Better Patient-Physician Bond Vital

Professional communication is a message within and outside the work area, expressed through speaking, listening, writing, reading, etc., by personal or electronic means. Letters, brochures, prescriptions, emails, news, blogs and reports, are a few examples of it.

At a workshop organised by the Nepal Medical Council to discuss and propose MBBS courses, a doctor confessed widely, "While communication skills are weak among workers working in other fields, doctors are the only class that accepts them." 

Certainly, there is a lack of professional communication knowledge and practice among varied professionals working in several fields like engineering, teaching, security, management and media. However, hardly anyone realises it for correcting unlike few candid doctors. Some departments teach it, but that is not enough. Professional communication means any professional or technical communication. 

Scanty communication

Professional communication was scanty and poor during the pandemic. First, the number of healthy doctors was dwindling and their communication with patients was ineffective as most of them had to do their duty with duress.  With a surge in COVID-19 cases from early May 2020, the imposition of lockdowns and preparedness measures for the detection and treatment of patients infected with the viral disease in Nepal, the delivery of non-COVID health services in public hospitals was affected, causing increased morbidity and mortality, according to a study conducted in 2021. 

Similarly, another study done in 2022 discloses that the pandemic has had a profound impact on healthcare services, creating uncertainty around timing and patient demand for services. The reality of multiple waves of resurgence, patient-related disruptions, and a shift to telecommunications create a number of constraints and challenges associated with disturbance across telemedicine and the continuum of care. John Noseworthy (2019) states that amidst the complexities and changes in the current healthcare services; the most fundamental element of healthcare remains the patient-physician relationship.

These days young people studying at universities, despite of their area of specialisations, are the future pillars of the country. So, professional communication research and education at universities is essential. Out of those students, some apply for scholarships, while others look for jobs. Some will become doctors or nurses. And after passing through public services, they enter public service. Some choose politics while others become business leaders. But whatever their profession, they need common skills, and it is the communication skills that professional communication teaches. To communicate effectively with people from diverse backgrounds, obtain new jobs, retain and promote, resolve misunderstandings within teams, work collaboratively, build positive relationships, and gain experience, and to give motivation and encouragement to fellows, it is vital everywhere and every time.

There have been some changes in the state of communication in various agencies, governments and private organisations between before and now. But that is just a beginning as that is still mere scanty. These public and private organisations are aligned with the 1 point zero to 2 points zero principle. So we see some improvements compared to the past. There are minor changes in speaking, but no fundamental difference in listening because nobody likes to listen to others. Perhaps listening is more important than speaking but the priority has been given to speaking mostly.

This is even more acute in Nepal's healthcare facilities. And not enough researches have been done on this topic in our nation. There was not much discussion or debate on this subject. General patients who go to hospitals face various hitches. Before going to a hospital, they are dissatisfied with an impression of selfish and inhuman doctors and hospitals. Their expectations are not unusual. Generally, they desire for getting kindness, trustworthiness, reasons and logics of doctors and hospital staff. They want doctors to spend enough time for them. In fact, when a patient visits hospital, s/he expects their doctor to talk to them and listen to them well. This really makes a big difference in the treatment of the patient. 

Many patients say that smiling, empathetic and sympathetic doctors cure half the disease right after their meeting. On the other hand, if they meet doctors who have the opposite personality, they feel fear and anxiety, and it may be a fruitless encounter. The main thing is that in this case, doctors’ instructions are not followed properly. As a result, patients do not take appropriate medications and the likelihood of subsequent follow-up care is also reduced. Therefore, it will mar the status of doctors and hospitals.

Looking to international practice, doctors need to communicate effectively with their patients. John Noseworthy further elaborates that a continued focus on patient needs and benefits of collaboration may seem dated or nostalgic, but caring for the sick requires face-to-face interactions grounded in trust, evidence, experience, and technology still needed. 

Therapeutic environment

The patient-physician relationship is essential to healing and it gives a meaning and purpose to their profession and life. Doctors have to prioritise communication with patients by building a therapeutic environment before treatment. When conveying a verbal or symbolic message, they should choose the right type of it. Information requested by the patient should not be hidden.

The nature of the disease and the increasing complications in the future should be discussed. The need for treatment and options should be implemented immediately and in the future as well. Even if the patient has to undergo expensive tests, it should be made clear to him/her in advance. 

Resultantly, this may build good trust so that the patients will recover from whatever sickness they go through. It will also negate the possible confrontations between doctors, hospitals and the patients’ near and dear ones. A full stop can be possible in the frequent vandalisms done by the kin and kith of the patients right after the death of the latter that causes a huge loss to both parties. With appropriate communication, such madness might not lead to mobocracy in the society. 

(The first PhD on patient-doctor communication in Nepal, Dr. Duwadi, an Associate Professor at Kathmandu University School of Management, researches on medical humanities and communication.)