Final Report > Chapter 23: Respect and Honesty > Communication skills: overcoming the barriers to effective communication > Improving the capacity to communicate

Improving the capacity to communicate

34 Given all the various difficulties in communicating effectively, it is no surprise that there has emerged among healthcare professionals a mentality of compartmentalising communication into specific tasks, for example, gaining consent to an operation, giving bad news, gaining consent to a post-mortem. In fact, of course, this approach is the very antithesis of communication. It proceeds on the basis of there being a discrete, single matter to discuss, all other matters being off the point. This may appear to be cost-effective in terms of professionals' time. Also, it allows them to control the exchange, if such it is, and thereby limit their exposure to that which is discomforting. But ultimately it is not effective because it falls short of meeting the legitimate needs of the patient.

35 There is evidence that nurses are exposed, in their education and training, to a range of communication techniques and skills. The same cannot be said consistently of medical education and training which, even today, does not give sufficient significance to communication skills. In many medical schools they are still regarded as soft `add-ons' to what is, in essence, a scientific education. The extent to which education in communication skills, such as it is, is carried through into post-registration training is also highly variable. Whereas for trainee GPs, communication skills form an integral and significant part of their training, this is not so for most doctors training to be hospital specialists. The result is that, all too often, senior hospital medical staff opt out of the job of communicating adequately with their patients. The point we seek to make is that virtually every encounter with a patient involves communication, and thus it should be good communication. It is not enough for the consultant to rely on the nurse or the GP `to do all the talking'. Crucial as they are, nurses and GPs should not be used as a means whereby a consultant can avoid engagement. That said, healthcare professionals do not act alone; we were persuaded by the submission from the Royal College of Nursing that, in addition to those `in the front line' who communicate with patients and serve as `the companion on what is often a difficult and lonely journey', there should also be others who can provide support. Counsellors, patients' friends and others can play an invaluable role in giving and explaining information in a non-technical manner. [29]

36 The way forward lies in understanding that two quite distinct developments must take place. The first challenge is to foster, encourage and shape the attitudes of healthcare professionals, both as they enter and as they progress through the profession. The second challenge is to reinforce the attitudes of openness and preparedness to communicate by offering appropriate training in the relevant skills. As regards the development of what we might call the `right attitudes', the starting point must be the selection of young people to be educated as healthcare professionals and then the education which they receive. The challenge is to maintain and build upon the attitudes which those starting out on a career in the NHS undoubtedly possess or aspire to: the values of caring, of comforting, of supporting and of truthfulness and honesty. So far from being blunted or lost, these qualities must be cherished and shown to be the true cultural tradition of healthcare. Equally, the challenge is to allow professionals already in the NHS to reclaim these attitudes by having the time, space and resources properly to care for their patients.

37 As regards training in communication skills, future doctors, nurses and all other healthcare professionals must be prepared adequately during their education and training. Priority must also be given to appropriate training in and the regular development of skills for those currently in practice. A comprehensive approach is called for. Communication skills are generic: they should no longer be packaged as though communicating was a series of discrete tasks which can be rehearsed and repeated with limited personal engagement. Communication skills go much wider than just the giving of factual information, the giving of bad news, or the obtaining of consent. They include listening skills, an ability to understand, to elicit and to assess how much information a patient wants, and not least the capacity to engage `in a normal human way'. Communication skills are crucial to enabling healthcare professionals to fulfill their professional duties: without such skills they are left ill-equipped to care for patients, in the fullest sense. [30]

Footnotes

[29] Seminar 3. The Royal College of Nursing. Position Paper

[30] See Chapter 25 on Competent Healthcare Professionals