Recently seeing a new doctor for the first time with my sick teenager, [our regular GP was away], I was taken aback when halfway through explaining a short history of what had been happening, he interrupted me mid sentence with, “do you mind if I ask the questions?” [with a tone of voice that indicated he didn’t give a rats if I minded or not]. A communication approach I had experienced several times prior to finding my current [and beloved] GP, I had forgotten how debilitating ineffective doctor/patient communication can be.
While there have been some moves to ensure that doctors leave the education system with adequate communication skills, unfortunately, there isn’t enough emphasis from the Australian Medical Association (AMA) and related professional bodies, on the importance and provision of skills for effective doctor/patient communication.
The current communication practice of many doctors is best described as ‘ethnocentric’; a view of the world where members of their own group [other medical and related health care practitioners] are valued and understood, while nonnatives/others [patients] are as seen as “fundamentally different and therefore deserving of different treatment” (Grimes & Richard 2003). While this, in and of itself, isn’t necessarily a problem, ethnographic communicators “develop simplified scripts in situations that necessitate interaction” (Grimes & Richard 2003), scripts which function to keep nonnatives [in this case, patients] predictable and within interaction limits. This leads to the sort of communication behaviour I was subject to.
Doctors need more than empathy in their doctor/patient relationships. I believe that they need to practice ‘cosmopolitan communication’; communication in which “others are treated [simultaneously] as both native and nonnative”. Importantly, cosmopolitan communicators understand and appreciate the genuine differences between groups, treat others as fundamentally like themselves and accept that “ways of understanding are open to change yet exempt from change” (Grimes & Richard 2003).
Neuworth (2002) in an important article in the Medical Journal of Australia, ‘Reclaiming the Lost Meanings of Medicine’, advocates doctor/patient relationships that are “intimate, sometimes gut-wrenching”. He states, “We need to create an ongoing public dialogue around the relational and ethical aspects of healthcare.”
Perhaps the practice of cosmopolitan communication may be a start. And maybe we could also encourage our accountants and other personal and professional advisors to do the same?
Image courtesy http://www.peanuts.com/ The Offical Peanuts website.
16 September 2005
Posted by Stephen Byrne at 7:21 PM