Health

Friday 11 July 2014

Tackling the growing disconnect between doctors and patients

IRELAND was freezing and covered in snow, but for author, journalist and healthcare trainer Rory Hafford, there was a silver lining. The appalling weather of two Christmases ago had turned out to be a welcome ice-breaker.

"People were more inclined to stop and chat to you, and always about the weather. In some small way, it brought people together, for a short time at least," he recalls.

But not everyone.

One miserable day in the middle of the big freeze, Hafford called into a local shop. But when he got to the counter, he did a major double-take.

"I had trouble believing my eyes. On the counter, in big, bold letters, was a sign. It read simply: 'Yes, it is cold.'

Hafford asked the guy behind the till if he had made the sign.

"Yes," the man replied, not looking at Hafford, instead busying himself counting out change.

Hafford asked why he had displayed it.

"He looked up at me, a frown creasing his brow; genuine confusion playing about his face.

"Why did I make it? Because it stops me having to talk to people. That's why."

For Hafford, it was the culmination of an alarming social disconnect which, he feels, has begun to take hold in Irish society.

"We now have small armies of folk shuffling, head down, hood up, plugged into their iPod; we have barrier-free, automated tolls; our government offices are guarded by tape-recorded messages; our phones have caller ID; our taxes are paid online; and our shopping can be ordered from the comfort of our beds!"

These procedures might be designed to streamline our lives, but at what cost?

"Ramp this up just a little bit more and, arguably, you could go from now until the end of your life without having to connect with another human being."

The Celtic tiger years drove a wedge between people, he says.

"We measured out our worth in terms of possessions and the number of foreign holidays we were able to cram in and the stockpile of shares we had amassed.

"Our status was solidified by where we sent our children to college and the size of our house and the horsepower of our car."

Empathy was one of the biggest casualties of this temporary, but ego-inflating, affluence, believes Hafford, a psychotherapist with qualifications in medical science, who runs a communications company to provide training programmes for healthcare workers and therapists. His new book, 'Broken Boy' (in shops from mid-May) also focuses on the subject.

He became so concerned about the general lack of empathy in society that a year ago he added a new course to his stable of 14 training programmes -- Empathy in Medicine.

Hafford, who works with hospital doctors and GPs, nurses, surgery receptionist and, pharmacists, had decided there was a pressing need for it.

"I find doctors are incredibly poor at communication. They may be highly clinically trained, but from a communications point of view they are very poor.

"That's why I wrote 'Medical Communications -- The Art of Connecting'. I felt that if you're talking about connecting with a human being it is about seeing things the way they will see things."

The catalyst for his empathy programme was what he calls "the chronic lack of communication" within the medical profession.

"There's a big thing in medicine called transference/counter-transference. This concept means doctors are trained not to get too close to a patient because they could lose their clinical objectivity.

"So when, as a doctor, you see a patient, you're looking at a collection of signs and symptoms and not at a person or a human being.

"I believe doctors should be looking at the whole human being. This is why complementary therapies are so important -- people are given more time to talk to the therapist."

He acknowledges that part of the problem lies in how the medical service is structured. "There is a well-known term in medicine called 'find it and fix it' and this leads to a conveyor-belt system, where they put the patient through the system as quickly as possible. You will find this in both general practice and in hospital medicine.

"We work with a lot of younger doctors, senior house officers and NCHDs, who are run off their feet. They are simply products of the system. I worry that if we're training young people like this now, what will they be like after 20 years in the system and they in turn will train other people?"

The Empathy in Medicine course has received positive feedback, he says.

"Some doctors say they have never actually considered the communication aspect of their work, that they just presumed they could communicate."

However, says Hafford, verbal communication makes up just seven per cent of our overall communication.

"Empathy requires spending more time with the patient, but the system does not want that because it wants to rush people through the system."

There is a need for more empathy and better communication, agrees patient advocate Stephen McMahon, who says he can identify with some of what Hafford says. As CEO at the Irish Patients Association who has spent 15 years listening to the complaints of patients, he reports that people often feel they're not being properly heard.

"You hear from patients that they feel they're going back to the GP with recurring problems. They say the doctor's not listening to them."

On many occasions, McMahon says, he's advised patients to clearly request that their doctors look at them as if they were seeing them for the first time. This is to encourage doctors to actually listen to what the patient has to say.

"We're hearing about poor communication, that the average interview is about six minutes.

"In a survey some years ago we found that about 30pc of prescribing doctors didn't give patients all the relevant information regarding the medicines they were prescribing."

Communication with patients is a major safety issue, he warns.

"If you cannot communicate with a patient how can you elicit the facts that are relevant to making a diagnosis? A consultation should meet the patient's needs and be sufficient for the doctor to be fully informed of the patient's symptoms so they can make a decision, and there should be communication about the medicine they are prescribing.

"It is important for the doctor to create the time to advise the patient about their medicine. That is empathy. There is a need for a caring presence, because this is really what enables patient-centred care.

"You can still be professional and step back to make the judgment, but it is very important for the patient to feel they are listened to and in a caring presence."

Limited time is a problem for family doctors, acknowledges Susan Smith, Associate Professor of General Practice at the Royal College of Surgeons and a practising GP, but student doctors are carefully trained in the art of communication, she says.

'Our system allows about 12 minutes per GP consultation -- that is the average amount of time spent with the GP. Time is a huge issue in relation to communication."

Despite this, however, communication training is regarded as a priority by the medical school system. "We would regard doctor-patient communication as an essential part of clinical training."

Patients value communication very highly, she says, and there is a balance between being a good communicator and a good doctor.

"We believe communication and empathy are really important. I don't think you will find a doctor who doesn't think that. You may find doctors who are under time pressure and may not sometimes communicate as effectively as they could but not everyone performs as well as they could all the time."

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