Please allow me to comment and suggest possible recommendations to address this endemic of poor doctors’ communication in Guyana. It is in response to a letter published on the 29th July, by a concerned patient Juliana Lopes. The letter is titled ‘ the medical council of Guyana needs to give this doctor a reality check’.
The experiences of these women are very distressing to read. There is a Facebook page shared with me by a friend where over a hundred women shared their painful experiences with this doctor. I’ve also had confidential conversations with friends in Guyana who described similar horror experiences.
One patient was reduced to tears when she was told that her baby is going to be a monster based on what this doctor saw on ultrasound scan. Suffice to say she never went back to the said doctor after that experience and chose to have her baby in America since she is an American citizen. If it was an isolated case, then we could have said the doctor had a bad day, but it is over a hundred patients over an extended period of time.To me that represents much more than a bad day and demonstrates a pattern of behaviour which needs addressing.
Editor, my aunt was understandably concerned that I was getting too involved in Guyana’s politics. She is concerned that I may suffer the same fate as my QC buddy and classmate Courtney Crum-Ewing. As a result I will try to avoid the political issues, but focus on social and medical issues.
Having said that, this should not be viewed as me taking the coward’s way out. As a matter of fact I’m prepared to take a bullet for women rights, homosexuals’ rights and opportunities for the underprivileged. These groups are marginalised and discriminated against worldwide. Today I will focus on women. I have written extensively on homosexuals and the underprivileged before.
I would humbly suggest that the problem of doctors having poor communication with patients in Guyana has its origin in medical schools. The curriculum in University of Guyana’s medical school is 20th century, focusing on disease prevention and treatment. Absolutely nothing on communication. We need to develop this curriculum for the 21st century.
Research done by the medical council in the UK found that about 45% of patient complaints is down to poor communication between doctors and patients. As a matter of fact, this figure is now improving since its recognition and steps taken to address it. As a result of these poor figures, the medical curriculum was redesigned with communication being an integral part.
From day one in medical school, medical students in the UK are taught communication. For the five years of their training, communication is integral.So much so that if a student gets all ‘A’s’ in her ‘clinicals’ but fails communication, then she will not advance until she passes communication. I know this much because as a consultant I’m involved in training and assessing medical students from the Nottingham University Medical School. I also worked as a clinical lecturer for Manchester and Cardiff medical schools.
And it does not end there. Even after they have completed medical school, their communication is being assessed by patients, nurses and their colleagues. All doctors go through this process. It informs their annual appraisal. Doctors who are found to have difficulties in communication have to go on a communication course and have to show improvement in their subsequent appraisal. Continued failure can put one’s medical registration at risk.
Don’t get me wrong, they are other aspects to a doctors’ appraisal in the UK including clinical work, audits, research, number of patients’ complaints, number of serious untoward incidences, conferences attended etc., but I am focusing on communication today.
Communication is not as simple as it may appear. It entails breaking bad news, consenting patients, discussing end of life care with family, discussion resuscitation with patients, communicating with colleagues, explaining diagnosis to patients, conflict resolution, how to actively listen to patients, communication with family, explaining complications of medications etc. Also in the 21st century with internet widely available, patients research their conditions and present to you, their doctor, with a 1000 pages of questions. Doctors in the 21st century should be trained on how to address this.
If I’m to now address the communication difficulties of doctors in Guyana, I would humbly suggest that the reasons why patients complain about poor communication by doctors in Guyana is two-fold.
Firstly, doctors are not trained to communicate with patients, so they feel threatened when a patient asks questions. And two, the health care service in Guyana is doctor-centred and not patient-centred.
By this I mean doctors think they are the bosses and should not be questioned. That may be true in the 20th century, but we are in the 21st century. Medicine is now patient-centred and rightly so.
The patients should be allowed to take ownership of what is going to happen to them in terms of treatment. We are merely professional advisers. Advising patients about pros and cons of treatment or non-treatment, but them making the decisions. That’s called patient empowerment and patients making informed choices, which are big in the UK.
