Careers - Core skills series: Communication

In this series we explore the key risk areas in general practice 

At a glance

In general practice communication has to extend to a greater number of people, so there are more opportunities for it to fail. Communication between primary, secondary, voluntary and social care should be viewed not as a chain, but as a communication net.

Prescribing

Good communication is particularly important when it comes to prescribing. Patients need to be made aware of, and recognise, adverse side effects. It is vital that prescriptions are written clearly and accurately, and computer-issued prescriptions are properly checked. It is also important that the patient understands clearly what the medication is for, and how they should take it. Check what other medication the patient is taking, and whether there are any contraindications with the current prescription.

Consultations

Good communication with patients during a consultation is your first line of defence in warding off complaints and potential clinical negligence claims. Effective interpersonal skills are particularly important for locum GPs because they often have only one chance to make a good impression.

Patients who are denied the opportunity to explain their concerns or reasons for presenting may feel alienated, frustrated or resentful. Patients who are kept informed about their condition, and who are actively involved in deciding on the appropriate treatment, are more likely to comply with suggested treatments and are less likely to complain if things go wrong.

Tips for an effective consultation

• Let the patient talk first. An uninterrupted history aids diagnosis.
• Use non-verbal communication to encourage patients to talk, eg, nodding, making and maintaining eye contact. 
• Well-aimed open questions can help “lead” the consultation. 
• Allow patients enough time to ask questions and clarify things. 
• If there is a lot of information for patients to digest, use patient information leaflets or factsheets.

Being open

Sometimes, in spite of your best efforts, patients will be unhappy with the care they have received.

The General Medical Council (GMC) emphasises that patients who have lodged a complaint deserve a prompt, open, constructive and honest response including an explanation and, if appropriate, an apology.

Colleagues

You and your colleagues should be aware of who is doing what, and understand the part they play. This will involve sharing patient information, which is entirely appropriate as long as continuity of care is balanced with the need to maintain confidentiality and patients are aware of how the information will be shared within the team.

If you are a locum GP, your colleagues should provide all the relevant details of the patients for whom you are responsible. Practices should have protocols in place for the transfer of relevant information between doctors. However, many do not cater for the nuances of working as a locum, so locums should have their own systems in place to ensure adequate clinical handover.

Using computers

It is important that the patient feels that they are receiving your full attention. Two helpful approaches are:

• listen – if the patient speaks, stop what you are doing and turn your attention to them – providing a useful opportunity for the patient to reflect and tell you any information they have forgotten. 
• explain – tell the patient what you are doing. You should ensure that other people cannot overlook your screen and make sure that when you are talking to a patient you have their records displayed and not someone else’s. There is nothing to prevent you letting a patient see their own records, unless these display harmful information relating to a third party.

Telephone consultations

Studies show that public satisfaction with telephone consultations is high, and patients increasingly wish to have this option. Talking to a patient on the phone, however, exaggerates the difficulties of a face-to-face consultation because there are fewer cues to pick up on.

Tips for an effective telephone consultation:

• Remember not to break confidentiality – be cautious about revealing your identity until you have confirmed that you are speaking to the patient. You should only discuss details with a friend or relative if you are sure that the patient has given their consent. 
• Empathise with the caller. 
• When gathering information on the caller’s problem, make sure you: ask some open questions and closed questions, ensure that you are in a position to reach a sound clinical judgment, agree a plan of action with the patient, and check that they agree with it and understand it. 
• Ask the patient to repeat the advice given several times throughout the consultation.
• Document the consultation accurately.
• Follow-up: check existing medication when prescribing new medication, explain to patients what they should expect by way of improvement, ask about significant symptoms to report, and advise when to phone back if they are not getting better.

"Talking to a patient on the phone, however, exaggerates the difficulties of a face-to-face consultation because there are fewer cues to pick up on"

Useful links

• GMC, Good Medical Practice 
• GMC, Confidentiality (2009)
• MPS communication courses and workshops
• MPS E-learning platform: Work through interactive case reports and earn CPD points, too!
• MPS communication factsheet
• MPS General Practice Conference 2013: Keeping Safe – Back to Basics