Posts Tagged ‘Communication’

A psychiatrist’s tale of going under the knife

By Dr P Grahame Woolf, consultant psychiatrist - 2nd March 2010 10:30 am

Doctors are notoriously bad patients. Before undergoing two cataract operations, I heard that familiar joke. Cataract replacement, with a 98% success rate, is one of the triumphs of modern medicine; would that psychiatry could come near to equalling it.

Cataract surgery is now generally performed under local anaesthetic, which provides the patient with a different perspective.

My initial assessment was a model of how these things should be, but pressures in the eye unit later undermined the ideal. The consultant surgeon conducted a thorough examination. An additional problem, double vision, was then explored by an orthoptist, who explained everything well. They recommended surgery on both eyes. I signed the consent form and was sent to book the operation. The booking clerk said there was a cancellation slot the next day, which I gladly accepted.

On arrival I was surprised to find myself under a different consultant surgeon with no explanation. I was seen by a nurse and then by the new consultant’s specialist registrar who would be doing the operation. The examinations were quick, mainly form-filling exercises. I learned that there was no operating list schedule, and that patients would be called to theatre in no particular order. As it happened, I was the last one, some five hours after the arrival appointment; no food to be taken whilst waiting. 

In the theatre ante-room there was repeat paperwork to eliminate risk of error; confirmation that I was the right Peter Woolf (not Dr, the IT didn’t have provision for that option); date of birth, which eye was to be done, etc.

Inside theatre, the scene was intriguing, with elaborate hi-tech machinery. I was laid down flat with my face covered, so one could not see what was going on. Background music played. The injections and processes were virtually painless. They involved what sounded like a dentist’s drill in one’s eye; you could feel it, but nothing hurt.

However, at one point, I sensed that all was not right. The consultant surgeon himself came in and took over, and the procedure extended to what felt like twice the expected duration, before on completion the team expressed relief and satisfaction.

Nothing at all was said to me throughout the lengthy process. Afterwards the consultant explained that because the new lens which had been inserted proved to be a faulty one, it had to be replaced, apparently a tricky exercise. The anomaly was so unprecedented that he had never encountered it before. The abnormal lens would be returned to the manufacturer with a complaint.

Next morning I returned to the department and the bandages were removed. Two sets of eye drops were supplied, to be taken alternately, hourly for a fortnight. It was a relief to have two eyes again.

At the follow-up clinic a fortnight later there was paperwork again, to plan for the second operation. It all seemed de novo. I was asked: “Do you want it done? It’s entirely up to you”, as if the decision had not already been made. The same risks explanation, as per the leaflet supplied, and a second consent form to be signed. In that rushed interview in a busy clinic there really was no time for, or encouragement to ask, pertinent questions.

Once again I was sent to arrange the second operation with the bookings clerk, from whom I learned that for various reasons the first opportunity would be several weeks later. On enquiry I learnt however that my original consultant could to do it the next week, so the clerk went off to explore whether I might be re-allocated to the original team, with which I had experienced such good rapport.

She returned to tell me firmly that was not to be, “you’re now under Mr X and must stay under him”.

Whilst waiting for the second operation recovery continued steadily, with the gratifying experience of regaining colour clarity and brightness, which I had been losing over the years without realising. Between the two operations grey morning skies seen through the right eye became blue through the new left lens.

At pre-examination before the second operation the same routine was repeated, with people in the clinic behaving as if they did not recognise me. I mentioned having not being told what had been happening during the previous prolonged operation. The response was: “No, we don’t talk to the patients in case it makes them more agitated”. I said that for me, the opposite would apply; written note was taken of that preference.   

In theatre again the atmosphere was tangibly less relaxed than the first time. The consultant was present throughout. The theatre nurse sounded less confident than the previous one.  After some time things began to sound fraught.  There were problems with the new lens; another was needed: “Should it be the 70 or the 70.5?” Some equipment available was not as wanted: “the straight one, not the curved one”. No reassurances or explanations were addressed to me.

Eventually all was complete. Sitting up again I was assured that the operation had been completed, technically perfectly. Surrounded by all the high-tech equipment I said that, being a doctor myself, it would be interesting to watch one of these cataract operations in theatre. The SpR thought that would be “against rules” but that I could look them up on the internet. 

During the evening, worrying visual manifestations occurred. The bandaged eye produced a coloured show, with bright, kaleidoscopic effects which somehow swamped the vision of the other eye. A thing like a shimmering coloured table cloth appeared - scary! My worried wife phoned the help number provided for nurse advice but failed to get through. 

