> > I spend half my time
> > now reassuring patients who do not "believe" my
> > SHOs' opinions! And it's
> > funny, my verbal communcation is often
> > mono-syllabic, yet my patients seem
> > to believe me; I can't explain that...
>
> It is probably their comunication skills that are at
> fault not their knowledge. I would guess it is your
> non verbal communication that is more convincing than
> the SHO's.

Hang on here. Bit of flawed logic here. The point is not whether a better
communicator can communicate better (on which we're all agreed) but whether
medical school training in communication skills makes a better communicator
(which on the evidence it might not)

> >----- Original Message -----
> >From: "Howarth, Paul - RCHT"
> >> Junior doctor, 'I have this little old lady who has had a
> fall, I am not
> >> sure if she has had a stroke or has a sub dural and she
> lives alone' etc
> >> etc (long and irrelevant details follow)
> >> Radiologist, 'Sounds like it can wait' etc
> >> Sen A/E, 'I have a year 65 old who has had a fall, she has
> hit her head
> >> and has a GCS of 8'
> >> Radiologist, ' put me back to switch, I'll get the
> radiographer in to
> >> warm up the scanner and I'll be there shortly'
> >
> >I had to laugh when I read your description Paul, how true!
> Sadly the long
> >and irrelevant details permeate the modern SHO's notes as well!
>
> In the case of the junior doctor, would you not describe this
> as a failure
> of communication, not of knowledge? In the scenario
> described, both the
> junior and senior recognised the need for a scan, but a more
> experienced
> person was better able to communicate that need. The example refers to
> doctor-doctor communication, but surely the principle extends
> to doctor-
> patient communications also?

Slightly different logical flaw here. Mainly semantic. You use the term
'communication' in its broad sense of assimilating facts, summarising them,
drawing appropriate conclusions and communicating these conclusions to
someone else. In that sense it is a failure of communication. What is taught
in medical schools under communication skills is only the last part of that.
In this case, therefore, communication failed due to a lack of knowledge not
a lack of 'talking skill'. Teaching less basic science and more talking will
worsen this problem not improve it.

> To return to my SHOs, take a simple example, the ubiquitous
> sprained ankle.
> I cannot bear to see them examining the neurovascular status,
> or "active and
> passive" range of movement, in these patients, let alone
> documenting this,
> and if they mention this to me in consultation along with all
> the other
> irrelevant negatives it drives me mad!

Agreed. Failure of communication brought on by lack of knowledge and lack of
focus will be improved by more training in basic science and diagnosis
rather than 'communication skills' in the narrow sense in which they are
taught.

> For
> instance, I've been involved in first aid training for a few years, and
> it's often very noticable that a new instructor will improve as a
> communicator with each course that they are involved with.

Sure, that's how you learn communication skills. Start with adequate
knowledge of your subject then get on and communicate. Now if you argued
that your instructors started as good communicators and then declined as
they moved away from the course they were taught on I'd believe you.

> Lastly, I totally agree with the shift of medical school
> training towards
> better communication. After all, what is the commonest cause
> for patient
> complaint and hence the time consuming process of investigating these
> complaints???? However, everything has to be of a balance and
> basic sciences
> are still important.

You're missing out a step here in your argument. As far as I can make out,
you're arguing 'Many complaints centre around poor communication rather than
lack of basic science knowledge. Therefore poor communication skills are
more of a cause of error than lack of basic knowledge. Therefore we should
teach communication skills at medical school at the expense of basic
science.'
Couple of flaws:
1. Perceived poor communication is not necessarily due to poor communication
skills. It may be due to pressure of time or lack of basic knowledge.
2. Volume of complaints rather than seriousness of consequence of error is a
poor way of judging priorities. It is possible that lack of basic knowledge
will result in more serious errors (if less frequent) than poor
communication skills.
3. There is no evidence that teaching communication skills at University
improves communication. (The evidence that a firm grounding is basic science
improves diagnostic acumen while anecdotal rather than based on RCTs does
exist)

Each of these points has to be disproven for your argument to hold.

Matt Dunn
Warwick




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