Doctors and patients need to have ‘the talk’ every time

Every time a patient seeking a second opinion asks, “Why didn’t he/she just say so?” I smile patiently and say it is all right, but it reminds me that we, doctors, need to do a better job of communicating with our patients.

Though communication skills are taught in medical school, their importance is not emphasised as much as it should be.

FLIES OUT THE WINDOW

So the little that doctors capture in class flies out the window once they get into practice.

I learnt this early on in my internship at the paediatric unit at the national referral hospital.

The intern doctor-on-call had to see all babies admitted to the ward, review them and take notes – a long process called clerking, that ensures that all medical details are fully documented for reference throughout the patient’s stay in the ward.

One bad night, we admitted 64 very sick babies. The ward was chaotic, with nurses settling the babies, giving medication, setting up infusions and oxygen masks and measuring out special feeds for the malnourished babies.

We made incessant calls to the intensive care unit, trying to get space for the very sick ones, in vain.

The unit was already full, with patients who had undergone open heart surgery as part of a special medical camp that was going on that week.

AUTO-PILOT

After the first 30 or so clerkings, I switched to auto-pilot.

The questions asked of the mother after establishing why the baby was in the ward are pretty standard, including the baby’s nutrition, immunisation status, developmental milestones and social environment. Asking the same questions 64 times on a cold, rainy night leaves one numb.

It is impossible to take adequate time to empathise with the mother and reassure her about her baby.

In the midst of it all, the nurses called for me frantically, to help with resuscitating some of the babies who were deteriorating quickly.

MASKED EMOTIONS

We stoically masked our emotions, so that we could face distraught mothers and break the sorrowful news, whenever we lost the battle and the little angels left us.

Such is the life of a doctor. Effective communication in a field dealing with life and death every day requires time and patience.

However, none of these are available especially in public hospitals where doctor-to-patient ratios are too high.

Attending to 70 patients a day at the outpatient diabetes clinic means that by your 40th patient you are no longer an effective communicator.

Proper communication skills fade in the background of starvation, overwork, fatigue and desperation.

You are reduced to a series of nods, grunts and monosyllabic responses.

Your goal at that point is to ensure that all patients are seen, prescriptions refilled, infections addressed and the very sick sent to the ward for admission. To make matters worse, is the frustration at not being able to provide what the patient needs due to systemic issues that are beyond your control as a doctor, and lack of a supportive system to promote proper communication between doctors and patients.

This communication gap means that patients cannot effectively participate in their care because they are not fully aware of what ails them.

They cannot make informed decisions while complying with the laid-out care plans, leading to bad outcomes and overall dissatisfaction.

Doctors lack fulfillment from a job well done, may miss out on critical information, that could alter patient outcomes, and form bad habits that persist throughout their careers.

It is no wonder that more than half of medical malpractice cases filed in Kenya arise from communication deficiencies between doctors and patients. Bridging the communication gap will lead to better health outcomes; therefore, barriers must be brought down to create environments where good communication thrives.

It is every patient’s right to be adequately informed about their health issues in a language they understand and at their level of understanding. Remember, there are no difficult patients, just patients in difficult circumstances.

For doctors:

Listen to the patient and be empathetic, ask them about their concerns and expectations

Be attentive, study the patient’s body language and facial expressions as they describe the illness

Focus on providing information and guiding the patient on what he/she can do to make things better along with the prescribed medication and treatment

Explain the tests and results, diagnosis, treatment options, benefits, side effects, alternatives, medication, lifestyle changes required, etc. and make sure the patient has understood.

Encourage the patient to ask questions

Work with a team of other healthcare workers such as pharmacists to explain medication, social workers to counsel

For patients:

Ask for explanations when you don’t understand.

Ask questions about your diagnosis, treatment and medication: What is that test for? Why do I need this treatment? Are there alternatives? What are the possible complications/side effects? Will this medicine interact with my other medications?

Know your family health history and create your own health history including current conditions, past surgeries and illnesses

Bring someone along to your appointments if necessary, take notes and rehash what the doctor said, just to make sure you understand