Clinical Communication in Medicine

Jo Brown, Lorraine Noble, Alexia Papageorgiou, Jane Kidd, Jo Brown, Lorraine Noble, Alexia Papageorgiou, Jane Kidd

• Publisher: Wiley-Blackwell
• Year: 2015
• ISBN:
  9781118728215
• Edition: 1
• Topic: Medicine
• Subtopic: Clinical Medicine

Highly Commended at the British Medical Association Book Awards 2016 Clinical Communication in Medicine brings together the theories, models and evidence that underpin effective healthcare communication in one accessible volume. Endorsed and developed by members of the UK Council of Clinical Communication in Undergraduate Medical Education, it traces the subject to its primary disciplinary origins, looking at how it is practised, taught and learned today, as well as considering future directions. Focusing on three key areas – the doctor-patient relationship, core components of clinical communication, and effective teaching and assessment – Clinical Communication in Medicine enhances the understanding of effective communication. It links theory to teaching, so principles and practice are clearly understood. Clinical Communication in Medicine is a new and definitive guide for professionals involved in the education of medical undergraduate students and postgraduate trainees, as well as experienced and junior clinicians, researchers, teachers, students, and policy makers.

CHAPTER 1
Introduction

Jane Kidd

University Hospitals Coventry and Warwickshire NHS Trust, Coventry; Institute of Medical and Biomedical Education, St George’s University of London, London, UK

We believe this book is unique, in that it presents the evidence that underpins effective clinical communication. It covers the theories that inform the patient-centred approach, the topics that are taught, how they are taught and how they are assessed.

We know many books exist about how to teach clinical communication or what to include in a clinical communication curriculum, but no other book on communication in the healthcare setting takes the approach of tracing the subject to its primary disciplinary origins, looking at how it is practised, taught and learned today, as well as considering future directions.

Inspiration for the book drew on our experience in teaching clinical communication, in conversation with our colleagues, both teachers and clinicians, which in turn identified a concern that the wide and disparate evidence base for the subject had not been effectively acknowledged, collated and presented.

The book aims to enhance understanding of effective clinical communication by discussing the theories, models and evidence in each of three areas:

• the doctor-patient relationship;
• key components of clinical communication; and
• effective teaching and assessment of clinical communication.

We hope that this will prove to be an important text for teachers, researchers, academics, learners, practitioners and policymakers alike.

Reading this book, you will find yourself introduced to, or possibly reminded of, theories and models from a wide range of disciplines that support effective communication. We believe that in the absence of this knowledge, learning clinical communication can often be superficial, as students learn simply to copy certain statements or behaviours, without a deep understanding of which approaches are effective and why.

We hope that by linking the evidence to the various facets of clinical communication you will understand both the principles and practice of effective communication and how these have come about in the modern world. For educators it may enhance practice both in the teaching and assessment of the subject, learners may more fully appreciate what they are being asked to learn, and as a consequence patients, carers and colleagues may benefit from the changes resulting from this deeper understanding. We hope mostly, however, that this book will stimulate debate, the foundation of healthy academic development of any discipline.

The book is designed so that you can dip in and out as you wish, or you can simply start at the beginning and read through. The chapters begin by providing historical context before describing current practice, providing you with an appreciation of the depth of the evidence supporting the various components covered. Each chapter concludes with a personal view from the chapter’s author on what the future might hold, given the changing context of the healthcare system, the complexity of the learning environment and the evolving roles of the professional and the patient.

We hope that you enjoy the book, that you learn something that you did not know when you picked it up, and that even if you do not agree with the ideas on what the future might hold for this infinitely complex topic, it challenges you to think about the subject and open it up for discussion.

PART 1
The doctor-patient relationship

Section lead editor: Lorraine Noble

CHAPTER 2
Introduction to the Doctor–Patient Relationship

Lorraine M. Noble

University College London Medical School, London, UK

The relationship between the doctor and the patient is fundamental to clinical communication. The perceived role of the doctor – as a healer, service provider, professional or evidence-based practitioner – creates an implicit contract that drives expectations, not only about clinical tasks to be accomplished but about the parameters of how doctors approach and respond to patients.

In this section, the historical development of the role of the doctor will be described, including milestones such as the birth of professionalism and the impact of evidence-based medicine. The influence of the context and practice of healthcare on the relationship will be considered, with its consequent implications for doctor–patient communication.

Models of the doctor–patient relationship will be discussed, exploring the changing notions of expertise and power and the focus on the patient as a person. Models of the doctor–patient consultation will be described, highlighting key frameworks that have influenced research, training and healthcare practice. As a backdrop to this discussion, key milestones arising from the research evidence about doctor–patient communication and the synthesis of evidence and practice will be considered, to summarise the current understanding of what constitutes an effective doctor–patient relationship and effective clinical communication.

The current focus on patient-centredness as an approach will be discussed, including the complexities of its definition and use in practice. The impact of current teaching and assessment on the present and next generation of doctors will be considered, including factors affecting the transfer of what is learned to the healthcare environment. The implications for learners of construing communication as a ‘set of skills’ and relationship building as a ‘skill’ will be explored.

The effects of changing healthcare practices and societal expectations about the roles of doctors and patients will be considered, including a discussion about what patients want, the impact of a team- or systems-based approach to care, and the role of technology. The section will conclude by speculating on what the future holds for the doctor–patient relationship in an electronic world.

CHAPTER 3
History of the Doctor–Patient Relationship

Annie Cushing

Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London, UK

At the very heart of communication in healthcare lies the expectation of the doctor–patient relationship. The doctor is a healer, witness to suffering, interpreter of symptoms, educator, advocate, and a provider of treatment, comfort and access to services. Whilst the Hippocratic Oath of ancient times embodies the virtues and values within the relationship, the ‘medical ideal’ is varyingly shaped by the social, scientific, technological and political contexts of the day (Sigerist 1933).

From a trade to a profession

Historically medicine was more like a trade, and doctors were little more than superior servants of the rich who could afford their services. The latter shopped around and decided what they wanted, whilst the doctor complied with issuing treatments (Porter 1997). This was akin to a consumerist model for those who could afford it, whilst the doctor’s success depended on the ability to attract patrons. Without standards of practice, quality control or accountability, the patient was vulnerable to quackery.

The birth of the profession in the UK came about through restricted practice with a set of standards established by the Royal Colleges in the 16th century (Warren 2000). Surgeons separated from barber-surgeons and became university educated when the London College of Surgeons was founded in 1745 (Science Museum 2014). These developments recognised academic rigour of physicians and surgeons, in contrast to a trade guild, but there was no ‘social contract’ with patients, and in fact doctors were more likely to flee epidemics during the 17th century than see any social obligation to stay and treat patients (Wynia 2008).

The modern use of the term ‘professionalism’ as a basis for the doctor’s role towards individuals and society was first mooted in England by Dr Thomas Percival in 1803, but not until 1847 in the USA was it enshrined as a social contract demanding altruism, civic-mindedness, devotion to scientific ideals and a promise of competence and quality assurance through self-regulation (Wynia 2008). Interestingly it...