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| PERSONAL VIEW |
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| Year : 2012 | Volume
: 25
| Issue : 3 | Page : 211-212 |
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In the News! An Opinion - Don't say …
Jan van Dalen
Associate Editor, Education for Health
| Date of Web Publication | 29-Mar-2013 |
Correspondence Address:
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1357-6283.109793
How to cite this article:
Dalen Jv. In the News! An Opinion - Don't say …. Educ Health 2012;25:211-2 |
In communication skills training with future doctors, after a situation is described, we often hear the question: what should I say when that occurs ?
There is no clear cut answer to that question. The only honest answer is: " it depends… ". Doctor-patient communication is influenced by a host of variables: the character and temperament of the those involved, circumstances like available time and the assumed impact of the information the doctor has, to name a few.
All these factors should be taken into account when the doctor decides what to say. Rapidly, the experienced doctor assesses the issues at stake and makes a choice of what to say and how to say it. Experience, training, social intelligence and knowledge of our patients are crucial in establishing rapport and exchanging the necessary information in the healthcare professions, where existential issues are addressed like reduced health and even death.
Many guidelines are available to arrive at decent, courteous and adequate communication in health care. Some guidelines take the shape of 'DOs and DON'Ts' while others focus on the goals that have to be reached in the consultation. Eliciting the patient's reason for the encounter and their agenda, or motivating the patient for a healthier lifestyle, for example, require different communicative approaches.
These two types of guidelines reflect two different ways of training.
DOs and DON'Ts are mostly found in behaviouristic training formats. Such training is characterized by the provision of a model, where learners are challenged to behave in such a way that conforms to the model. Feedback typically involves predefined checklists (indeed, DOs and DON'Ts), commenting on how closely the learner approaches the criterion. On the other hand, a training focused on the goals of the communication is more often indicative of a constructivistic approach to learning and teaching. Within this approach, there is ample recognition of the many ways in which a goal can be accomplished. Based on a multifactorial view of doctor-patient communication, the latter approach seems to be more appropriate for communication skills training.
But it probably is not fair to take a one-sided view and choose between these two approaches. For good communication, we need to master the craft (like asking open questions and giving a summary that recapitulates the points that are most important for the patient) as well as judge which individual approach would be best for this very patient we are attending to. In the words of Salmon & Young [1] that I referred to on a previous occasion [2] , we need communication skills to be skilled communicators. These are two sides of the coin, and both should be addressed in training.
In June last year, an insightful paper appeared in Oncology Times: 8 Words and Phrases to Ban in Oncology ![3] Although phrased as DON'Ts, this paper is helpful for both types of training described above. It gives specific suggestions about how not to phrase certain information, but, additionally, Robert S. Miller, the author and an oncologist, clarifies what the impact of such unfortunate phrasing can be. We probably all recognise the eight examples Miller describes: "aggressive"; "OK?"; double negatives; " well-developed/well-nourished "; "well tolerated"; "suggests…"; the military metaphor; and "if you had to get cancer, then < fill in > is a good one to get." For an outsider, and all but patients are outsiders, these phrases or metaphors do seem to be sensible. It takes empathy and compassion to see what damage we actually can do by using them.
May I encourage everyone interested in communication in health care to add to the list of expressions that may have damaging effects on the patient's well-being? This will help to stop our learners from asking for expressions as formulas to cope with circumstances in which communication is extra sensitive.
| References | |  |
| 1. | Salmon P & Young B. Creativity in clinical communication: from communication skills to skilled communication. Medical Education. 2011;45:217-26. 
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| 2. | van Dalen J. Communication skills: the wrong analogy. Education for Health. 2011;24(2)
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| 3. | Miller RS. 8 Words and phrases to ban in oncology! Oncology Times. 2010;25:20.
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