I began this project looking into communication methods in patient-physician relationships. By researching language barriers, the effect of interpreters in hospital settings and non-verbal communication methods, I decided to focus on the inability of patients and physicians to communicate in real time. While investigating this area of communication, it became apparent that many physicians graduate medical school without being taught how to deliver bad news to a patient.
It is important for a physician to recognize that all bad news will have adverse consequences for both patients and families and it is critical to change patient expectations while delivering difficult news. Abraham Flexner shaped the current medical curriculum of the United States in 1910 by acknowledging that there was a “public interest” in the changing world. Our society has changed significantly since 1910 and public interest also continues to evolve. By adapting the teaching methods of medical schools in the United States today by teaching physicians how to deliver bad news, both patients and physicians will benefit.
There are three main constraints affecting the implementation of an alternative communication curriculum method. Medical students face four years of tight schedules with neither space nor time to spare; current curriculum content is focused highly on rote learning of textbook-style information; and many curriculums do not focus on today’s social needs and the public interest of society.
Elisabeth Kübler-Ross, MD, brought the five stages of grief to the public’s attention. It is important for physicians to acknowledge that patients will not all go through the cycles of grief in the same order and some may never accept their change in lifestyle due to bad news. Family members are also likely to be at completely different mental states than the patients and will feel frustrated because the patients may deny everything that is happening to them.
According to the Press Ganey, as much as 50% of substandard care is related directly to physicians’ communication with patients. However, the bottom line is that the changes in communication methods are not that intimidating. They require going back to basics with interpersonal skills.
Providing future physicians with strategies to use, with no definite rules, they will have guidance in their relationships with patients, specifically when delivering difficult news. Developing a curriculum with a variety of components – interdisciplinary courses, simulations, reflections, mentoring, testimonials and recognizing teachable moments – will promote better communication in patient-physician relationships. Through continuous student and faculty evaluations of interventions and recognizing the changing public interest, the impact on student self-confidence and their behaviors through curriculum intervention will create a more empathetic physician.
Creating a generation of physicians who care and are interested in improved communication with their patients will create a more empathetic patient environment. By providing a communication curriculum method that any medical school could use to adapt to their own medical curriculum, physicians will take communication seriously both as students and in practice.
Education will always needs to be adapted and revised, especially in such a shifting world. But, hopefully, through improved reflection and understanding, communication strategies will be taken more seriously and increased empathy will result.
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