On the next morning - as the great freeze of 2010 got under way - I returned early to the hospital, worrying whether the retina might have been affected (detached retina is one possible complication on the patients’ leaflet).

I told the clinic nurse that I had a worry. She did not know me, nor that I was a doctor, as I re-iterated when asked to give my particulars all over again. “Well, I’ll put down, you like to be addressed as Dr.” The SpR saw me in due course, and reassured me that the visions were not sinister; probably some “edge optical effect” of the “very large replacement lens” they’d put in. 

Despite the typically harrassed atmosphere (the snow had disrupted travel for both staff and patients) I did pursue some questioning and received from the lead consultant, who was also at the clinic, another explanation of my bizarre kaleidoscopic visions: “just the jelly rolling around in the back of the eye - it sometimes picks up the retina a bit but only quite slowly”. I also mentioned that the atmosphere had seemed fraught at the second operation, with the nursing assistants unable to find instruments, etc?

Several weeks later, at the final out-patients review I was called in from the corridor loudly, Peter Woolf, by that same consultant (as if he hadn’t connected who I was?). Again the various people who saw me that morning seemed unaware that I was a doctor. A nurse asked how long I’d been one and seemed impressed that I answered “about sixty years”. Later the consultant reassured me that the two operations were perfectly normal “apart from circumstances”.

This is, of course, just one story; one with a happy ending, that could be widely duplicated. But the message has to be that time constraints loom large in medical practice, whether it be GP appointments or a busy specialist hospital department that is, in a way, a victim of its own success.

The staff have no time to achieve rapport with patients; instead there is an expectation that patients are totally deferential to an overly stressed clinical team. There is plenty of scope for improvement in everybody’s best interests - however busy a clinic.   

Tips on making your New Year’s resolutions a reality

By Susan Kersley - 16th December 2009 11:58 am

As we come to the end of another year it’s that predictable time for time to both reflect and look forward to a better life in 2010.

The New Year is also a time for resolutions and vowing that you really will keep to them. This year, instead of setting unrealistic goals, you could spend more time considering the way you’d really like life to be. How are you going to live with the challenges of life as a hospital doctor, and deal with them differently, next year?

Here are five tips:

1. Set clear boundaries: don’t expect others to be mind-readers. Stop yourself getting frustrated if colleagues, nurses, or secretaries don’t seem to understand what you want them to do. Maybe you’ve made assumptions and haven’t been really clear about what you are expecting from them.

2. Decide what you really want. When you know what it is you want then you will be more able to tell others and no longer have to put up with unsatisfactory performance.

3. Communicate clearly. Give a positive feedback sandwich if you are not happy with the way someone is behaving. Say something complimentary then get to the point about what it is you really want - end with something positive about them.

4. Be responsible for yourself rather than everyone else: you can’t always be responsible for others’ feelings. You may be avoiding making a decision for change because you think someone will be upset. Tell them what you are going to do and when and then allow them the chance to deal with it in their own way.

5. Improve your self-care. Stop neglecting your own needs and care of your body, mind and spirit in whatever ways are good for you.

Susan Kersley is a retired doctor and life coach.

Improving cultural awareness in your communications

Bob Mathers - 18th November 2009 10:28 am

A company, Today Translations, recently placed an advert in The Glasgow Herald seeking speakers of ‘Glaswegian’.

Candidates, it said, must understand “vocabulary, accent and nuances”. The boss insisted there was a genuine need.

She said: “We’ve already had calls including someone who said they could speak English, German, French, Spanish, Italian - and Glaswegian.”

A former lord provost was insulted, claiming: ”I travelled the world and nobody failed to understand me.” He missed the point which is that accents can create barriers and cause difficulties. Accents in themselves are fine as long as they are understood.

Within the NHS, there is still a greater likelihood of overseas qualified doctors failing in postgraduate exams and job applications than indigenous doctors. Part of this has to do with the cultural barriers encountered. Is it the case that if the appropriate vocabulary, accent and nuances go missing in action, the perceptions, expectations and assumptions of colleagues can lead to prejudice?

Historically, more delegates at our workshops have been from overseas, underlining for us the importance of clear communication. It’s obvious. You are not effective or influential if you cannot communicate clearly. Articulating, questioning and listening can all suffer because of accent. Yet we are either too embarrassed or reluctant to risk accusations of political incorrectness, to point this out.

Trainers have better opportunities to pick this up in 1-to-1 sessions. Making general observations in public and personal ones in private, works - ask any wage negotiator.

