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Thursday , March 10 , 2011
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Speech ‘therapy’ for doctors

“Without surgery, your father won’t live more than three months. Even the surgery is risky, he may die in the OT,” said a reputable gastroenterologist to a worried daughter.

The cancer patient survived three years without surgery.

Ila Das, a 65-year-old Kasba resident, was told that she required knee replacement surgery to be able to walk more than a few steps at a time. When her husband politely asked the orthopaedic surgeon whether he could consider the option of getting the surgery done in Chennai or Mumbai, the doctor threw a fit.

“He asked us to get out of his chamber and threw the prescription on the floor,” recalled Ila’s husband, 70-year-old J. Das.

A medical degree that comes without the skills to communicate with patients has been identified as one of the cancers plaguing healthcare, prompting the Medical Council of India (MCI) to include communication in the MBBS curriculum.

Based on the British model, the communication module is currently being tuned to the Indian medical exam system.

“An expert committee was set up about four months ago to suggest changes. Exams will henceforth include an analysis of the communication skills of medical students,” cardiologist Devi Shetty, a member of the MCI’s governing council, told Metro.

Officials of The Royal College of Surgeons, Edinburgh, used actors posing as patients to test the communication skills of 60-odd examinees at the Chittaranjan National Cancer Institute last week as part of the five-day MRCS (Member of the Royal College of Surgeons) exams.

“Doctors must be able to speak the language patients and their relatives can understand,” said I.K. Ritchie, the vice-president of the Royal College of Surgeons, Edinburgh.

Every examinee was required to communicate with two patients, spending 10 minutes each listening to their problems and dispensing advice. Two assessors sat in the room observing how doctor and patient discussed the diagnosis, treatment protocol and likely complications.

Sources in the MCI said assessment of doctors’ communication skills in this manner could soon become the norm across Bengal.

Kalyan Das, a post-doctoral trainee at SSKM hospital’s plastic and reconstructive surgery department, took the MRCS test last year and realised how different it was from all the exams he had cleared in his medical career. “Never before had I been tested for communication skills. It was an eye-opener,” he said.

An MCI official said the biggest challenge for a doctor was to take the patient into confidence. “That’s something that can be achieved only through communication, which we are planning to introduce as a subject for MBBS students. Practical classes will also be held, where junior doctors will be asked to communicate with patients,” he added.

According to surgical oncologist Gautam Mukhopadhyay, the ultimate test of a doctor’s communication skills was to break a piece of bad news to the patient or members of his or her family.

“To inform a patient and his family that he has cancer is no mean task. It requires special skills to convey the prognosis to patients and their relatives,” Mukhopadhyay said.

Sanjay De Bakshi, the local convener for the MRCS exams, said the stress on theory in medical colleges was denying doctors the chance to improve their skills of communicating with patients. “In our medical colleges, a graduate has to study throughout his yearlong internship to qualify for the post-graduate courses. So he ends up with hardly any exposure to practical challenges,” he added.

Lal Mohammed, a 19-year- old student from Nalhati in Birbhum, went to SSKM last year to get his deformed right index finger set right with plastic surgery but ended up losing it. He had been told it was a “minor thing” and that surgery would repair the deformity.

“Had the doctor explained everything properly to me, I would have taken an informed decision not to undergo surgery,” said Lal.

Oncologist Mukhopadhyay said many medico-legal cases against doctors were the outcome of poor communication.

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