Medical students should take communication courses to learn how to better interact with future patients and their families. This is the statement of the Minister of Health, Alexandru Rafila, who wants more patience and empathy from them. Basically, before donning the white coat, students should learn to be not only consummate professionals, but also people.
Alexandru Rafila proposes communication courses for future doctors. Photo source: archive
What do we want from a doctor when we enter the office? To be a good professional, to know his job perfectly, to be confident, to treat us with care and respect. We want simple explanations, on our understanding, empathy, moral support and patience. To focus not only on the medical act itself, but also on the human side of his job. This ability, with which some are born and which others acquire, should be taught from the benches of the faculty, from the first years of study.
“These communication courses (…) should be part of the training curricula for nurses and doctors. I think that the optional part is not very tempting because we also have this problem – anything that is temporary tends to become permanent and I don't think that the temporary is a good thing. For 22 years we have been struggling with Health Education in schools, I don't think we have to wait another 22 years to introduce communication as a discipline. People, when they are sick, or families of children when they are sick, need not only encouragement, they need an explanation, they need a person to communicate with and who understands their anxieties, and they need encouragement and empathy” , said the Minister of Health, Alexandru Rafila, on Tuesday, at a medical conference.
Rafila is of the opinion that these qualities needed by the medical staff must be acquired “in an institutional framework”. “You can have these things natively, but they must be acquired in an institutional framework that the school offers, whether we are discussing the faculties for medical assistants and midwives, whether we are discussing the faculties of medicine and maybe we manage to think and to a communication“, explained the Minister of Health.
“A doctor told me, 'I'm out!' They should learn to be more human”
An excellent idea because, indeed, many doctors fail this test of humanity with flying colors. “There is no empathy. I had a negative experience with a doctor who told me to “Get out”. We failed to understand each other, to communicate and we ended up with a different dialogue. Unfortunately, we are talking about a reality that we live almost daily and that we have to change”declared for “Adevărul” Radu Gănescu, the president of Patients with chronic conditions.
He recognizes the problem, which is that when it comes to communicating with the patient, many doctors are not good at all. “You can't really change those from the older generations. We are talking about an attitude and an outdated way of relating. They still go by the idea that I am the doctor, I know best, I saw you, I gave you treatment, goodbye. There is no dialogue, there is no communication, empathy, understanding”.
But, Radu Gănescu hopes, things could change for the better if today's students, tomorrow's future doctors, were guided from the faculty benches and taught how to work, communicate, relate to patients. “We are not inert, objects. On the contrary. The emotional impact of receiving a serious diagnosis is extremely high. You can't treat the patient as if that person doesn't think or feel anything.”
A harsh diagnosis shatters your world, you feel the ground slipping away from under your feet, you experience terrible moments, moments that sometimes mark you for life, and the doctor should offer you a helping hand to get well, but a shoulder on which to put – figuratively speaking – your head. “We have hopes from the generations to come. These communication courses should be their textbook from the first years of college and teach them how to have a dialogue with the patient who, often, has no medical expertise, no information, no knowledge, does not understand what is explained to him. Then, often, even if a doctor is very good at the art of dialogue, there are patients who fail to perceive the importance of the information received. And as a side effect, they probably won't follow the recommended treatment.”
The doctor-patient relationship in other countries, based on empathy and mutual respect
It is very difficult to tell a man that he suffers from an incurable disease, that his chances of survival are minimal. This is the reason why doctors tend to self-educate, they try not to get involved emotionally, but only medically, in the respective cases. “Even so, that doesn't mean you don't have to be careful how you communicate, how you give bad news to the patient,” considers Radu Gănescu. Here came a concrete example: “I have a friend whose mother was diagnosed, in a hospital abroad, with cancer. How is it done there? The doctor gave him the news, explained what stage he is in, what is the evolution of the disease, what are the steps to follow, what must be done from now on. Then, after two hours he came again and talked to the patient. Then, again, he discussed with the woman to whom he also recommended psychological counseling. For us, however, this counseling is seen, most of the time, as a financial burden, not as a necessity”
This is what future doctors should learn from school. “Let's stop having those dialogues like “You have cancer. That's it. What else do you want?”, Radu Gănescu wishes. The doctor should also pay attention to the body language, to the gestures he makes involuntarily, to the tone of voice or intonation.
Radu Gănescu considers Minister Rafila's proposal a very good one, but to take shape in reality, the curricula should be modified. “To make room for these courses among the already existing ones“. Radu Gănescu is of the opinion that the lack of communication and involvement of doctors is the effect of the system itself, full of hiccups. “We have few doctors and there are times when they can no longer cope with the large number of patients. Then, the working conditions of these people leave much to be desired. Therefore, they are no longer reluctant to get involved more than they already do.”
“You cannot be hostile to a suffering man”
Ionel Sinescu, former rector at UMF Carol Davila, is of the opinion that students could follow some special modules within the faculties that would teach them how to behave, how to interpret various investigations, how to recommend a certain treatment to the patient, how to – convinces him to undergo this treatment. “These communication courses are more than necessary. The doctor has information that he must know how to communicate to the patient as simply, efficiently and correctly as possible. Leave no room for interpretation. Then you cannot be hostile to a suffering man. Therefore, patience, understanding, empathy are needed. But, beyond this essential aspect in the profession of a doctor, a patient also needs competence. He doesn't necessarily expect words, but above all deeds”.
A patient, continues Ionel Sinescu, immediately feels any hesitation of yours, as a doctor, interprets the inflections of your voice. They are very sensitive to details to which they pay great attention. What is the doctor's duty? “To mobilize the patient in such a way that he can fight the disease, have hopes, but not in vain. To trust the medical act, trust to sit on the operating table and leave his health, even his life, in the hands of the doctor. We're talking about an extremely close relationship developing here. Or should”.
Many of these “secrets” of communication are learned in school, many from practice. “This skill is passed on to students by teachers, by mentors. This knowledge should be passed down from one generation to another and then completed, perfected during the residency. These notions must be taught in educational institutions and they must be taught correctly. In this way, they will be a foundation for leaving college. Then, during residency and during medical practice there should be other courses and other levels of training: and professional, and communicative, and emotional, and from all points of view. To become a real, cultured, competent doctor who works in civilized conditions with patients who are confident in the medical act”.
Ioanel Sinescu is of the opinion that the doctor must learn to work as a team with the patient, because both are ultimately pulling the same wagon: the health of the sick person. “Know how to pose the problem, be in control of yourself and the information you convey, be rational and at the same time empathetic with the patient, but without conveying unjustified optimism. But don't go to the other extreme, scare him, tell him “You have cancer”, You will die in 6 months”.
Effective communication is essential in the medical act, which is why, Ioanel Sinescu believes, this art should be compulsory taught in school.