Individuals, although resident in UK for some time, can still have gaps in their communicating framework. Many, described as having a ‘communication problem’, do not have a problem at all. They just have a strong accent. Is this the tip of a cultural awareness iceberg?

In the safe environment of the training room we have people pronouncing ‘v’ as ‘w’ to the point of distracting from the content of their presentations or emphasising the second of a four syllable word when it should be the first. Amid peer discussion, practice and much laughter, we all deal with it in our own way. It reinforces for us the elemental nature of fun, although humour can sometimes be cruel.

If you’ve ever sat at a crowded table where everyone but you is laughing at something you get a sense of the loneliness of the outsider. But the transition from confused person struggling with subverted cultural norms, into a confident member of staff cannot be managed by ignoring behaviours which do not match cultural expectations.

How can we assist individuals to reach their potential? The right climate will encourage any plant to grow. Important qualities which help to create a strong performing, developmental climate are professionalism and leadership and these start with each of us.

As a recently fired trust director said: ”Byraway see thae furriners, nae affence but haufa thaim dinna unnerstaun wut we’re oan aboot. It’s a pain in the erse tryin tae get yer point acroass. Ahm definitly gaunae go fur wanna thae interpretatin joabs.” (for a translation, please contact Today Translations)

This is Bob Mathers’ final article in this three-part series on communication. Read the first and second parts.

Bob provides non-clinical communications training for health professionals. Email him on bobmathers@btinternet.com or call 07816 230 213.

Medical graduates are poorly prepared

By Mike Broad - 10th November 2009 8:16 am

Newly qualified medical graduates are poorly prepared to work as trainee doctors, a survey reveals.

The findings, published in Postgraduate Medical Journal, are based on 228 senior doctors’ critical assessment of a wide range of core skills and competencies among trainee doctors at two teaching hospitals in the East Midlands.

Trainee doctors now complete a two-year generic Foundation Programme, which forms the bridge between medical school and specialist or general practice training.

The senior doctors were asked to score how well prepared their F1 trainees were to work as doctors, six months after they had graduated from medical school, using a five point scale.

The junior doctors were assessed against most of the expectations for newly qualified doctors set out by the GMC, in Tomorrow’s Doctors, as well as 18 general criteria.

The senior doctors (107 consultants and 121 specialist registrars) scored the juniors below three on 48 of the 70 items assessed against the GMC criteria and above the midway point for only six of the 20 clinical and practical skills.

Carrying out basic respiratory function tests, prescribing, and more advanced communication skills were some of the areas where juniors performed below par.

But they scored well on basic communication skills and how to ask for help, prompting the authors to wonder whether medical schools have not “gone too far in emphasising risk management and, perhaps inadvertently, helplessness”.

The responses, which reflected a high degree of agreement between the two groups, showed that the senior doctors felt the fledgling juniors were inadequately prepared to start work as a doctor.

They said: “The findings give cause for concern. Senior doctors perceived that the undergraduate medical degree had not adequately prepared F1s for practice, especially in clinical and practical skills.”

Among other things, they call for more opportunities for ward based experiential learning and for senior doctors to be more explicit about what is expected of F1 trainees.

The GMC’s publication Tomorrow’s Doctors is also to blame. The report says: “SpRs and consultants may have inappropriate or unrealistic expectations made more likely by the lack of specific criteria in Tomorrow’s Doctors.

“In addition, the perceived lack of preparedness of F1s is further challenged by the lack of explicit criteria in the work based assessments of the Foundation Programme that F1s must pass to gain full registration with the GMC. As a consequence of the lack of specific criteria, expectations about preparedness for practice at the undergraduate and postgraduate level are not aligned and the transition between medical graduate and first year junior doctor remains highly problematic.”

The authors point out their survey provides only a snapshot of graduates from one medical school and in one area of England, so may not be indicative of trends across the UK. But they also say that their findings back up other broadly similar research.

A GMC spokesperson said Tomorrow’s Doctors had been re-launched since this research’s questionnaires were conducted.

She said: “It is important not to jump to conclusions from this study. Tomorrow’s Doctors will require that students have more opportunity to apply their medical knowledge and skills in hospitals and surgeries before they graduate. ’Student assistantships’, which are work placements, will be rolled out to help prepare medical students for the Foundation programme.

“A lot of work was undertaken to map F1 outcomes to the undergraduate competencies, including clinical and procedural skills. The GMC also agreed a revised Foundation programme curriculum and specific outcomes for F1 doctors which will give medical schools a clear understanding of what they should be preparing medical students for in the workplace.”

