Students should: be aware of the main principles currently shaping policy, training and research on clinical communication; understand the value and limitations of these principles; be able to draw on the principles critically when considering communication in specific settings. They will also acquire detailed understanding of communication needs in selected clinical areas. Specific objectives follow.
Introduction and orientation
Be aware of the range of reasons why communication matters; be aware that what is written about clinical communication reflects distinct ethical, theoretical and ‘technological’ perspectives, and that these are often conflated.
Part 1: Principles
Ethical context. Be aware of the legal and historical context for the current emphasis in health policy on empowering and partnering patients; distinguish models of relationship including paternalism, consumerism, partnership; distinguish different ethical ideas of patient autonomy.
Psychological theory. Understand attachment theory and its origins, understand its application to clinical relationships; be able to infer implications for clinical practice in different situations; understand limitations of the theory as an account of clinical relationships
‘Technologies’. Understand the concept of patient-centred care and its focus on patient needs; understand its relevance as an ethical goal or practical tool. Be aware of the history of the concept of shared decision-making; know current ideas on what a ‘good’ decision is.
Part 2: Principles into practice
Communication in cancer care. Know the nature and prevalence of emotional effects of serious disease such as cancer; understand how emotional needs can be met by practitioners’ emotional or instrumental responses depending on context; understand how practitioners can have the role of attachment figures. Be able to advise practitioners on how to provide emotional support in cancer care.
Communication about medically unexplained symptoms. Know the scale of the problem of unexplained symptoms; know the concept of ‘somatization’; understand how clinical communication can contribute to the problem; understand patients’ need to have symptoms explained. Be able to advise practitioners on how best to help patients with unexplained symptoms.
Teaching practitioners about communication. Understand the theoretical basis of communication skills training; know how the approach is implemented in different settings; understand limitations and critiques of the approach; distinguish teaching of skills, knowledge and attitudes. Be able to draw on the module to design a teaching program to support practitioners in a specific setting.
Course instructor: Prof. Salmon