KR Sethuraman MD PGDHE
Professor of Medicine JIPMER,
Pondicherry
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Communication Skills in Clinical Practice
(Doctor-Patient Communication)
© 2001, KR Sethuraman
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2001
Publishing Director: RK Yadav
9788171798490
Typeset at JPBMP typesetting unit
Printed at Gopson's Paper Ltd., A-14 Sector 60, Noida 201301, India
My wife Anandhi
“Behind every author, there is a caretaker Who fosters freedom to be creative.”
5PrefaceOne of the things the average doctor does not have time to do is catch up with the things he did not learn in school.
If medicine is a mystery to the average man, nearly everything else is a mystery to the average doctor.
—Milton Mayer
The Toronto Consensus of 1991 clearly stated that communication problems in clinical practice are important and common. It also showed that quality of communication is related to health outcome for patients, but that traditional medical education is ineffective at teaching communication. Teaching communication skills should be included at all levels of medical education and, even more importantly, should be a mandatory element of the medical school curriculum and programmes of continuing medical education.
At the Jawaharlal Institute of Postgraduate Medical Education and Research, we have been conducting training on clinical communication skills since 1993 for the students. The materials collected and used by me in these training sessions form the basis of this book. The anecdotes cited are real life incidents culled from my diaries. Anecdotes are perhaps weak as evidences but they are phenomenological observations that convey what can happen.
Communication skills are complex. Learning resources are available from several sources. I have primarily culled learning points on dyadic communication skills from three sources: Clinical, Social exchange and Management perspectives. There are several epistemological differences among the three perspectives, which have been harmonised to some extent to give a holistic view of doctor-patient communication.
This book is aimed at the students, educators and practitioners of clinical medicine and allied sciences, viz. dental, nursing and paramedical disciplines. In this context, the terms “Care-provider” and “Care-seeker” are more appropriate but less elegant than the older terms, Doctor and Patient, which have been retained in this book.
The book has three parts. The first part deals with the core skills of effective communication, the second with clinical applications and the third goes beyond 6communication to its raison d’être, viz. prudent and patient-centred clinical practice. Practical exercises are suggested at the end of every chapter to enable the readers acquire relevant communication skills.
This is perhaps the first book on doctor-patient relationship written in India. All constructive criticisms are welcome to improve this further. Lastly, I record my sincere appreciation of the support given by Jaypee Brothers to medical writers in India, including myself.
KR Sethuraman