Importance of communication to patient experience
29 May 2015
A couple of weeks ago I underwent a routine exchange of my extra-anatomic stents. This was my sixth urology operation since I presented with the obstructive uropathy that heralded my diagnosis with a rare form of soft tissue sarcoma. Along that journey I have met a number of urologists of all grades. I freely admit to being a very nervous surgical patient; I hate the idea of handing over control; of being exposed in theatre; of spending more time in hospital.
My consultant came to consent me for this most recent procedure. After a friendly greeting he sat on my bed. His first question was "how was the skydive, Kate?" I showed him the pictures of me jumping out of a plane at 10,000 ft a couple of months earlier. "How's work going?" The next question "tell me about what's happening with your cancer." After the consent form he gently negotiated his way through antibiotic choices, VTE prophylaxis and how long he expected me to stay in hospital.
This seemingly simple act of gaining my consent for a routine operation, which I'd had many times before was actually magically converted into a therapeutic encounter. That was achieved because of my consultant's fantastic communication skills. He managed to distract me, consequently helping me to relax and relieve my significant anxiety. He involved me in my own post-operative management to give back an element of control. His body language said to me "I've got time for you". His open and engaging questions said to me "I'm interested in you as a person".
I'd now like to contrast this experience with an episode when I was admitted fairly unwell with a stent tract infection soon after some chemotherapy. I'd been referred to the on-call consultant urologist by the oncology team. He stood by the door of my room with his arms folded, barely examined me from a distance, then declared that there was no surgical intervention necessary, that I would get better on antibiotics and left. The encounter was extremely brief. I felt as though my problem had been dismissed, he was uninterested and I was just wasting his time.
Communication has such a massive impact on the experience you have as a patient. Poor communication can cause lasting psychological distress. Good communication can have huge benefits beyond just the mechanical sharing of information and may even improve patient outcomes. Learning to communicate is a lifelong journey that never ends in medicine. At the heart of this learning has to be the patient's experience; everything about even the shortest conversation may be remembered for a lifetime by that person...