Communicating to influence in a multi-disciplinary world

By Bob Mathers - 9th November 2009 9:46 am

“Communications technology is shrinking the world.” But one consequence is that technology is sidelining our personal ability to communicate. Is the cause:

1. Generational? Most under-thirties are suspected of confusing communication with button-pushing and ignoring those they can’t hear for the headphones.

2. Political? Grammar was dropped from the national curriculum so fewer can structure thoughts well enough to string a sentence together.

3. Managerial? Laurence Peter’s dictum that “every employee rises to their level of incompetence”, i.e. great staff, shame about the managers.

So, how to cope with new trends like sharing more information with other professionals and patients? It’s not a big deal. It simply involves many small, delicate, personal interactions. If we took responsibility for these more often and spent less time apportioning blame afterwards, we might be better at communicating.

Some special people have the knack of touching others in ways that matter; a kind word here, a refusal to put up with any nonsense there or a willingness to waste three minutes in idle banter elsewhere in spite of grave tasks ahead. They are aware of the context and are able to create instant rapport and empathy while drawing upon superb time management skills. Call it a tactical sense, well developed antennae or supreme self-confidence, but it works.

The best of them keep a low profile; listening before speaking, not speaking without listening; asking without assumptions, not telling with prejudice; probing to the heart of the matter, not accepting bullshit.

With enough time and the right attitude you can influence anyone. Your agenda has to be open, not hidden. But the larger the organisation the more tactical you must be to succeed. It’s a fine judgement which, in the end, comes down to trust. If part of your role is to influence the next generation, they need to trust what you say to them. You can’t influence people who don’t trust you.

Consider these aspects of influencing:

1. Commitment: People are more likely to do what they commit to of their own accord. It’s the basis of the coaching philosophy. Are you able to convince others’ with the strength of your arguments, rather than the threat of your power?

2. Reciprocity: What you give is what you get back - show trust in others first.

3. Expertise: People are more likely to heed the advice of experts - do you sound as if you know what you are talking about?

4. Example: People will sooner copy what they see you do, than do what you tell them. Would you believe a politician talking about thrift and integrity while reading their latest expenses claim?

5. Liking: People like people who like them. Although a subjective claim, accept that you won’t hit it off with everyone but it helps when you can - do most of your colleagues like you?

Influence has a malign aspect too. Don’t forget that mood and attitude can often be unconsciously revealed by body language before you say a word. Tread softly…

This is Bob Mathers’ second article in this three-part series on communication. Read the first article.

Bob provides non-clinical communications training for health professionals. Email him on bobmathers@btinternet.com or call 07816 230 213.

Shifts damage communication and continuity

By Mike Broad - 6th November 2009 11:28 am

Poor communication is a significant factor in patient deaths in an emergency or urgent setting, a confidential review into the care of over 3,000 terminal patients finds.

In 13.5% of cases a lack of communication both between different grades of doctors within clinical teams, and between different clinical teams and other health care professionals was noted.

The hard-hitting report by the National Confidential Enquiry into Patient Outcome and Death also reveals two-fifths of patients received ‘sub-standard’ care, highlighting problems with the involvement of patients and their families, continuity of care and a lack of senior input, particularly at night.

Deaths in acute hospitals: caring to the end? finds that a coordinated handover of patients between night and day staff only occurred in a quarter of the teams, prompting calls for new systems that enable clinical teams to have a better understanding of a case throughout a hospital stay.

More prompt review of patients by consultants is also urged. The report claims there was a clinically important delay in the first consultant review in 25% of cases.

The report’s author said: “Change in the hospital team structure over recent years has seen individual clinicians become transient acquaintances during a patient’s illness rather than having responsibility for continuity of care.

“Staffing arrangements and shift working have also been shown to be disruptive and with the implementation of the European Working Time Directive, this disruption is likely to continue and to impact on the training of tomorrow’s doctors.”

In 16.9% of patients who were not expected to survive on admission there was no evidence of any discussion between the health care team and either the patient or relatives on treatment limitation. In 21.8% of cases DNAR orders were signed by very junior trainee doctors.

Mr John Black, president of the Royal College of Surgeons, blamed multiple handovers. “This report highlights the loss of proper team working in hospitals, resulting in dangerous failures of communication which make it harder and harder for clinicians to provide safe care for patients,” he said.

“The problems revealed in this report date from 2006 and 2007, when the NHS was already struggling to meet the demands of a 56-hour working week. Now that, in theory, everyone in the NHS is working for only 48 hours the situation in the country’s hospitals can only have worsened.”

