Teaching the importance of communication between doctor and patient

Romania is one of the poorest countries in Europe and is still recovering from a troubled history and the violent excesses of the Ceausescu regime. It is also however one of the most beautiful countries in Europe containing both Transylvania and the amazing Carpathian mountains.

We arrived in Bucharest airport and were picked up by our hosts, Daruieste Viata, a Romanian NGO who had invited us to work with Romanian oncologists and deliver a two day, intensive Advanced Clinical Communication course.

Put simply, if you are a child in Romania diagnosed with cancer, you have a 50 per cent chance of dying. A sad statistic that Daruieste Viata are tackling by modernising and equipping hospitals and clinics to aid the diagnosis and treatment of cancer.

Clinical Communication is the kind of communication that is used between a doctor and a patient, for example, when the doctor is gathering a clinical history or explaining a treatment or a risk to a patient. It has been taught as a core component of medical student education in the UK for the last 20 years. It is well embedded in doctor education and supported by extensive research literature.

This is not the case in Romania however where medical students and doctors do not routinely experience this kind of education and where life as a doctor can be very tough indeed, with few doctors (39,000) to treat the Romanian population (22 million) and a brain drain to the West.

Carmen Uscatu, President of Daruieste Viata said: “We believe that the patient and the doctor need to become a team. It is our great wish that one day we can have communication classes in the curricula of our Medical School and Residency programmes”

I have run the Advanced Clinical Communication course with my former colleagues at St Georges Medical School for five years, working with senior doctors on the real communication problems they experience in the workplace. Over the years we have worked on issues ranging from communication challenges with patients and their relatives, conflicts between healthcare colleagues, the nuts and bolts of breaking bad news to patients, dealing with clinical error honestly, to teaching at the bedside and much, much more.

The two-day course is very practical and learner centred. We use role-play to recreate challenging situations and actors to simulate a range of patients and health care professionals coupled with in-depth and constructive feedback. Participants give great feedback about their learning experiences and some have gone on to set up learning groups of their own.

We ran the course in central Bucharest with 18 participants booked (16 doctors and two nurses) and all arrived enthusiastically for a weekend of hard work. We were lucky to have four highly trained actors to work with us and, most lucky of all, the participants were willing to conduct the workshop in English as our Romanian was non-existent.

Romania is a very different country to the UK and yet we worked on very similar issues such as the best way to break bad news to a patient, or how to include a relative in a clinical conversation without compromising the patient’s autonomy or confidentiality, and how to deal with end of life issues sensitively and honestly.

The one difference I found during the weekend was the need to support and encourage participants to use empathy in their clinical consultations and to see this as a strength in clinical practice.

I was amazed that despite having no formal clinical communication education these health care professionals were so committed to improving their communication practice. Bearing in mind that they had in the main never experienced an interactive lecture, or worked in a small group, let alone learned through role play, they embraced the course with energy and enthusiasm. And all of this in a second language!

One participant (a young oncology resident) said of the course: “I was afraid of the patient’s tears, but when we did the role play, I realised that the most frightening thing wasn’t the crying; instead it was the words and feelings of the person in front of me. This exercise will definitely help me handle such a situation better when I have to do it in real life.”

As well as running the course we had also taken part in radio and TV news interviews as the course had attracted media attention. By Sunday evening we were all tired, but happy about a productive weekend, and reflected on the way home about our whistle-stop visit to Romania and the fine people we had worked with there.

These doctors and nurses are the first communication champions in Romania and I wish them the greatest success in the world.

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