Communication in health care: Are we failing in medical education?

Professor Alan Bleakley, Penninsula Medical School believes that current medical education is not addressing communication issues in the training of new doctors as best as it could. He discussed the importance of communication in medical as part of a co-hosted seminar between the Centre for Medical Education and the Social Dimensions of Health Institute (SDHI) at the University of Dundee today.

More than 40,000 deaths in the UK are estimated to be the result of medical error. Human failings by far outstrip any other cause for these errors of which many lead to preventable mortality or lasting impairment. Particular, cross-team communication is error prone and may result in fatal mistakes. A range of factors have been found associated with ‘hypocompetence’ or underperformance, including status asymmetry, high/autoritarian control style and lack of team coherence and cooperation.

A key facet that is currently missing in medical education is that future doctors are not encouraged to develop a ‘tolerance of ambiguity’. Guidelines, safety standards, risk aversion, fear of litigation, targets etc. constrain the space in which tolerance would flourish.

At the same time, doctors are confronted with different styles of working. Frequently, in training and later practice they are not connected to one ward but ‘float’ between different units, work in transient rather than stable teams. Alan Bleakley calls this with reference to Deleuze and Guattari’s thinking ‘nomadism’.

In world that is multi-connected the traditional paternalistic (‘male gaze’) authoritarian style in health care is misplaced and a more collaborative, less hierarchical approach is required. Education needs to be mindful of the increasingly ‘fluid world’, in which we operate and recognise the need for democratisation.

There is rising evidence that empathy is on the decline in medical doctors. Doctors remain poor at ceding authority, managing confrontations and maintaining eye contact with patients. In an era of targets and evidence-based practice, ‘complexity’ is often not acknowledged and formulaic solutions and guidance are sought.

At present, medical education seeks to provide communication ‘skills’ and effect behaviour change. What it fails to do is understand the value constructions that underpin behaviours. Bleakley diagnoses a lack of ‘democratic literacy’ in new doctors. A more holistic, biographical approach is needed to improve clinical capabilities.

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