The Art of Communication and Counseling for Ethical Practice of Medical Science

Most doctors in India practice ethically. However, it’s a growing fear among patients that most doctors practice unethically! There is, at present a huge Trust Deficit in the minds of patients when they visit our OPDs and Hospitals.

The Art of Communication and Counselling can help us bridge this Trust Deficit. Most patients speak the language of the world – they narrate their stories using feelings, people, events, and superlatives. Whereas doctors speak the bio-medical language – we like to talk in terms of timelines, measurements, probabilities, and diagnoses.

This creates an inherent conflict in any doctor-patient interaction, but this can start to get resolved if both sides acknowledge each other as experts. Doctors no doubt are experts in the disease and its treatment, but the patients are also experts in their own illness experience, and we need mutual help and cooperation to be able to do our job well.

Therefore, when we doctors start respecting the person of the patient, it has been shown to improve patient outcomes and patient satisfaction. Not only that, practicing this Art of Medicine also improves doctor satisfaction!

Volumes can be written about the Art of Communication and Counseling, and the various nuances. Most doctors believe that they have wonderful communication skills, whereas most patients report that they came out dissatisfied with the quality of communication after a consultation. In fact, most people make up their minds about trustworthiness of a doctor within the first few seconds!

So what can we do? Let me share 3 key strategies that will help you gain the trust of most patients within the first 30 seconds of starting a consultation!

A. The Golden Minute. Listening is a key element of communication. As doctors we’re in the habit of interrupting patients while they’re speaking, very often within 12-15 seconds of them starting to narrate their story. Whereas if we let the patients speak uninterrupted, and actually encourage them to add more, they will still finish their opening statement within 30 seconds! Encouraging patients to speak freely creates a positive dynamic in the consultation, and the patients feel that their voice matters too, and that the doctor is willing to listen to and understand their unique concerns and context! This makes them more receptive to our suggestions and advice later in the consultation.

B. Effective Non-Verbal Communication. Most of our meaning is conveyed through our body language and tone of voice, very little is conveyed through words! A positive environment can be created in a consultation by the doctor sitting squarely in an open stance, with good eye contact, and leaning forward slightly, showing interest in what the patient has to say. There should not be any furniture blocking the space between the doctor and the patient. The doctor appears unhurried and relaxed, giving adequate time to the consultation. The effect of all of this is to help the patient and the family relax, and become more open and confident in sharing history, and more cooperative with examination and deciding treatment plan.

C. Effective Verbal Communication. We may have listened very attentively, and grasped every nuance of the patient’s story, but the patient won’t know it until we show the patient that we’ve listened! We can echo the patient’s statements, ask for clarifications, and share our thoughts aloud, all this shows the patient that we’re not only listening but also reflecting on what the patient is saying. It also helps to paraphrase and summarise the salient points towards the end of history taking, and asking the patient whether we got everything correctly.

When we do all this, the patients are convinced that we are acting in their best interest, and because we have taken the pains to understand their unique persona and their circumstances, our treatment recommendations and lifestyle advice is appropriate and worth following.

The above recommendations work for most common situations. There are other frameworks for specific situations, e.g. for “difficult” patients exploring their ICE (ideas, concerns and expectations) helps, for teenagers there’s HEADS approach, and for breaking bad news to patients we can use the SPIKES model. While counselling patients regarding diet and lifestyle changes, it helps to keep in mind the Transtheoretical Model of behaviour change.

Like any other Art, it takes several years to become competent and a lifetime to gain mastery in communication! Small changes everyday in our practice style can add up to big improvements in a few weeks in our mutual trust and relationship with our patients!

Let’s start today!

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