Each of us has his or her own experience of illness. Mine has been better than many: I am not in pain and, for the most part, I have been able to get on with my life. Indeed, the experience itself has had a curious fascination. In particular, I have become interested in why some interactions with clinicians are satisfactory – uplifting, even – and why others are not. What marks out the good communicators from the indifferent and from the inept?
This question has prompted me to take an interest in the way doctors and nurses are trained, before qualification and in service. Are good communicators born or can they be trained?
Manchester’s powerful programme
This interest took me to see one of the best examples of communication skills training – at Manchester Medical School. It was deeply impressive. Not only were the exercises I witnessed imaginative and powerful, but it was clear that the programme was not a ‘nice to have’, an add-on to the core curriculum. Students and faculty were evidently strongly committed to it.
I came away clear that training can help medics avoid some of the worst communication howlers but unclear as to how to instil qualities of warmth and empathy if they are not already present in students. And can one select out those students who might be academically able but awkward or reluctant communicators. Even if it is possible to spot those who are not going to make it as communicators, is the temptation of recruiting on the basis of academic ability alone simply overwhelming?
Training after qualification
Beyond that, I remained concerned as to whether the post-qualification training interventions are, or could be, effective. The first thing to say about this is that considerable efforts have been made on this front since it was emphasised in the Cancer Plan of 2000.
It is difficult to evaluate many of the initiatives taken, and I am not aware of any comprehensive attempt to take stock. Work still continues in some centres, but central funding is drying up. And so one is left with anecdote. One physician described to me a hospital-wide immersion course in advanced communication skills, well-run and taxing, but not evidently curbing the worst shortcomings he witnessed from day-to-day.
Others express the concern that junior doctors do not receive the support they need when they first come into bruising contact with the realities of hospital life. Classroom theories must seem remote from many young doctors in the course of their early clinical experience: experience which is still described by some as ‘brutalising’.
What are we to make of all of this? Well, I think it is too early to draw firm conclusions. We don’t have the evidence. Indeed, I am hoping that the About Me campaign will help us to gather some of the qualitative evidence we need.
This article was first published on the Marie Curie blog and is reproduced here with permission.
Marie Curie will be conducting research into how care can be ‘About Me’. If you would like to get involved, please contact Caroline Weston at caroline.weston@mariecurie.org.uk And find out more on the About Me web pages and share your experiences #AboutMe
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