----- Original Message -----
From: "Michael Stewart"
Subject: Re: Decline of Anatomy
> >> 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'
> 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?
Ah, but is this simply poor communication? I believe this, very common,
scenario represents dysfunctional reasoning, a basic breakdown in logical
analysis of a case. I frequently see juniors writing long-winded notes on
patients, going into mind-boggling and irrelevant detail, just because
they're on automatic pilot (I think). You might call that poor
communication, but I see it as knowledge, or at least comprehension,
failure. They're failing to see what's important in the case, failing to
analyse, to prioritise and ultimately to sell the salient features. I
suppose the above case is a good example of the senior being "monosyllabic",
yet he gets his message across more effectively. But to call this
communication skill misses the point I feel. The senior has a better grasp
of the pathology and the logistics of health care, that's all.
> I don't think that I agree with you here. Possibly some people have the
> potential to become good communicators and others don't, but that's not to
> say that they will have the ability fully formed at age 18/23/whatever.
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. Some of the
best
> trainers that I know openly admit that they have improved with experience,
> and didn't stand up for the first time and reel off a perfect talk!
OK, I've gotta accept that we can all improve with experience, I'm not so
sure about training though. For example, I've been through the ALS
open/dialogue/closure training; it's total crap, teaches you nothing about
how to actually teach. You may however improve from watching others and from
experience, which you will pick up on these courses.
> A potential doctor needs to have an attitude of being willing to
> communicate, certainly. This attitude is not the same as having the skills
> to do so.
OK, but should we be rehearsing how to speak to patients? They're human
beings for Christ's sake, shouldn't be any different from speaking to your
relatives or friends. Do we really need to go on courses to learn this? And
if we do, then isn't something seriously wrong? God forbid that we start
treating our patients like customers; next we'll have to go on away-days to
optimise our client-care efficiency.
Adrian Fogarty
|