Final Report > Chapter 23: Respect and Honesty > Communication skills: overcoming the barriers to effective communication > Awareness
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Awareness
30 Time, however, is not the only factor. The attitude which the clinician brings to an encounter with the patient also matters greatly. As we were told in Phase Two by the Royal College of Surgeons:
`Whilst the pressures on time undoubtedly contribute in some instances [to poor communication], the style of practice, sensitivity and personality of the surgeon are equally important.' [25]
31 This point was developed in an expert opinion commissioned by the Inquiry from Jean Simons, Head of Bereavement Services at Great Ormond Street Children's Hospital. Drawing on extensive research into parents' and patients' experience of the communication skills of healthcare professionals, she wrote:
`It was most patients' experience that although doctors thought in their interviews they were giving time and space for the patient to express their feelings, they were on the whole preventing the patient from doing so by their own need to give information (as they thought the patient needed to hear), changing the subject, offering premature and inappropriate reassurance, and insisting on their own agenda prevailing in the interview rather than partnering the patient in the discussion.' [26]
32 Thus, a further problem which needs to be recognised is that communication is not easy. The patient may be apprehensive. The doctor may be anxious to do a good job and may not be sure how much the patient wants to know or how much he or she should be told. Breaking bad news and dealing with bereavement is always hard, for the doctor as much as for the patient. Nowhere was this more evident in Bristol than in relation to communication about post-mortems. As Mr Dhasmana told the Inquiry:
`This used to be a most difficult period ... I was always emotional during this meeting and the only way I could really, just, you know, express it was quickly get to the point. ... It used to be very difficult for me to communicate very well at that time.' [27]
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Footnotes
[25] Seminar 7. The Royal College of Surgeons of England. Position Paper
[26] 10k Simons J. `Giving Information to Parents with an Unwell Child', Annex B