Communication cuts across every aspect of good healthcare but it’s also one of the most difficult things to get right consistently. I think we can do better.
I know from working as a doctor, and from experiences as a patient, that we don’t always get it right. In fact, 8 out of 10 complaints in primary care are about poor communication. I’m sure we can all remember the times when what we were told and how we were told it, was unclear, unhelpful or otherwise unsatisfactory.
All of our stories about healthcare, are fundamentally about humans helping other humans with their problems. Those stories all begin and end primarily with communication. They begin, for example, with a doctor and a patient talking about exactly what the problems are, in as much detail as possible.
The middle of the story is where all of the medical science comes in. The doctor works to apply all the science and technology and statistics and data and guidelines, to analyse the problems and (hopefully) come up with a solution or a strategy for dealing with the problem.
The end of that chapter of the story, is with the doctor explaining what they think is going on and to give the patient the means to solve the problem. That might involve, for example, talking through how to take a medication and its benefits and risks.
So good healthcare must begin and end with effective communication. And if we don’t get it right, all of that clever stuff in the middle – all the biomedicine – is no use to anyone.
The trouble is, communication is a lot tougher than we realise. A lot of us might think about our minds like a bucket, filled with blocks each representing a piece of information. So, if I want to tell you something, I take a block out of my bucket and drop it in your bucket. Now you have that piece of information.
But when we talk to each other, it’s more like potato printing. We start by knowing what impression we want to leave on the page. But exactly how that turns out depends on lots of factors: how we carve the potato, how much paint we put on it, how hard we press. So communicating even simple factual information is a lot messier than we might like.
And communicating information in healthcare is even more difficult: there are often life altering decisions resting on what is communicated; the information can be very complex; and there are usually time pressures.
We can do better though. By understanding the challenges, we can start addressing them. And I think we have a shared responsibility to make communication easier between doctors and their patients.
More and more patients recognise the challenges and come prepared for getting the most out of an appointment. NHS Choices has some top tips for how to do that. But doctors need to up our game too, to meet the information and communication needs of increasingly well-informed patients.
The first step is understanding more about what it is that people really need. What information do you want? What format do you want to get it in? What is useful to know and what isn’t?
David Neal is a doctor practicing in North West London. He has a background in psychology and has worked with the World Health Organization on information sharing and communication. He is Co-Founder of Vesalian.