EHA 2010 Annual Meeting, 10-13th June 2010, Barcelona
Dr Steve Johnson - Yeovil District Hospital, UK
Communication Skills in Clinical Practice
I am here at the EHA today, having run one of the regular sessions that are co-sponsored with the European School of Haematology, where we put on a piece of theatre that involves a real clinician and a couple of actors and a clinical scenario which is played out in front of usually an audience of about 150 people.
Why are these communication skills workshops necessary?
I think the concern for a long time has been that communication in the clinical setting, communication with medical professionals, healthcare professionals and patients is really important. There’s a huge amount of evidence from government driven audit and surveys, and bureaucratic literature that that’s true, and also from the sort of semi-medical/legal setting - anybody who’s involved in handling complaints from patients is aware that around 85% of them relate to bad communication and only about 15% relate to bad clinical decisions. So a drive to improve communication with patients is an enormous part of improving the experience for patients. It’s important also for achieving good compliance with complicated treatment, and it’s important for the healthcare professionals as well; if you go to work and you repeatedly have bad experiences of communicating with patients, you are much more likely to burn out, be lost to the profession as a consequence of dissatisfaction with your own performance. So there are lots of good reasons for trying to improve the standard of communication between healthcare professionals and patients.
What scenario did you address in today’s workshop?
We set up a really scary scenario for Graham Jackson, who is a haematologist from Newcastle. We gave him a very arrogant businessman with an aggressive lymphoma, a Burkitt’s lymphoma, and previously undiagnosed HIV as part of the presentation, and we made Graham tell the businessman the diagnosis in front of his wife. I thought it worked really well and it worked really well partly because I use excellent actors to put this sort of thing on and they presented the scenario, reacted to the way Graham approached it very well. And the other thing that I thought was successful about today is that the audience were very engaged, and in the period of discussion after the little role play had finished, I thought they asked some very perceptive questions, both of Graham as a clinician and of the actors, putting them back into role as patient and wife, and getting them to explain how they felt about hearing the news of the lymphoma, and of the HIV.
How much variation is there in issues faced by clinicians in different parts of the world?
A haematologist from Saudi Arabia was talking about the grave difficulties in being frank about either the diagnosis of malignancy, or about HIV, in that cultural setting. That’s something we’ve explored in previous ESH/EHA Congresses where we’ve put on sessions like this.
What do you hope to achieve in these workshops?
What I really feel about this whole area is that you can change behaviour, you can change the way people communicate with patients, but you can’t do it with a single piece of twenty minute theatre in a room with 150 people. And what the theatre of the Congresses does is to make people aware that more protracted communication training might be desirable and necessary for them. In the UK, as you perhaps know, the cancer networks organise courses that run over three days with one facilitator for every five delegates. Those are supported by actors and supported by video feedback and that sort of intensive coaching can really change the way people that approach the problems that are presented by communicating terrible things to patients.
Are the workshops available to professionals from other countries within Europe?
Well in the past the EHA was in the fortunate position of being able to run three-day courses in the three days running up to the Congress, in the city where the Congress was going to be, and that was industry-funded. It was obviously an expensive thing, because it involved us hiring actors, video equipment, facilitators from various locations in Europe, and I guess it cost a lot of money for maybe 20 or 25 delegates. Anyway the industry ceased to fund it and the ESH didn’t have the resources to carry on with the programme. But I felt that it was valuable, that particularly some people from the less rich member countries were able to send promising young doctors to come on the three-day residential course and then stay for the Congress as part of a package, when they perhaps wouldn’t have been able to get there before. But as you can hear I feel really strongly that if you want to change behaviour, you need to have people over two or three days in a small group with the video feedback and good actors.