Communication (skills)

28 Jan

“Write it down Nick,” commands my friend (who has written more column inches for various publications than I’ve scribbled prescriptions for amoxicillin) “I want 750 words by the end of the month on the subject of COMMUNICATION.”

So here it is: my first blog. Naturally, when considering the subject of communication one thinks of computers and e-mail, Skype, telephones and fax machines, pen and ink, telegrams, sign language, the written word, semaphore, Morse code, plain old speech and gesticulation (to name but a few). All of these are undoubtedly worthy subjects in their own right, but I prefer to consider communication skills tuition back in medical school in the mists of 1995.

We found ourselves around ten to a group charged with the task of interacting with an actor who had been brought in for us to interview and to whom we would each have the task of breaking bad news (I had to tell her that as a result of being typecast in one too many episodes of The Bill she was no longer to be considered for ‘third paramedic from the left’ in next week’s Casualty). For most students, the concept of role-play was, in embarrassment terms, second only to watching John Barrowman delivering a Scottish accent in a ginger wig on the never-popular Tonight’s the Night (if you haven’t – don’t) – but it struck me that simply believing the situation was real was the best way to deal with it and so took to it without much difficulty.

Watching my colleagues cope with this ordeal was particularly fascinating. As a generalisation, the more academically gifted among our number struggled the most, delivering the bad news with all the sensitivity of one of the Four Horsemen of the Apocalypse on a stressful day: “Erm, I’m afraid it’s cancer and you’ve probably got about six months. Any questions?” This would be met with (real) tears from our thesp’ before the tutor called a halt to proceedings and addressed the remainder of the assembled to query: “What do we think was particularly good about D ’s approach?” I think the answer could be summarised in two succinct words, the latter of which being “all”.

The actor interested me greatly too. I loved the fact that she would respond with complete realism throughout each student’s fumbling attempts to impart the worst. This would be followed by closure of the eyes, a rolling of the shoulders before she would smile demurely, look around the room and exhale happily – this was coming out of rôle (and yes, the ‘ô’ is important). Then would come her comments about how “she” was feeling (“she” being the character, not the actress herself of course).

For my own part, I didn’t fare too badly and generally followed the rules about “firing a warning shot” before launching in with the main event – “Well, I’m sure the fact that I’m sitting here with a list of local florists and samples of various woods has probably alerted you to the fact that I’ve not come to announce that you’ve won a fortnight for two in the Maldives?” To be honest, it seems to me that communication skills is something which you can’t teach – you can either do it or you can’t.

I always thought that I was quite good at it until some years later, when just coming to the end of GP training those who knew best put together an afternoon’s session with, you guessed it, actors and role play. The brief was to explain to the actor why he wasn’t getting antibiotics for his cold. All seemed to be going swimmingly until his hands appeared from below the desk: a cigarette lighter in one and a can of fuel in the other. He played it perfectly, his face giving nothing away and for a fleeting second I thought he was going to do it. He didn’t and left with a prescription for 30 amoxicillin, 20 clarithromycin – and smoking cessation advice.

Perhaps the finest example of poor communication I ever saw was a consultant on a ward round at our local district general hospital who was asked “How long do you think I’ve got?” Dr K smiled, dropped his head to one side and simply replied: “Well, if I were you, I wouldn’t be booking any holidays after July.”

Come to think of it, blogging is also a means of communication and I’ve had my 750 words so for blog number one, my July has come.

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