Let me give an example to highlight the issue. A close member of my family in her 60s recently developed a melanoma in her eye. She experienced exemplary care and was referred to the national centre for proton beam therapy, the current treatment of choice. After many months, it was apparent that this treatment had failed and eventually her eye was removed and a false eye inserted. When she returned for review, she had two questions. She was a doctor herself and understood that her chances of survival were low but wanted to know, given that the initial therapy had failed, what her prognosis had now become. And secondly, she wanted to ask about her false eye which was remarkably sunken compared to her real eye. The doctor started awkwardly, implying incorrectly that the delay in having the eye removed was because my relative had desperately wanted to retain her eye. And then when my relative tried to ask her first question about prognosis, the doctor didn’t either reply with useful information nor offer to try to find out, but simply ignored the question. Following this lack of responsiveness, she did not feel empowered to ask her second question at all.
So even a knowledgeable health-professional patient was not able to make her voice heard. Interestingly, the evidence shows that most patients do not voice their concerns and questions overtly, but mostly hint at them through covert verbal concerns and non-verbal cues. And most health professionals do not pick up these cues or explore them with the patient. A conspiracy of silence interviews ensues that prevents patient-centred approaches from flourishing.
Now I’m not suggesting that all encounters are like this but it is a good example of a common problem. Communication between health professional and patient is the final common pathway enabling the patient voice to be heard and collaborative decision-making to become a reality. There are two essential components to this. One is providing patients with appropriate information so that they can converse more effectively with health professionals: this is what so many of the members of National Voices strive so hard to achieve. The second equally important area involves training, so that both patients and health professionals are skilled enough to be able to engage in these conversations in a fruitful collaborative way.
And that’s my world as the immediate past president of EACH. I was a GP for over 30 years but for 25 years, my major enthusiasm was in establishing communication skills teaching in the UK for healthcare professionals. What drove me in this direction was that in my generation, we had no training whatsoever in how to communicate. And yet it seems such an essential core component of everything that we as health professionals do.
We have achieved a lot in changing education in the UK. For instance, in my medical school Cambridge, each student now has a half day of working in a small group with a simulated patient (actor) and a facilitator every 5 weeks for 3 years, exploring basic and more difficult communication challenges such as exploring the patient’s perspective, breaking bad news, dealing with somebody from a different culture or social background from themselves, dealing with addiction, shared decision-making and explanation of risk.
So how can EACH work together with you? EACH is a global charitable association of committed researchers and teachers of healthcare communication. It is the natural home for everyone concerned with healthcare communication and also the pressure group working to promote the changes necessary to really transform communication between patients and health practitioners. We would like to help you to empower the patient to get the best out of the consultation and to improve the standard of health professional communication. We would be keen to forge a relationship with you all so that we can:
- Discover what patients and patient groups are really concerned about in health professional/patient communication and what you would like to see prioritised in our work.
- Discover how we might advocate for the implementation of this in your world.
- Ensure that EACH would be a first port of call for advice and help about communication in your health area.
In the first instance, we have convened a meeting to enable the member organisations of National Voices to meet EACH and begin a dialogue of mutual benefit. We very much hope to continue an ongoing relationship with you.