Home > News > Nation
Sunday August 25, 2013 MYT 12:00:00 AM
Sunday August 25, 2013 MYT 10:15:37 AM
by audrey edwards
Enhancing the communication skills of its doctors and nurses is one of the targets the Health Ministry has set to improve its services.
FOR Sophie (not her real name), visiting a public hospital every few months has been a norm for more than a decade. A diabetic, the 20-something has seen her fair share of doctors and nurses both as an inpatient or for consultations at the specialist clinic.
Sometimes, she says, she could be made to wait for hours for a consultation that lasts only a few minutes with a doctor who is seemingly in a hurry to wrap things up.
“It can be a bit irritating because you wait for hours and then the doctor or nurse doesn’t seem interested in explaining things to you.”
She remembers a particular incident where a doctor flippantly told her that she did not have long to live because of complications that could set in.
“I thought she was being really cruel because you can have a longer life as long as you keep your (blood) sugar level under control. I remember crying after seeing her because the last thing you need when you have a sickness like this is someone crushing your hopes of a good life,” she says.
Sophie did not lodge a complaint against that doctor, choosing instead to prove the “haters” wrong and be as healthy as she can.
“I can understand if they are overworked but surely it doesn’t take much to be nice. There was also the time when I accompanied my mother to see a doctor and she ended up being treated like she was an ‘ignorant old lady’, which of course made me angry. Above all, I don’t think anyone should make assumptions when they are treating someone,” she says.
Since then, Sophie has seen a change for the better.
“Nowadays, there is an improvement among the doctors and even the nurses are friendlier. It definitely makes matters easier and you feel that they do care about you.”
Health Minister Datuk Seri Dr Subramaniam recently said his ministry was exploring ways to improve communication skills among its staff through, among others, a more structured training programme that would encompass all levels including during training at medical schools and in a staff’s continuing professional development (CPD).
He said that while the subject of communication skills was already in the curriculum of many medical schools, the ministry would look at how it could enhance and monitor the curriculum.
Before this, Dr Subramaniam had cited poor communication skills as one of the reasons contributing to a controversial issue in Penang involving some doctors who were alleged to have refused to treat patients.
The issue came about when Pinang Tunggal assemblyman Datuk Roslan Saidin told the state assembly in July that doctors in two public hospitals had refused to treat several patients.
However, Dr Subramaniam stressed that the move was not just because of those incidents.
According to a study reported in the United States in 2010, only 48% of patients said they were always involved in decisions about their treatment, and 29% of patients didn’t know who was in charge of their case while they were in the hospital.
Meanwhile, 81% of patients and 71% of doctors agreed that communication made a difference in “whether a patient lives or dies,” according to the survey of 500 doctors and 800 patients.
A doctor’s point of view
Dr Alan (not his real name) considers himself a “patient and polite” specialist who takes time to explain matters to his patients despite seeing up to 20 of them daily.
Each session takes about 15 to 20 minutes, and sometimes up to 30 minutes if the patient is newly-diagnosed with cancer.
“Sometimes, language can be a barrier because while most of them speak Bahasa Malaysia, there are some locals who don’t,” says the 39-year-old doctor stationed at a general hospital in east Malaysia.
“It is hard for them, especially those who come from rural areas, to understand surgical procedures. When you go into detail, they don’t get it. It is okay until something goes wrong, then they start pointing fingers.”
Besides picking up communications skills along the way, including when “hanging out with friends”, he says taking a course during medical school on skills such as how to talk to patients also helped in identifying his shortcomings.
Problems in communication also arise when there are too many housemen, which result in them not having much time with patients, says Dr Alan.
“But that shouldn’t really be an excuse,” he adds.
Malaysian Medical Association president (MMA) Datuk Dr N. K. S. Tharmaseelan feels doctors must be made to attend CPD courses and workshops on communication skills, adding that it would soon be made compulsory when amendments were made to the Medical Act.
“It should then be taken into consideration as part of their KPI (key performance indicator).”
