Just as “a spoonful of sugar makes the medicine go down” so a teaspoon of love added to medical care makes all the difference to healing.
Well-developed communication skills are recognised as a vital component of medical care, the nature of the doctor/patient relationship being seen in itself as therapeutic. Thankfully, unlike the time of my training, developing communication skills is now seen as an integral part of medical training. However it is still seen by some as the ‘touchy-feely’ side of medical training, somehow an art less valuable to master than the myriad of facts and technical skills that constitute the science of Medicine. In truth, the healing that we bring through Medicine will not take place without both components being held as being equally valuable. In fact, it is that higher level of communication based on compassion that sustains us as doctors, preventing the development of cynicism or burnout.
Why we need to develop communication skills
Well-developed communication skills are foundational to patient-centred care, to informed decision making, to effective information transfer, to effective team care, to patient satisfaction and indeed to clinical outcomes. A recent JAMA study(1) showed that elderly patients admitted under female interns had better outcomes, a lower mortality and lower readmission rates than those admitted under male interns. It is not the gender of the clinician that matters here, rather that in part, the difference in results was thought to be better communication.(2) If skilled and compassionate communication was valued more in medical care and practised by all clinicians, would we see improvements at all levels?
Good communication improves staff relationships
We know that absenteeism is frequently associated with interpersonal issues amongst staff. Staff who communicate well together, who feel valued, cared for and respected are more likely to work together well and provide an improved level of patient care. When we start to value one another, recognising that from the cleaner to the staff specialist we are all vital cogs in the medical machine, when we start to honour one another and recognise our common humanity, we will start to recognise each other’s needs both professionally and personally.
Let us think for a moment about medical referrals or discharge summaries. These are part of the bread and butter of communication. That these are communicated in a timely and accurate fashion is known to improve patient care. We honour our patient by passing on information which may reduce unnecessary investigation, waiting times, repeat visits or readmissions and facilitate appropriate and timely management. We honour our colleagues by respecting their expertise and assisting them in their work. Respect is foundational to good communication.
What Communication Skills are Needed by Doctors?
Are the communication skills taught in medical school adequate in clinical situations? Often in medical settings we are working in highly complex and emotionally charged clinical environments. The level of communication required in these situations surpasses that which a simple training can give, and could leave many experienced psychologists feeling out of their depth. Doctors need to be able to communicate well not only with the patient being cared for, but with their families and carers, and with all members of the team caring for them. Importantly in such situations the doctor needs to be able to deal with their own emotional response. Having compassion not only for all those involved but for themselves is of vital importance. Doctors throughout their careers should be supported to further their counselling skills and to practise self-care to support their own emotional well-being.
What is Compassionate Communication?
What we bring energetically into our relationships with patients is often disregarded when we consider our counselling skills. Whether this is vocalised or even recognised by us, we are all aware to a greater or lesser extent of “energy”. We can feel when someone is fully “with us”, if they are distracted, if they are withdrawn, if they are hostile, if they are truly caring. We can feel anger, frustration and sadness, all without words being spoken.
Energetic awareness is that sense all of us use to gauge safety and acceptance. Just as we as doctors can sense our patients, they too can sense our energy. Is the energy we bring based on love and compassion or not? Compassion does not judge, it respects equality and a shared human experience, it acknowledges suffering. Compassion makes a deep connection, not mind to mind, but heart to heart, soul to soul. In compassionate communication, the patient feels not only cared for, but cared about and loved.
To wholly communicate, we use all of our senses. We listen with our whole being, being consciously present to all that is occurring, not only with the patient but within our own minds and bodies. We listen fully with our ears, hearing all that is said, and all that is left unsaid, picking up tones and volume, picking up on hesitation, picking up on silence. We listen with our eyes, looking for body language, for incongruencies. We listen with our noses – does anything seem fishy here, am I picking up a sense that all is not as it seems, is there a hidden agenda? What is the essence of this encounter? We listen with our own bodies. How are we reacting? Are we feeling fear, anger or sadness? Are we shrinking away? Are we feeling overwhelmed? We listen with energy, feeling what is really going on.
Each of us is the same at the level of heart and soul – whatever you believe that soul to be.
When we deeply acknowledge this equality and learn to value how each of us, in our own way, contributes to the whole, then the barriers come down. When the barriers are dissolved, understanding and love become a possibility and the seed of compassion is sown and can flourish.
Compassion supports us too
Bio-psycho-immunology has found that sympathy and empathy may cause the same physical response to brain waves that experiencing suffering yourself invokes. Compassion however ignites the cells stimulated when we feel love and joy.(3,4)
Bringing Love and compassion to our patients is healing for them but also brings joy to us. Recognising and practising this can change the face of medicine.