The college called for an opt out from the WTD so that ‘proper’ clinical teams can provide on-call cover throughout a 24-hour period.

Read the full report.

Tips on how to open better channels of communication

By Bob Mathers - 21st October 2009 7:48 pm

The biggest barrier to communication is other people. We know they are affected by moods, stresses, hidden agendas, personal insecurities, etc. While we cannot change their personality, focusing on the issues instead while communicating can help.

Collectively, it might be possible to do something about how their negativity affects our own ability to communicate. One idea is from internet technology, specifically the world of Massively Multiplayer Online Games. For those unfamiliar, these are games played simultaneously by thousands of players on the internet using PCs, smart phones or consoles. The players learn to ‘interact meaningfully’ i.e. cooperate and compete on a large scale in real time.

Is this concept familiar? What is interesting is that players across the world have developed a self-policing way of dealing with individuals who slow things down, behave annoyingly or disrupt progress. They establish rules like the ‘No Asshole Rule’ or ‘Don’t be a Dick’ (as in an abrasive and inconsiderate person of either gender). Dicks, for example, have an exaggerated sense of their own importance, refuse to follow the normal rules of social behaviour and often change their views as occasion demands so they are difficult to rely upon.

The vulgarity is deliberate. It is to distinguish etiquette from matters of broader concern i.e. anti-social behaviours. Could we do something like this?

There are enough barriers already without our having to put up with individuals who poison the atmosphere and sap everyone’s energy. Political correctness in the NHS may discourage this kind of approach so look first at a related barrier, language.

This can cover accents, use of slang and jargon, and the cultures these represent, and unusual manners or poor handwriting (it’s not just doctors). Accept that it is an imperfect, confusing, multi-cultural world so perseverance, tact and timing are required.

Timing is asking for assistance at the right time, not making a mess of it quickly on your own. It is easier to sort out small problems at the beginning rather than major incidents at the end.

Better listening would help. How do we do this? Here are basic ideas, culled from our last dozen workshops. They emphasise two things: A. what’s on people’s minds and B. how easy it is to kick start the process of improving without much effort.

Here are some of the behaviours that help:

1. Stay quiet; stay still; maintain eye contact.

2. Always be open and show it in your face and body language.

3. Adopt a receptive posture/attitude; mimic others’ body language if you need.

4. Avoid interrupting; allow others to finish speaking; don’t keep thinking about what you’re going to say next instead of listening.

5. Observe and question judiciously as part of the listening process.

6. Ask when you need clarification; nod to confirm understanding.

7. Try to keep assumptions in check; be prepared to change your mind.  

8. Empathy (“I understand”) not sympathy (“I agree with you unconditionally”).

9. Summarise often but stop a discussion when it overheats.

10. Think tactically - a discussion with colleagues often has a purpose.

11. Rehearse possible conversation scenarios in your mind beforehand.

12. Remember their name - it is an individual you’re talking to, not a number.

This is Bob Mathers’ first article in this three-part series on communication.

Bob provides non-clinical communications training for health professionals. Email him on bobmathers@btinternet.com or call 07816 230 213.

Tips on cutting medical jargon and improving communication

By Dr Emma Cuzner, MDU medico-legal adviser - 17th August 2009 11:24 am

Doctors and the NHS were criticised recently for using “inaccessible language” by the Plain English Campaign.

The growth in management-speak in the NHS - with such phrases as “service users” and “disinvestments” - has the potential to confuse patients. A spokesperson for the campaign suggested that some doctors might also need to address the way they communicate with patients.

Most doctors recognise that the success of their relationship with patients is largely determined by their ability to communicate clearly and effectively. Doctors generally try to avoid using complicated medical terminology to describe medical conditions and treatments, but it is easy to forget that medical terminology may seem alien and off-putting to a layperson.

They may not understand what you are saying and failures in communication can translate into medico-legal problems. For example, patients who say they were not clearly warned about possible complications of a particular procedure are a common theme in complaints and claims notified to the MDU. 

The GMC devotes a section of Good Medical Practice to communicating effectively with patients. It says that doctors must listen to patients’ views and respond to their concerns; explain to patients their condition and the treatment options in a way they can understand; respond to questions and keep patients informed; and ensure patients are informed about how information is shared among the healthcare team. It also says that doctors should ensure, “where practical that arrangements are made to meet patients’ language and communication needs”.

