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Gold, incentives and meh

Good communication is the key to improving patient care

Dr Mike Knapton writes

Communication skills are essential for success in many careers but arguably, none more so than in clinical care, and in my profession, general practice.

General practice is seen as the ‘face’ of NHS care for the majority of people, and GPs are the main route to effective treatment and excellence in patient experience. For most people - especially those with long term conditions - ten minutes with their GP is precious. From my own experience, consultations are viewed as a chance to discuss not just physical concerns, but emotions, finances and social concerns such as job security. For the most part, a satisfactory outcome for the patient is dependent on establishing a rapport between patient and doctor and this in turn is predicated on excellent communication.

So it is no surprise that the profession is brought into disrepute when reports suggest we are failing our patients on the grounds of poor communication.

But instead of adopting the default response of demonising GPs it is important to look at what is going wrong and understand why.

As a charity engaged with its supporters, BHF hear many stories from heart patients about dissatisfactory experiences with their GP, often linking back to poor communication. In fact, a recent survey where we spoke to over 200 GPs revealed that more than three quarters (78%) of us have had a patient request another consultation to clarify issues raised after their first appointment.

Personally, this provokes an innate professional desire to understand how poor patient outcomes like these can be avoided in the future, whilst wanting to get to the bottom of what’s going wrong. With an estimated one million consultations taking place every week day in general practice there is pressing need to address this issue, which sits at the heart of clinical care, the conversation a patient has with their GP.

A simplistic conclusion would be to blame a lack of training - demanding more resources be pushed into educating healthcare professionals. However new BHF research also showed that most GPs (67%) were completely satisfied with the level of communication training they received.

The pitfalls

It may not come as a surprise that the most critical issue for GP’s was time. The ten minutes allowed for each consultation has resulted in more than eight in ten (84%) of us not considering the patient’s agenda as the priority, and being more concerned with pressures to meet our priorities, such as QOF targets.

Assessing how each patient wants information delivered were common concerns for almost all GP’s (94%), with 10 minutes cited as being not enough time to establish whether someone wants quantitative facts or a more qualitative approach, or a mixture of both . And for the few who are able to interpret an individual’s preference, three quarters simply said they don’t have time to sensitively address the issues raised.

The very nature of delivering bad news was also seen as a key challenge for many, who claim that no matter how they communicate information, it’s difficult for patients to view this as a positive experience.

Yet many communication issues could be improved if GPs got to know the resources they have available to them.

Patient information is vast and GP’s should see this as an extension of the appointment itself. Leaflets and booklets are some of the most under-utilised resources and can hugely improve a patients understanding of their condition - often providing answers to questions they might have following their consultation.

If you’re speaking to someone who has suffered a heart attack, for example, showing them information on how this is caused or what treatment they will require will help to counteract feelings of being overwhelmed.

Best practice is to ask if a patient would find a leaflet helpful. Then indicate which part of the leaflet is most important, highlighting and customising it. Use a pen to draw arrows, and circle blocks of text. Evidence shows that this increases the chance that a leaflet will be read and acted upon.

And the availability of high quality leaflets and booklets was acknowledged by 64% of GPs, however reluctance to administer these was worrying.

In fact four in ten (39%) said they’ve felt uncomfortable giving patients a leaflet about their condition for fear it may be perceived as a ‘fob off’. This outlook poses a massive threat to positive outcomes given the ability of these resources to aid patient recall and understanding.

Language barriers and low literacy levels were also reported as communication barriers - perhaps another factor holding us back from exploiting the information we have available.

Since time pressures and QOF targets don’t appear to be on the way out, we need to have more confidence and tack to deliver these resources if we are to ensure patients leave our surgeries feeling calm, informed and empowered.

Find more information or and simple and concise patient resources here.

Dr Mike Knapton is associate medical director at the British Heart Foundation

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Readers' comments (8)

  • Communication skills, you say? Never heard of them. Definitely not in UK medical schools or the MRCGP curriculum.

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  • Communication is often poor because GPs put their own agenda and emotions above the needs of the patient. In my experience, it stems from their need to 'prove they are right' (even when they are proven to be blatantly wrong). The knock-on effect of this, is long-term distrust which may never be regained. The simple word is 'sorry' is just beyond some GPs.

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  • GPs should be invited to join their local Balint groups.

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  • Communication skills? What a radical idea!..not heard of that one but it's sure to catch the inter-web and the gramophone.

    'Other health professional' 5:43pm nice for you to join the debate. Always good to hear from the punters ..please be sure to let us know your views next time your here.

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  • Nothing about increasingly unrealistic expectations of patients bringing multiple problems and 10 mins being woefully inadequate nowadays to sort out them out properly and communicate managements plan back....all the Doctors fault.....we must do better!!!! Same old story.

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  • Given the tendancy of patients to try and slip in three of four complaints into a consultation, there is very little meaningful communication that can be done in ten minutes.

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  • If a large number of customers of Tesco says they don't like their minced beef to be comprised of horse meat, should Tesco keep delivering horse meat? Or should it take it's customers' views into account and adapt its offer accordingly?

    Services should try adapting to patient needs - why should patients have to adapt to GP's needs?

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  • Errr because Tesco can actually charge their customers

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