Masking the communication

crop man putting medical mask on face of ethnic child
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When I explain that my job is teaching student doctors and other healthcare professionals to learn how to communicate with patients, there’s one response I often receive:

“But surely that’s just common sense?”

Frequently, and without awareness of any apparent contradiction, they immediately follow up the “common sense” remark with an anecdote about when some doctor said something terribly tactless to their Aunty Mary, and how Aunty Mary was traumatised for years by it.

Doctors used to receive very little training in communication skills. When I first started working in Leeds in the late 80s, one doctor told me that his entire communication training consisted of a senior doctor saying “And if the patient cries, you fetch a nurse.”

These days all student doctors receive a lot of training in communication. For example, they are taught to talk to patients without using complex medical terms. It is everyday language to them so they sometimes don’t notice it’s jargon: “We have the test results. You have had a myocardial infarction”. At the other extreme, they need to learn to communicate without over-simplifying and talking as though to a toddler: “So how are we today? Let’s pop you up on here and have a little look at your tummy.”

There’s a tremendous amount for students to learn, and what’s more they need to learn it so it’s embedded in their practice – so they can still do it when they’re tired, and when they’re stressed, and when they’re worried about something that’s happened at home – and, more recently, when there’s a global pandemic.

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I worked with the late, wonderful Yorkshire doctor Kate Granger a couple of times, recording an interview for medical students about the need for compassionate care and the importance of communication in medicine. Kate was diagnosed with cancer and died in her thirties, four years ago. During her illness she was so struck by how often medical professionals forgot to introduce themselves, that she and her husband started a campaign (#hellomynameis) about the importance of introductions, as these are key to building rapport with patients. The slogan has been adopted widely in the UK and in many other countries too.

A few years ago some medical schools, including Leeds, began training their students in telephone consultations. Students are usually very surprised by how much more difficult it is when you can’t see the patient and pick up their non-verbal cues of worry or confusion. On the phone, everything needs to be extra clear and simple.

Then coronavirus happened and everything changed. Suddenly, far fewer consultations are face to face; some are by phone, some are over the internet. When they are face to face, both doctors and patients are wearing masks – a term that has long been used to mean ‘hiding’, such as “It masked the patient’s symptoms.” Certainly masks, or the telephone, or even online with the camera on, can have a strangely distancing effect which is not what is needed for clear, sensitive communication.

Touch is important, too. Some patients want to be hugged. Others don’t want to be touched at all and, as always, it’s a judgement call. Now, touch has been reduced as much as possible for reasons of safety, with patients who are seriously ill – or even dying – unable to hug or even to see their loved ones.

Suddenly healthcare workers have been thrown into a situation where communication and compassion are even more vital than usual.

When the next academic year starts I know we’ll be discussing the challenges of all this with the students – and we’ll be discussing it over the internet, because that’s how the sessions will take place. We need to think about how we can best equip the trainee healthcare professionals to communicate with compassion and clarity in this strange, touch-free world where the doctor and patient are sometimes behind masks, in different rooms, different buildings, different cities. It will take a lot of thought and reflection and planning. It’s not “just common sense”.

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