Doctors' communication of trust, care, and respect

Editor—At last the medical profession seems to be waking up to the realisation that what is taught under the umbrella of “communication skills” covers too narrow a range of activity.¹ Good communication skills are the output of a number of more sophisticated inputs. Good observation skills, good listening skills, ability to reflect, ability to detect emotional content, and problem formulation are some.

For far too long medical teaching has focused on teaching a narrow set of skills such as “breaking bad news,” in the belief that those skills generalise across situations. They do not. The psychology literature has documented this for some time.^2-4 Doctors need a framework of knowledge in which to make a set of skills work. This framework has been notably absent in many undergraduate curriculums, resulting in acquisition of a rather wooden set of “skills” that can be applied only in limited situations.

Patients want medical practitioners who are skilled in the art of sincerity, able to detect emotions, and able to express genuine interest in why they have been consulted. Communication skills is a form of skilled information processing and should be learnt in the way that other skills are learnt, built on a firm knowledge foundation including how information is processed, and practised.

People are happy to accept that doctors don't know everything and even that they make mistakes. What people find harder to swallow is disinterest, clumsy questioning, or ham fisted handling around something that has a lot of meaning for most people—threats to health.