Petra Zrníková, our Membership Secretary, compares her native Slovakia with the UK and the implications for teaching.
Building the doctor-patient relationship is sometimes taken for granted or forgotten. The prestige of medical education often promotes the misconception that a doctor’s communication skills are ‘inborn’ and that there is no need for training. This is especially true of older doctors with significant years practice who argue that they are experienced enough. This attitude is then often passed down to medical students. Ensuring that a doctor´s nonverbal communication is in accordance with the appropriate verbal information about the patient diagnosis and treatment is unquestionable. Patients with their doctors to be competent and knowledgeable but they also need to be able to relate to their doctor and to feel understood, particularly in specialist medicine, where the relationship is a short-term one. Developing rapport is of vital importance – a patient needs to feel comfortable in discussing problems with an unfamiliar person and to benefit fully from the consultation. This is impossible if doctors feel under pressure and their consultation period with the patient is limited.
Communication difficulties
Patients who complain about poor communication may have experienced a mismatch in terms of their preferred communication style. Some may want a short, clear discussion, while others prefer a softer approach when talking about their complaints. Some patients want detailed information, while others simply want to know which course of treatment to follow. Doctors therefore need to be adaptable to different patients’ needs. Patients also complain about the overuse of medical terms or feel that a doctor is under pressure for time. They criticize doctors who speak in a monologue without leaving time for their questions. Sometimes they feel that their problem is being trivialized or denied. They want a doctor to show empathy, understanding and other emotions.
A significant difference between the UK and Slovakia is requesting a ‘second opinion’ – the process of seeking an evaluation from another doctor to confirm the diagnosis and treatment plan of a primary physician. In Slovakia, patients are afraid to ask for a second opinion because it means questioning the doctor´s knowledge. Some patients, especially the elderly, might not know about their rights. An important patient right is being able to make a decision on how much information a patient wants about their condition and how much relatives should know. Moreover, in Slovakia, it isn´t common for a doctor to summarize the conversation, neither would he or she ask the patient to do so.
Reports from the UK and Slovakia on receiving information and involving the patient in their treatment present similar results. According to Knezović and Ralbovská (2012), 85% of participants in Slovakia said that the patient has the right to receive complex information and both the doctor and patient have to be sure they have made themselves clear. Only 5% of respondents felt they did not need detailed information, and 6% believed that it is the doctor´s decision what he says to the patient and their relatives. Some patients (3%) were not aware of the principles of doctor-patient communication, or how it should be performed.
In the UK, the Patients Association report on information provision (2011) noted around a third of respondents (30.2%) felt they were involved to a greater extent in their care and 44% felt they were a little involved. The vast majority (84.6%) said that they would like to be more involved in decisions about their care and 63.2% said that access to more information would help them become more involved in such decisions. The Patients Association report on primary care (2012) showed that 57.7% of patients felt involved in decision making about their treatment compared to 37.1% of those who were dissatisfied. However, when the respondents were asked if they wished to become more involved, 80,1% responded positively.
Implications for teaching medical English
Students might have sufficient knowledge of language but quite often their language competence is marked by traditions and meanings of nonverbal behaviour coming from their mother tongue. In teaching communication skills, it is essential students learn to match the correct nonverbal signs to the target language instead of to their own native language. For example, in the UK it is common for a doctor to introduce himself, shake the patient´s hand and ask how he or she wants to be addressed. None of these are common in Slovakia. There is no handshake and with adults, the patient is addressed as ‘Mr’ or ‘Mrs’ followed by their academic title and/or surname. Similarly, it is rare to provide a patient with a detailed description of each step taken during the examination process.
In my experience, I found out that students don´t have sufficient knowledge of the principles of communication and building doctor-patient relationship in the Slovak medical environment. So when they are asked to compare cultural differences in the UK and Slovakia, they can say very little about it. Similarly, the students are not used to analysing the doctor´s behaviour. They mention eye contact but rarely do they say anything about haptics (touch), proxemics (distance) or tone of voice. They aren´t aware of the importance of atmosphere and cannot recognize a patient´s feelings so they don´t describe them at all. In terms of linguistics, they lack vocabulary and grammar structures used to express empathy, reassure their patient or give bad news.
To teach communication skills I like using videos (see pdfs online) and I recommend reading the Calgary-Cambridge Guide (see Silverman et al, 2013) and Good Medical Practice (General Medical Council).
References
Bujalková, M., Zrníková, P. (2016) ´Nonverbal communication for enhancement of foreign language professional competency in medical students´. In Athens Journal of Philology, vol. 3, no. 3, pp 175-188 Komunikácia lekára s pacientom (Doctor-patient communication).
Knezović, R., Ralbovská, R. (2012) ´Správnou komunikáciou k zmysluplnej a efektívnej liečbe (Appropriate communication towards useful and effective treatment)´. In Prohuman.
Oxtoby, K. (Sept 2012) Are GPs Poor Communicators? In BMJ careers Primary care. Patients and GPs – Partners in care? The Patients Association.
Silverman, J. et al. (2013) Skills for Communicating with Patients. London, Radcliffe Publishing.
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