The medical profession is currently under siege as never before with a spate of high profile malpractice cases. This attack is taking place at a time when the National Health Service is undergoing a ‘culture change’ brought about by a shift in the public’s attitudes to authority, in general and more specifically, by the demystification of medicine. The perception that doctors are a race apart is finally beginning to wane.
These forces have fortunately already led to a number of radical developments in the last five or six years in the way doctors are being laid on a more patient-oriented approach. Whilst, in the past communicating effectively with patients was left basically to chance, this is no longer the case. As part of their final assessment, doctors now have to take a practical examination where their communication as well as clinical skills are carefully scrutinized.
If you ask most people what makes a good doctor, they will not say someone with sound medical knowledge. The first thing that will spring to mind is a good bedside manner; in other words, good communication skills. But what does a good beside manner, or communication skills, entail?
All too often people complain about the lack of sensitivity of the doctor they encounter whether they be generalists or specialists. Some other frequently voiced criticisms are that doctors sound as if they are delivering a lecture when talking to patients; pontificating from on high. Or that they lack basic social skills; or indeed that they are bad listeners, concerned only with delivering their message rather than becoming involved with any kind of negotiation with the patient. So it would be safe to say that the most important aspect of a good bedside manner is good interpersonal skills.
From the patients point of view the interaction they have during their consultation with a doctor is very personal and hence emotional, while for the doctor it is merely a logical and objective process. And so, the chances of the doctor patient communication breaking down are high if the doctor is not sufficiently skilled in handling the patients emotional needs. A doctor must be able to deal with the full range of a patient’s feeling, showing sympathy and empathy especially when handling difficult situation, like breaking bad news etc.
Another aspect of the good bedside manner, which is more often than not overlooked, is having the ability to talk patient using lay language that they understand, while at the same time, avoiding any hint of condescension, or being patronizing. The inability to do this has a number of effects. When doctors use medical Jargon, patients feel that they are trying to hide something. Doctors can also give the impression that they do not know what they are talking about; or even that they do not know the solution to a problem.
It is also essential that the doctor at all times is able to maintain authority. For example, doctors need to deal with some patients belief that medicine is infallible, i.e. that the doctor has the panacea for every woe! This is certainly no easy task, as most people’s expectations are raised by the daily diet of wondrous developments in medicine.
The other side of the coin is that, as people’s awareness and knowledge have increased, albeit often misinformed by the internet etc, the stronger their doubts about the medical profession have became. And coupled with the rise in general educational awareness, the public have consequently a lower regard for doctors. This in turn has affected doctors ability to communicate. They are not able to hide behind the veneer that technical jargon created.
At last, the pendulum has swung in the patient’s direction. The onus is now upon doctors to adapt themselves to the patient’s needs rather than the patient approaching some awesome god like figure. The veil has been lifted and temple violated.