Talking to patients, carers and colleagues - communication skills count

D V K Chao
Editor, The Hong Kong Practitioner

We need to communicate to patients, carers and colleagues during our daily clinical practice. Training for communication skills aims to enhance clear, effective and sensitive communication. Clinical skills training provides the scientific basis enabling clinicians to manage their patients. Although communication and clinical skills are needed at the same time in our daily clinical duties, training curriculums have traditionally set them apart as two different aspects of training.¹

The current practice of teaching communication skills separately from clinical skills reflects a reductionist paradigm _ by breaking down the complex phenomenon of a consultation to its basic components.¹ Clinicians with strong clinical knowledge may be unable to translate their skills into effective clinical care.² Poor communication can often lead to poor health management.³ Evidence building up from international experience in different countries suggests that most complaints about consultations are related to poor communication.⁴ This has led to an increased emphasis on communication skills training around the world.

Learning communication skills in a clinical environment has many advantages. The training is based on real life clinical situations in a professional context. Its relevance to practice can be easily felt by the participants. Role modelling by the supervisors can easily be appreciated by the learners.

Questioning and giving explanations or information sharing are two crucial facets in communication. Questions may help to clarify details, to elicit responses, and to emphasise key issues. Closed questions should be restricted to establishing facts or baseline knowledge, while open questions can be used to clarify or probe in all other circumstances.⁵ Time should be given for the response, sometimes a brief period of pause could be most revealing. If an unclear response is received, follow that up with another question; it should not be confrontational though. Plain statements describing the situation can be good questions in the appropriate settings.

Giving explanations can be difficult. Checking understanding before, during and after the explanation is given can be most useful. If in doubt, pitch things at a more fundamental level and work upwards. Information should be delivered in bite size chunks.⁵ Summarising from time to time and reiterating essential points can help to bring home the important messages. Observing the verbal and non-verbal cues throughout may help to give an idea of the recipient's grasp of the topic.

Another important issue on clinical communication training is planning. Good planning will go a long way to provide a structure and context for the participants as well as a framework for reflection and evaluation. The clinical environment that we work in, be it in an outpatient clinic or in the surgery in the primary care setting, has lots of rich ingredients for clinical communication training, so we should use it well.