There was a story of a man, troubled by stress at work, went to see his GP with a complaint of a headache so he could get a much-needed break from his source of depression.
The GP, having poor command in communication skills, decided the patient was MC-seeker and sent him home with a quick prescription of paracetamol. The GP missed the crucial diagnosis of major depression.
In another story from gynaecology, a young woman was on the trolley heading towards operation theatre until the moment she told her attendant that she felt happy to finally having the operation so she could start a family – she was about to undergo a hysterectomy.
Paediatric meanwhile brought a story of a mother who was asked to consent for a lumbar puncture on her two-month-old child. Being uneducated and scared of not knowing what the lumbar puncture was, the mother in her hesitation, confusion and worry about her child, did not give her consent. The doctor, who did not picking up this cue, wrote in the notes ‘parent not consent for lumbar puncture’. The child unfortunately later diagnosed with meningitis with abscess, resulting in almost certain chance of permanent neurological deficit.
Medical case likewise, reported a case of an elderly man who was admitted after a fall. He was assessed and determined to lack mental capacity secondary to dementia. On the late evening of his second-day admission, the patient asked for self-discharge. During the conversation with the patient, the night covering doctor was not able to detect the incoherence and inconsistencies in patients’ demand for self-discharge. Subsequently, the doctor missed the important hints that the patient has lacked in mental capacity and allowed the patient to self-discharge – despite knowing the patient also had a fractured humerus and suppose to undergo an operation.
Palliative care is probably the specialty that illuminates the importance of communication skills the most.
From resolving conflict towards mutual agreement among family members and patients about deciding the best course of end-of-life care, communication itself can be therapeutic in its sensitive and empathic nature of practice.
Above were examples from medical practice across the globe on how communication is central to medical practice. It goes beyond just classic history taking and knowing how the patients attribute medical jargons in their own local dialects.
Communication in medical practice is about building a therapeutic relationship to serve mutual agenda based on openness, trust, and respect. This is the core aspect of the professional and ethical conduct of medical practice.
Further evidence of this important aspect of medical practice was regrettably demonstrated through litigation.
Among all cases of lawsuits for medical negligence, poor communication is central that drives patients to seek legal action against their own doctors.
In contrast, it was found that patients were more forgiving if their doctors communicate effectively with honesty and respect, even if the fault was on the doctors’ side.
In ethical cases, there was strong evidence to show that patients commonly do not understand what their doctors were explaining to them about the procedure they had just consented.
Therefore, in the context of practicing medicine in Malaysia, the proficient command of national language should be upheld to reflect the integrity of medical profession regardless of the status of appointment, either permanent or contract position.
There were reports that Health Ministry will liaise with education ministry to allow potential candidates to sit for single-subject (Bahasa Malaysia) SPM examination.
This is laudable approach and hopefully, will come to eventuate so the nation can benefit from the valuable contribution of talented foreign graduates who are looking for practicing medicine in Malaysia.
This will preserve the integrity of the medical profession and more importantly, advocate patient-safety and patient-centred care at the heart of healthcare in Malaysia.
Dr. Mohd Salami Ibrahim
Medical Trainee Lecturer,
Universiti Sultan Zainal Abidin (UniSZA).