Within the intricate tapestry of a hospital, often overlooked, lie the perspectives of medical students, an underused source of first hand information. As we are exposed to a multitude of clinical scenarios, students naturally become observers of the communication dynamics that ebb and flow within the NHS. We encounter a spectrum of interactions, from heartening to disconcerting. Some of which offer invaluable insights into the realm of what is effective communication and what clearly is not. To explore these hidden insights, I compiled a list of questions in a survey to explore gaps in the communication skills of those they have shadowed through their placements. The survey was distributed to a small group of medical students. Their responses, along with other remarks compiled within this article, sheds light to an array of information needed for the improvement of patient safety and staff wellbeing.
Exemplary communication skills
When asked to recall instances of exemplary communication skills, one student recounts that during an Intensive Care Unit (ICU) placement they saw “incredible communication” where the consultants engaged empathetically with the patients family, addressing sensitive matters without the use of medical jargon. This student elaborated on the experience by saying “it has changed the way I speak to patients and I will carry it with me through my practice”. Having experienced and heard the same from other medical students, it is clear that departments with a focus on end of life care (such as ICU, palliative care and oncology) tend to emerge as sanctuaries of effective communication. Here, the slower pace of ward rounds (due to the depth of information needed for the proper care of each patient) allows for meaningful patient and carer engagement, enabling clinicians to delve into concerns and tailor responses with utmost sensitivity.
Tailoring communication to the individual
The significance of effective communication is also evident when small gestures create a lasting impact. Students recounted a few instances of this, one where a doctor “explained the process of taking bloods to a child” to ease their nerves or when there was a deaf patient on the ward round and the consultant “utilised a pen and paper in order to communicate”. Though seemingly easy, due to the rapid pace at which clinicians usually carry out these activities, they may not even consider the way they are communicating with their patients. Those who offer tailored interactions stand out from the rest.
Disconcerting gaps in communication
However, amidst these sparks of effective communication, disconcerting gaps surface, often between medical professionals themselves. When asked about the gaps between staff, most of the students commented that during ward rounds, doctors may forget to inform the nurses of the next steps with a particular patient before they leave the ward which leaves the nurses in an unnecessary pursuit. Two students mentioned how illegible writing from doctors have often been a cause of confusion and though seemingly minor, these blunders tarnish the seamless exchange of critical information and can actually reduce patient safety.
Describing experiences they had noticed between patients and healthcare teams, one of the students recalls this harrowing encounter-
“There was a patient who had undergone radiotherapy on their stomach and was therefore unable to eat without vomiting. The team following them up did not refer the patient nor did they flag the fact they had been unable to keep food down for over a month as a concern, so by the time the patient presented to the clinic they were extremely emaciated and unwell. The lack of communication led to an almost fatal outcome to the patient.”
The medical team’s failure to follow the patient, though shocking to read, highlights the far-reaching implications of communication errors when transferring patients between teams.
It also begs the question of how often this has occurred especially because since the COVID-19 pandemic, it’s clear to see how overworked the NHS system and staff are. Some clinicians go above and beyond in their clinics. Yet, some patients have clinicians who don’t and are often left with an impression that they are not the priority in their encounters.
A 4th year medical student elaborated that the gaps between clinicians and their patients are often due to a lack of time–
“Doctors often run through new diagnoses/ medications quickly and don’t always ask if patients have questions. There’s been times the patients have left the clinic and then left confused to what is being done next.”
When asked what advice they would offer to patients to combat these situations, a lot of the responses echoed that patients should speak up, come with questions prepared and if at all unsure, should ask clinicians to repeat themselves (without the jargon) as many times as is necessary to understand. Yet, we know that patients don’t always feel encouraged to do this.
Hesitancy to confront poor communication
As the survey delved into the final question, a disheartening theme emerged – a hesitancy to confront poor communication. The reasons behind this reluctance paint a sombre picture, with some students citing that challenging poor communication may trigger unwarranted scrutiny and potential repercussions. The reflections of students also echo the broader reality of healthcare disparities, where individuals from black, asian and ethnic minority (BAME) backgrounds face unique challenges in asserting their voices.
“As a woman of colour I believe I would be given a more aggressive outlook by others and statistically I have a higher chance of being reported for minor things or even just for responding to unkind comments. I would rather not risk getting reported and therefore just take it up with a senior e.g. who would have more power than if I was a junior doctor…. Although, throughout my medical school career I have heard unkind and questionable comments and I have not challenged it as the individual saying these comments is in a senior position and makes me think about the impact it’ll have on my own education.”
The response from this medical student resonated deeply with me, especially as a woman of afro-Caribbean descent. As hinted above, women from BAME backgrounds are more likely to experience discrimination and fitness to practice referrals than their white counterparts (17% compared to 6.8%). NHS England reports that this number has been steadily increasing, reaching its highest level in 2022 since 2015. The hesitancy to challenge unkind or questionable remarks, especially when voiced by authoritative figures, highlights the challenge that power dynamics can have in fostering an inclusive environment.
Ray of hope
Nonetheless, a ray of hope shines through as healthcare institutions embrace initiatives to dismantle these barriers and take an active stance against this narrative. Initiatives such as the NHS guardian system and active bystander training show that individual trusts are involved in a transformative shift towards a more inclusive and supportive environment. We know that the journey toward rectifying communication gaps necessitates a fusion of individual efforts and institutional support. As medical students dare to voice their observations, there is a unified call for change. The echoes of our experiences should urge clinicians to break down barriers and pave the way for a future where effective communication is not just a skill, but an unwavering commitment to the well-being of patients and practitioners alike.