EFFECTIVE COMMUNICATION, MANAGING DIFFICULT ENCOUNTERS AND LEADERSHIP
Communication is an essential core skill of a general practitioner. Non-effective communication can lead to patient complaints and disciplinary problems. In this article Dr Hana Patel discusses how the General Medical Council’s ‘Good Medical Practice’ guidance can aid improvement in our communication skills and assist in making us communicate more effectively.
In its guidance entitled ‘Good Medical Practice’, the General Medical Council (GMC) outlines the standard of professional conduct the public expects from doctors in the UK. The GMC has defined four domains for doctors to ensure that their practice meets expected standards. These domains underpin the GMC’s fitness to practice: Knowledge, skills and performance; safety and quality; communication, partnership and teamwork; and maintaining trust. In clinical care, effective communication is essential for doctors not only to communicate with colleagues in their team, but also with colleagues outside the healthcare team, so that there is continuity of care and tailored treatment for patients.
When communication goes wrong
A survey carried out by the British Medical Association (BMA) in 2003 found that over a quarter of cases leading to disciplinary action were caused by ‘poor communication’. Despite communication skills being an integral part of the medical school curriculum in the UK, poor communication between professional staff leading to failed communication with patients, is the most frequent cause of disciplinary problems. There are a lot of communication skills courses and books focusing on communication between doctors and their patients, but not on non-clinical encounters.
Common problems for speciality training doctors
General practice speciality training (GPST) doctors face similar issues around non-clinical communication with members of the hospital and general practice team. Common topics leading to disputes and generating complaints include the negotiation of annual leave or study leave, arranging protected time for Workplaced-based Assessments (and completing them in a timely manner), communicating with clinical and educational supervisors when things go wrong and being given feedback.
Tips for effective non-clinical communication
While it is always advisable for GPST trainees to discuss immediate concerns with their line manager or supervisor, remember to include your educational or clinical supervisor if possible before escalating concerns to your GP training programme director (TPD). Finding protected time away from patient care is a good starting point. Be prepared for a planned meeting with an agenda and include the key points you would like to cover with specific examples of issues. This is a productive way to structure the meeting.
It may be helpful to bring along any particular guidelines, contracts or references for the attention of your supervisor or line manager. You will get the most out of the meeting by having suggested outcomes, an idea of what you would like to happen and suggestions for problems encountered. Such discussions or meetings can be sensitive and lead to conflict if not prepared for correctly. It is important to follow a process, in order to build rapport and manage expectations on both sides. Preparation can allow you to assert yourself without appearing aggressive. Good preparation can also facilitate effective communication with patients, clinical colleagues and managers.
Non-clinical communication is important particularly when things go wrong and it is usually then the first time that GPST trainees consider its’ importance. The RCGP curriculum heading ‘The role of the GP as a leader and manager in healthcare’ also lists essential capabilities for doctors to demonstrate in training. Capabilities to:
Challenge and critically appraise the performance of colleagues, peers and systems
Demonstrate an ability to moderate leadership behaviour to improve engagement and outcomes
Appreciate one’s leadership style and the impact of this on others
Think critically about decision making, reflecting on decision-making processes and explaining those decisions to others in an honest and transparent way
Dr Hana Patel https://orcid.org/0000-0002-1056-9271
References and further information
British Medical Association (BMA) Communication skills. Available at: www.bma.org.uk/advice/career/progress-your-career/communication (accessed 20 February 2020).
General Medical Council (2013) Good Medical Practice. Available at: www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice (accessed 5 March 2020).
RCGP. GP curriculum. Available at: www.rcgp.org.uk/training-exams/training/gp-curriculum-overview.aspx (accessed 20 February 2020).
Conclusion: Any final tips? Learning and demonstrating effective communication within clinical and non-clinical settings enables GPST trainees to develop some of the attributes of good leadership. This also has a direct impact on safe and effective patient care. Fostering a culture of learning and developing communication skills is essential for future leaders of the NHS. Developing the ability to form teams that work well together to achieve the best outcomes for patients is the essence of good leadershipVisit Details