Posted on May 8, 2017
Whilst doing my doctoral research in organ transplantation I came to understand just how challenging it is for health professionals to talk to patients and their families, especially when the news is bad. I saw people with exceptional medical skill who would rather hide in a broom cupboard than have a difficult conversation. There are quite a few reasons why doctors and nurses don’t like breaking bad news to patients. They may feel ill-equipped to deal with emotional reactions. They may feel that they have failed to ‘save’ or ‘cure’ the patient – which was probably what the patient or family expected, and naturally what was hoped for. It goes without saying that ‘difficult’ conversations involve a certain level of skill, empathy and the ability to provide a bit of initial support and counselling. However, it seems that this is something which isn’t really emphasised in medical training in South Africa – and maybe it’s something one learns-by-doing rather than being formally taught.
Why is communication important?
That aside, communication with patients and their families is one of the most critical skills that health professionals should learn because, when it’s done properly, it has two major benefits. Firstly, it improves overall patient care – it gives patients and their families an opportunity to ask questions and to gain clarity on the way forward (or on what happened in a serious adverse event). This promotes a sense of control for patients and gives grieving families a modicum of closure. Secondly good, open, timely communication can prevent some of the most unpleasant aspects of medical liability. According to this 2015 article in the South African Medical Journal, miscommunication is the second most common source of malpractice challenges against doctors – patients want “answers, explanations and reassurance”. At a recent seminar by a representative of the Medical Protection Society, it was noted that families who feel that they have received adequate information from their health professional in the event of an accident or death are less likely to lay charges of negligence or malpractice.
Some tips for good communication with patients
So what kind of information do patients and families want? Well, often they just want to know exactly what happened, and how it happened. They want to know who was there and what was said. And they usually want to hear this from the doctor who was in charge of treatment.
What can health professionals do to improve their communication? Firstly, make time to listen and to answer questions. Secondly, try apologising if you have made a mistake (unless you were deliberately negligent, this won’t be construed as a legal admission of guilt). Finally, remember that talking to patients and their families is not an admission of failure, it actually enhances your practice. By giving patients the info they need, and by listening and answering questions, you are promoting ‘autonomy’ – placing the patient or family as the locus of care and giving them the tools to make reasoned decisions – and that’s the basis of patient-centered care after all.
 Howarth, G., Tiernan, J., Gillespie, G., & Carstens, P. (2015). A good complaints system. SAMJ: South African Medical Journal, 105(6), 425-426.
 Howarth, G. “Keeping Out of Trouble When Trouble Comes A Calling”. Ethics Alive 2017 Medico-Legal Seminar. Wits Donald Gordon Medical Centre. 13 March 2017.