consent. Make sure they are aware of this includes aspects of their medical history that are relevant to the current illness but which may be sensitive, for example, certain infectious diseases or termination of pregnancy.
It can be helpful to have discussions with family members in the presence of the patient to avoid any confusion about what you have said.
Principles of good communication: at a glance
1. Explain yourself - make sure your patient knows who you are and your role in their care. It might sound obvious, but time spent explaining who you are and why you have come to see the patient, and checking they have understood your explanation, will help your consultation.
2. Keep it open - when taking a history or seeking patients’ views about their care, ask open questions. Try not to interrupt but regularly acknowledge what patients are saying.
3. Double check - repeat back what a patient has said to you to check your understanding. Check the patient’s existing understanding of their illness if you are covering a sensitive topic or communicating complex information and check that the patient has understood.
4. Look for clues - look out for non-verbal clues such as the patient nodding or looking confused or distressed. It’s also important to make eye contact.
5. Don’t presume - avoid medical jargon which will mean nothing to your patients. Consider using visual aids such as diagrams when explaining procedures and risks. Record your use of these in the notes.
6. Be considerate - avoid over familiarity and be polite, even if you are extremely busy, under pressure or tired. Give the patient a chance to ask further questions and explain what will happen next.
7. Make notes - record what has been said to the patient and what you found on examination. Sign and date your notes clearly. Good notes that are legible, accurate and written while the facts are still clear in your mind, are essential to continuity of care. For example, your colleagues may need to know what the patient has been told or which family members the patient is happy for the team to talk to.
The MDU’s new consultant pack contains 18 fact sheets on subjects such as communicating with patients and colleagues, good record keeping, supervising staff and marketing and media. It’s available free for MDU consultant members.
