The Heart of Medicine: People Skills

This week has been a curious one. Similar in many ways to the past 4 weeks – leaving work a good three or four hours after my shift ‘officially’ ended, exhausted, dreaming of hospital proceedures, patients symptoms and endless hatred for my 5.30am alarm call. This week however also heralded my first penny dropping moment about medicine (well, second I suppose, as the first was that patients actually can and do die).

Communication and People Skills are at the heart of medical practice.

I’ll say it one more time – communication and people skills.

I can imagine, if you are one of the lovely three people that read my blog (!), that you might be thinking – hang on, surely it is expert medical or surgical knowledge that is at the heart of medicine? Nope, not in my opinion. That knowledge is acquired and present in increasingly degrees over time and experience. That however is not what lays at the heart of the patient’s experience, for that guys and girls, is how we – as health care professionals, whether you are doctors, nurses, porters or health care assistants – is how we talk to them, how we communicate illness, treatment, prognosis and plan. It is in all essential purposes how we, as one human being, speak to another human being.

Now often when we speak to them they are in a vulnerable state, cocooned in a tiny hospital bed with machines bleeping, strange faces coming and going, and the moans and groans of patients in the surrounding bay. For those patients, kindess, patience and empathy are essential. I have bore witness to this over the past month or so (it’s amazing really how much experience even one day in a hospital as a junior doctor can bring you) and have seen it done well and also seen it done very badly. My experiences this week have been of a different caliber however…

…for this week my hospital experience as a doctor would have been more akin to a segment on the Jeremy Kyle Show.

Why do I say this? Because I have had to deal with three very angry sets of patients and their relatives. When I say angry I mean my finger is hovering over the speed-dial to hsopital security angry. However, since I was having a rather fatalistic approach to my day given that another patient had sadly passed away (although an expected death a very sad one) the night before and I had a list of tasks so long that one if I could bend time itself would they all be completed, I decided to take the patient notes and the very angry, large and rather scary looking son, of this patient into the relatives room to speak with him. Now any doctors reading this may feel that was inappropriate and not for someone of my junior and inexperienced station. My defence is – nobody else was going to do it and I am tired of seeing the ‘it’s someone elses problem if I just ignore it’ approach to matters outside of actual treatments.

Sitting down with this son before I said anything, I thought about the only real thing I could remember from a “breaking bad news” lecture. Tip number one – let them speak first – as in all liklihood they will have an entire script in their head about what they want to complain about. So, that’s what I did. I sat down and said, “I’m listening – please tell me what’s wrong”. And he then proceeded to shout and rant for well over 5 minutes. I stayed tight lipped only throwing out the few occassion non-verbal cues that show I am still engaging with him. And it worked. As the 5 minutes on, the ranting became less as all the frustration left him and the whites of his clenched knuckles slowly became a much better, well perfused, pink. I do have to confess I did have an “oh sh*t” moment when I realised he had my name and was threatening to go to the local papers!…loosing my General Medical Council (GMC) licence one month in would not be cool.

So what’s the moral of the story? Being a doctor is busy and it is stressful. Being a patient is more stressful. Being a patient’s relative is very stressful and scary too. It may not directly help the patient get better but even just 5 minutes to speak to the family, or the patient, to understand their concerns will be a game changer. It is all about communication.

This week I have both loved and loathed my job.

What I thought I might do each week is finish off with the low-light and the high-light!….

Low-light: Being asked to complete a death certificate of a patient that I didnt realise had even died (had occured overnight)

High-light: Being provided access to the nurses secret stash of ward biscuits!

Have a great week everyone and I’ll see you next Sunday.

Dr Nick



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