As a matter of fact there are lots of research done which show that a patient who is knowledgeable about his/her condition, who is actively involved in developing a treatment plan and who has family involvement is more likely to comply with their treatment and have better outcomes.
Not sure why a research was needed for that, since it is self evident. Also, there are lots of supporting evidence that poor communication has a detrimental physical and mental effect on patients and families with patients having poorer outcomes.
In addition, poor communication by a doctor can be distressing to that doctor when a patient makes a complaint which has to be investigated. It is important that employers, as part of their duty of care to that doctor, have processes in place to support such doctors.
Finally, poor communication can affect a hospital financially from litigation and compensation payouts. No health service has limitless financial resources, so all pennies count. So I would argue, with these facts, that it is imperative that communication is taken seriously by all medical schools in Guyana and also the medical council.
What is playing out in Guyana is a power struggle between patients and doctors. Patients have rightfully moved forward to the 21st century model of health care delivery, but doctors are stuck in the 20th century. Doctors should be given support to move forward to be on the same page with their patients. Also doctors should understand that it is not their bodies that have the ailment. Why should we decide what happens to someone else’s body?
So Editor, I do wish to humbly suggest five recommendations:
1. The medical curriculum at the University of Guyana medical school and all medical schools in Guyana should be reviewed with a view to having communication an integral part of it. It needs to reflect the communication demands require of doctors in the 21st century. There are lots of books available on Amazon with regards to communication, but I would humbly suggest that communication professionals are employed to develop a communication curriculum to teach and assess communication for future and current doctors.
2. All doctors in the health service must have their communication assessed annually. This assessment should take the form of patient survey, staff survey and colleague survey. This survey should be developed by the medical council with active involvement of communication consultants. Doctors who have deficiency in their communication should have remedial work either by undertaking a communication course approved by the medical council and/or University of Guyana medical school.
3. If a serious concern is raised about a doctor’s communication, this should be investigated by the employer by a consultant who is independent of the said doctor. If these concerns are confirmed then remedial work should be recommended before that doctor engages with a patient again. If the concern is about a privately-operating independent doctor, then in the absence of other independent doctors to investigate, the medical council should take the lead in investigating said doctor.
4. The medical council of Guyana is strapped for money. Most medical councils are. They should think of innovative ways to increase their finances. I would argue that the medical council should facilitate the development of a communication course for doctors, conducted by communication consultants. This will help to raise desperately needed funds. No medical council can exist on only doctors’ registration fees. Also, the council can have communication sessions as part of their continued medical education.
5. The medical council should set minimum standards for non-English-speaking doctors who wish to work in Guyana. This should be tied with English courses for those doctors whose English may be deficient.
In closing, I trust that the medical council investigate the said doctor who has some very serious allegations made against him. Allegations of discrimination based on marital status, religion or personal choices are serious. If this doctor was in the UK he would have been suspended from practise and have his fitness to practice investigated. Unfortunately this will never happen in Guyana. Frankly I do not believe that these concerns will be taken seriously, since in Guyanese parlance ‘ he ain’t kill nobody’ .
This doctor may never be investigated because of his background and status. And having doctors investigate doctors, as would be the case, never made sense to me. I wrote on this extensively and the fact that the medical council should be independent of doctors or politicians. Nothing seems to have happened, but then again what do I know?
For the many ladies affected and offended by this doctor, please accept my humblest apologies on behalf of all doctors. What you have experienced should not have happened. It stemmed from a weak medical council that is failing to adequately regulate doctors and an educational system that is inadequately preparing them. Ladies, please continue to stand up for your rights and hold us doctors to account. We are here to serve you all. We as doctors should see that as a privilege.
Dr Mark Devonish MBBS MSc MRCP(UK)
Consultant Acute Medicine
Nottingham University Hospital
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