The MMA conducts courses on communication skills at both national and state level on a monthly basis, he says.
Including communication skills as part of the KPI would raise one’s need to acquire it, and good communicators and those who have never had complaints made against them should be given incentives to motivate others, he adds.
Studies have shown that many medical negligence suits are filed but upon investigation, 90% of the time they were the result of improper or inadequate communication, Dr Tharmaseelan reveals.
“Patients did complain about the treatment received but investigations showed complaints were almost always due to poor communication.”
He stresses that it takes patience to become a good communicator, and that communication skills cannot be developed overnight. Even those with the “gift of the gab” must have the patience to listen to become good communicators, he says.
“Communication is a two-way mechanism – talking and listening. One who talks eloquently need not necessarily be a good communicator if he is not able to listen to the other party patiently. He should give the other party time to talk and listen to what the other has to say.
“Also, communication is both verbal and non-verbal; mannerism, body language, eye contact and tone of spoken words along with being empathetic are essential components of communication skills.”
He reminds that being aloof, speaking in a loud manner, inappropriate body language, having no eye contact, inappropriate facial expressions and apathy towards another will certainly result in communication problems.
“There should be expressions of interest in communication. These, along with well chosen, simple, easy-to-understand words will certainly help in a mutually beneficial consultation,” he says, adding that in a multilingual society like Malaysia, one has to ensure that doctor and patient truly understand each other.
Striving to be better
“When there is a problem communicating with one another due to language barriers, a translator should be sought among the staff or the relatives of the patient,” Dr Tharmaseelan suggests.
“We must also pay attention to the sensitivities of others in a multiracial and multi-religious society.”
He also stresses the importance of being patient as either party can be provoked or become irritated after a tiring day or stressful episode before the consultation.
“When one is talking to give information, the other party has to listen, reflect on it and give the relevant answers. Otherwise, either side may not be able to gather relevant information or give relevant answers and provide/ receive appropriate treatment,” he says.
While most institutions of higher learning, especially medical schools, have communication skills as part of their curriculum, the skills were learnt in the classroom and might not necessarily be exercised immediately in actual situations, says Dr Tharmaseelan.
Too many doctors with inadequate exposure, too many patients, increased waiting time and lack of time for consultation could all result in problems in communicating, he notes.
“Sometimes, in some units, there are 100 doctors who are undergoing internship. They all may not receive the same quality training exposure especially with regards to communicating and exposure to deal with patients. Coming into direct, one-to-one dealing with patients is important but this opportunity to interact is limited. This does not allow enhancement of communicating skills.”
He adds that as public hospitals become more crowded, the waiting time will be lengthened and when patients finally see the doctor, consultation time and communicating would be reduced.
“When a doctor makes a hurried consultation, it may result in dissatisfaction among patients who would have expected the doctor to have spent more time talking to them. This disappointment then leads to a chain of events that result in complaints about treatment received without it being dependent on the outcome of treatment,” he says.
Malaysian Nurses Association president who is also the Allianze University College of Medical Sciences nursing faculty dean Dame Ramziah Ahmad says nurses undergo training in communication skills with the 10S concept.
These are core modules including senyum (smile), salam (greet), sentuh (touch in order to reduce a person’s anxiety), sensitif (sensitive to the multiracial and multi-religious society), segak (well-groomed), semangat (spirited), selidik (research), sopan (courteous) and sedia (prepared).
Training involves staff nurses, matrons and sisters, says Ramziah, a former trainer at the Institute of Public Health Management.
The training programme was started because the complaints lodged were mainly related to communication skills, she explains.
“We then follow up with their respective hospital directors three months after the course to find out if they were using the 10S,” she says, adding that the number of complaints arising from communication skills have since reduced.
“Everyone, even those in the private sector, should put the core modules into practice,” she suggests, while also stressing that it is important to have the skills inculcated in them while they are training as nurses.
Tags / Keywords:
Copyright © 1995-2013 Star Publications (M) Bhd (Co No 10894-D)