Your publication of an article entitled Communication Skills by Mike Fitzpatrick1 has made us uncertain as to the purpose of the Back Pages of your journal. If they exist to offer provocative opinion to your readers, you have succeeded. If they are intended to be based on and knowledgeably informed by the full breadth of current literature, then your success is more questionable in this instance and may mislead your readers.
There is ample evidence that clinical communication can be both taught and learnt.2 We are not aware of any evidence of the benefits of apprenticeship learning of communication, indeed the reverse has been suggested.3 To propose that the teaching of communication is in any way ‘comic book’ does not reflect our experience of current undergraduate and postgraduate teaching at this university and elsewhere. On the contrary, learners and teachers take the task extremely seriously and we have evidence, from course evaluation, of learners' improving skills.
Where Fitzpatrick is appropriately provocative is in his discussion of teaching the on-going doctor-patient relationship, which he describes as heavily influenced by previous mutual interactions. We in no way underestimate the difficulty of such teaching at either undergraduate or Foundation levels, but argue that training has to begin somewhere, in the same way that a cyclist must first learn to balance and steer before attempting to travel any distance.
In our communication teaching with undergraduates, we have not used a Breaking Bad News video for nearly a decade, as we have found live demonstrations and experiential training in small groups using simulated patients much more effective. May we, through your columns, extend a cordial invitation to Mike Fitzpatrick to attend some of these current evidence based courses for medical students. We hope that such an experience will both rekindle his faith in the future competence of our profession and knowledgeably inform further discussion in the Back Pages of your journal.
Footnotes
The Back Pages exists to publish articles on all aspects of general practice, and allow writers to express more extreme and more personal views, which would not survive peer review. They recognise our view that there is much more to general practice than questions that can be answered by means of formal research. More than anything else they share with the rest of the Journal the duty to inform, to encourage debate, to provoke, and if we can, to entertain. Having two serious letters challenging Mike Fitzpatrick suggests something's working right — and attacks on editorial policy are especially welcome if they reveal that the BJGP is being read and taken seriously. Ed.
REFERENCES
- 1.Fitzpatrick M. Communication Skills. Br J Gen Pract. 2005;55:725. [Google Scholar]
- 2.Kurtz S, Silverman J, Draper J. Teaching and learning communication skills in medicine. Oxford: Radcliffe Publishing; 2005. [Google Scholar]
- 3.Barnett M. Effect of breaking bad news on patients' perceptions of doctors. J Roy Soc Med. 2002;95:343–347. doi: 10.1258/jrsm.95.7.343. [DOI] [PMC free article] [PubMed] [Google Scholar]