The following tips will help doctors avoid communication problems:

1. Try to explain your diagnosis, proposed treatment and any relevant risks to patients in a way they can understand and give them a chance to ask questions. If you wish to examine the patient, you must seek permission and will need to explain why it is necessary and what you intend to do during the examination.

2. While you talk, watch for appropriate acknowledgements and/or signs of any confusion. Remember, you understand medical terms that may mean nothing to many patients, such as anti-emetic or hypertension.

3. Try to resist the urge to interrupt but regularly acknowledge what patients are saying. To check that you understand what a patient has told you, repeat it back to them.

4. If a complaint is made, listen carefully. Before responding, make sure you understand the nature of the patient’s concerns. When providing a written response to a patient’s complaint it is important to use clear language to explain the treatment that was provided and the doctor’s clinical decision making in an attempt to resolve any misunderstandings that the patient may have.

6. If something has gone wrong, explain to the patient as soon as possible what happened, why it happened and what steps you have taken to prevent it happening again. Be ready to apologise, if appropriate.

7. The use of abbreviations should be avoided wherever possible, both for the purposes of clarity and ensuring patient safety when the records are used by other clinicians caring for the patient, and for the avoidance of doubt if these records are required later for medico-legal purposes.

The MDU has also launched Communication Skills for Doctors workshops to explore alternative and practical ways of thinking about communication with patients and colleagues.

Grounded by lessons in communication

By Stephen Campion, chief executive of HCSA - 26th June 2009 2:00 pm

Thank goodness it’s Friday I thought as I left an HCSA council meeting last week preparing for the 4.25pm flight from Leeds to Southampton.

The flight actually left at 9 o’clock that evening and arrived at 10.15 pm. Flybe (or as I now call it Flymaybe) claimed that the delay was due to a “technical failure” which cut no ice with my fellow passengers, many of whom said that this was a frequent occurrence - particularly when insufficient passengers had bought tickets to make the scheduled flight economic.

I thought about this when I received an email this week from a consultant asking my views on who should tell a patient that his/her operation had been postponed. Should it be the doctor, manager, ward clerk, nurse or patient liaison officer? So far as Flybe was concerned the answer is simple; no-one has that responsibility. All the information you need to know is on the departure board which unhelpfully read “waiting” or some similar unhelpful advice.

And the NHS? Communications are important. Of course the patient must be told why the operation had to be postponed; ideally the patient should be warned that this could happen and be reassured as to future treatment and care. Communications are vital in the NHS, not just the doctor/patient relationship but in the wider context of its management.

And then I read in the Health Services Journal about how foundation trusts are facing real difficulties in this recession: The chief executive of one NHS trust with a large PFI scheme told HSJ there was “absolutely no way” the trust could take forward its plans for a new hospital and still achieve foundation status.

The chief executive asked not to be named as the trust does not want to anger Monitor in advance of its application for foundation status, but said: “What they have effectively done is cancel the rest of the PFI pipeline. I’m not even sure the Department of Health knows what’s going on here.”

Well I doubt that Flmaybe can learn from the Department of Health - but like the anonymous chief executive I do wonder what is going on now we have left the era of boom and entering one of bust. Perhaps we will be told!

Ethnic minorities more critical of NHS services

By Mike Broad - 17th June 2009 9:36 am

Black and minority ethnic groups are less likely to report positive experiences about health services than white British counterparts, a Department of Health report reveals.

BME groups were more negative about questions relating to ‘access and waiting’, and ‘better information and more choice’.

These findings from the National Patient Safety Survey, which include responses from people accessing the emergency department, primary care, community mental health and inpatient services, have changed little since the previous report in May 2008.

The biggest differences in response between BME groups and white British counterparts were in primary care.

Patients from Asian and Chinese groups were least likely to give positive responses. Results for black patients were mixed, although they were slightly less likely to give positive responses, particularly in primary care and A&E surveys.

Commenting on the report, Dr Raman Lakshman, BAPIO’s vice chair of policy, said it was difficult to fully know the reasons for the disparity but suggested it could relate to problems with expectation and communication.

“Some BME patients may find it difficult to communicate their concerns to doctors and some doctors may find it takes longer to communicate clearly to some BME patients,” he said.

“However equality of care is enshrined in the NHS and it may be reassuring to BME groups if they find this explicitly stated as part of the GMC’s Good Medical Practice.”

Professor Bhupinder Sandhu, co-chair of the BMA’s equal opportunities committee, said: “Cultural background needs to be taken into account - there are gaps there and they need to be addressed.

“Medical and nursing staff need to be aware of diversity issues in health and bring about change.”