Communication issues represent one of the biggest areas of complaints in medicine and likely other professions as well. It is estimated that well over 80% of complaints are due to failures in communication and so improving this can reduce complaints and improve patient satisfaction.

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Words Matter. They really do. The words we use can have a profound impact on the others around us.

Sticks and stones may break my bones but names will never hurt me

unknown rhyme

Names may not hurt but words can, and the words we use are very important. Evidence shows us that the vast majority of complaints about medical care are due to issues in communication, and this is likely to be case for other professions as well. It is estimated that well over 80% (if not higher) of complaints are because of some issue in communication with our patients – in fact I do recall a previous course on this that I attended in the UK that claimed over 95% of complaints were due to communication errors.

All sources agree – communication is one of the biggest issues when it comes to complaints.

This YouGov survery in the UK suggested that at least 3 in 5 complaints about General Practice were due to some issue in communication skills, ranking even higher than complaints about medical care or misdiagnosis. That’s quite a statistic.

It doesn’t matter what you do medically. If the patient feels you have not listened then they will never be happy

Anon doctor

consultation models

Communication is something that we cover quite extensively in our GP training, and there are numerous consultation models that we learn, each one of course claiming to be some new-found holy grail of consultation style. One of the models that really stuck with me was by Roger Neighbour in which he talks about giving the patient a ‘receipt’. No it’s not a physical receipt of money paid (although that may be coming later), it’s a metaphorical receipt. It’s an acknowledgement. It’s a sign that you’ve listened and done something. A wise senior doctor once said to me in my training – ‘It doesn’t matter what you do medically, if the patient feels you have not listened then they will never be happy’.

Now the doing something doesn’t actually have to be a prescription, although that is often the easy thing to do and so may be the default fallback position for many doctors, leading to ‘placebo prescribing’. It can be anything that makes the patient feel like you’ve done something, that you’ve paid attention to them, that they matter.

We may change models as we learn and grow as doctors, but in practice over time we tend to settle somewhere that we are comfortable with, some sort of mix of all of the models that we learn about. Experience also teaches us that no one model of consultation is the best and we need to be a little fluid about it.

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COMPLIANCE

I hate the word. Well not hate, but dislike, especially in the context of a medical consultation. The word is outdated and harks back to a time where the doctor was lord above all and the patient was, well, basically they were there to just shut up and be shouted at and told off for being an idiot.

Thankfully we’ve moved on a little from those times and we are now talking about concordance, recognising that the patient isn’t purely there to be told what to do, but to be involved in the consultation – the patient centered approach.

So what does this have to do with communication?

Well actually the style in which we consult is at the very heart of communication and vice versa. They are entwined so deeply that they are impossible to separate and so we cannot discuss one without the other.

I felt like they just spoke at me

Anon patient

Unfortunately as a GP I often hear complaints. Thankfully not about me but rather about other doctors and healthcare professionals. In line with the above stats these complaints very rarely revolve around the actual medical care that the patient or family member has received, rather the way in which it was delivered.

Usually I’ll hear something like ‘I felt like they just spoke at me’, or like the above that they were simply a bystander and was just there to be told what to do and if they didn’t like it well who cares. If there is a complaint about the medical care they received, more often than not when we do discuss it then it usually boils down to a communication issue, that the patient didn’t feel good about the encounter. Although usually the actual standard of medical care was fine (it’s very rare that I feel there was substandard care), the perception of that care is that it was substandard, which leads to complaints.

I felt like they said what they had to say but didn’t think about how it made me feel

Anon patient

Very often there is a mismatch between what we think we say, what actually comes out of our mouths, what we think the patient hears, and what they actually hear. This can lead to issues. This is where clarification is really useful, to get a sense of what the patient actually took away from what you said.

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A simple flowchart demonstrating the process that can lead to a complaint

The above flow chart demonstrates the process that we go through in a consultation on both sides of the conversation. Very often there is a difference between what the doctor thinks they are saying and what they are actually saying. There’s even a difference then between what they actually say and what the patient hears, and so it carries on.

Let’s take an example

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An example of how there can be a mismatch between our thoughts, words, and the resulting perception

Now the above example may seem silly, even extreme, however it’s a very real scenario. One I’m frequently having to deal with as a GP. Even as a parent I’ve had very similar scenarios with my daughters when getting unwell.

This was brought home to me recently when I saw a patient who had been for mole mapping aka total body photography. They had been told “there’s a mole that was slightly suspicious and we took photographs of it to send to a dermatologist, but it may take a few weeks for the dermatologist to respond. Sometimes it can take a little longer

Seemingly innocuous right?

Wrong. This patient was in my room the next day in floods of tears. Devastated. Anxious. Scared. Why?

Well their perception of the encounter was unfortunately quite different. What they heard was you have a melanoma that we need to remove instantly or you will die but the dermatologist won’t look at it for weeks if ever’

Quite a difference between what the patient understood by it and what the clinic said to them. If only the clinic staff had stopped to check what their understanding was of it then that could have resulted in a happy patient, rather than a patient who has vowed never to return to them.

Thankfully I was able to examine and reassure the patient that their mole was likely harmless but after listening to their concerns, we agreed the best approach was to have a follow up plan with photo surveillance program to be sure. I used my flow chart above, and now the patient is happy.

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So my advise would be think about what you are saying. Before you say it, whilst you say it and after you say it, and next time you have a patient who appears to be unhappy with what you have said, just think about checking what they actually took away from that consultation.

You will hopefully leave your patient happy, content, and confident in you, and as a bonus you may just stop a complaint before it even happens.

Dr Suresh is a GP and skin cancer doctor in Brisbane, and patients can book with him at this link

#thehonestdoctor

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