Medical Matters: Think I need communication training? Well, you’re the doctor

I am glad to see that medical students are now learning the fascinating art of communication skills. And while trainee GPs and psychiatrists spend more time than most analysing speech, body language and the mechanism of the consultation, all new doctors learn communications at some stage in specialist training. This is commendable, but you can’t beat experience.

Communication works both ways. For example, patients who have served their time in the consulting chair quickly learn to recognise the phrases that set their patient senses tingling. Phrases such as “I’ll look that up” or “I’ll get back to you on that” often cause alarm . “I have that myself” is less than satisfying. “It shouldn’t worry you. It will probably be okay” or “You could lose a few pounds” seldom have the desired effect. Likewise “I don’t like the look of you.” There is no way that things will go well after that. The classic patient reply is “You’re no George Clooney yourself.”

This may all seem innocuous and a normal friendly sharing of information, but a lot of what both parties say can be construed as lies, half-truths and ill-informed comment if things go wrong. A medico-legal consultation, for example, can have more subtexts and hidden agendas than a parliamentary party meeting.

After a while you start to imagine people’s thoughts floating over their heads in a bubble, like they do in comics. And if you work for a few years you learn to spot quickly the phrases that mean danger. Some things people say make a GP’s spirit rear its head like an old warhorse and gallop away to hide. But you learn to yawn with your mouth shut and maintain a poker face, although inside you may be crying or laughing hysterically.

The first scary cliché you will hear comes not from patients but from administrators and unscrupulous colleagues.

“It’s a vocation.” That means someone is trying to take advantage of you. They will presume on your time and good nature and you will end up broke and exhausted.

“Gentleman’s agreement.” Any scoundrel who says this is afraid to put it in writing. Anyone who uses it is no gentleman and you will up a sadder and wiser young doctor.

“I’ve cut down.” Smoking is a subject obscured by lies, denial and deceit. It is matched by drink and, in fact, all sorts of drugs. You can’t believe any of it.

“I’ll keep on going in my own way” is commonly used by people who are supposed to be losing weight or managing chronic conditions. They are ignoring all facts and evidence, and all the tests show that they are heading in the wrong direction, but what the hell, the way is their own so that’s all right.

“This may be against your principles” means that whatever they are about to propose is not only definitely against your principles but also probably dangerous and illegal.

“It’s only a cold.” Check him out. He probably has pneumonia.

“But my previous doctor always used to . . .” If you can track down the previous doctor it is odds-on that they will deny vehemently ever doing or saying such a thing. If they did, they have probably been struck off.

“It’s urgent.” Often accompanied by “You have to write me a letter. Now.” This is usually a letter that is due that afternoon, usually for a judge. They will have had months or even years to get it ready, but now the emergency is yours as well.

“I don’t like antibiotics but . . .” means “I’m looking for antibiotics.”

“You’re the doctor.” Even if this is delivered in a cheery tone with an accompanying smile, there is an underlying sense of menace. It is a phrase often uttered by colleagues who don’t agree with you.

“Sure that’s no harm?” They expect you to agree. It certainly is harmful, whatever it is, if they have to ask.

“It’s the only thing that works” means that I’m addicted to whatever I am looking for. If you were genuinely looking for a solution you would be happy to try something different.

Words can heal, soothe, injure and change behaviour. It can be difficult to come up with the apt phrase every time, and ill people can be vulnerable and slow to appreciate a joke. Communication training is great, but experience is the best teacher.

Dr Pat Harrold is a GP in Nenagh, Co Tipperary. Dr Muiris Houston is on leave.