Good doctors are good communicators – it’s that simple. This article by Dr Emma Green examines how building your communication skills will stand you in good stead as a doctor in the UK.

The more traditional “communication skills” teaching has focused on the doctor–patient relationship, yet communication between colleagues in hospital and primary care settings is equally important.

Communicating well within a team demands more than merely listening and passing on messages. Doctors must work within their competence, seeking advice and assistance from senior clinical colleagues where appropriate. It is also essential to communicate clearly and appropriately with all clinical and administrative colleagues you work with directly, as well as doctors who refer to you and to whom you refer.

The consequences of poor communication

Although there are often many factors leading to adverse outcomes, it is undoubtedly the case that poor communication and inadequate handovers can result in inappropriate prescriptions, incorrect diagnoses and patients lost to follow-up. These have clear potential for patient harm, and an associated impact on the team arising from complaints, claims and disciplinary investigations.

On occasion, doctors may need to act to protect patients from potential harm caused by inadequate systems or procedures, or as a result of a colleague’s behaviour, performance or health. Medical Protection recognises that this is never an easy decision. If you need advice on the appropriate action to take, you should usually raise this with your educational supervisor and you can always access expert medicolegal advice via our advice line.

The importance of good handovers

Good handovers are essential to provide good continuous care, maintain patient safety and avoid errors. After every handover, all members of the team should have the same understanding of what has been done and the priorities going forward.

The handover requires both the ability to receive the necessary information and the ability to provide meaningful information for the next shift or handover event. This can cause problems because the team taking over lacks first-hand knowledge of the patient. If a patient’s condition unexpectedly deteriorates, this team is reliant on notes, verbal information, and secondary information from other clinicians to make decisions. This places responsibility on all parties involved to ensure the accurate transfer of all relevant information.

The lack of consistent processes, the absence of best practice guidelines and the limited use of protocols mean that handovers are fraught with risk.

To reduce the risk of an adverse outcome you must be satisfied that suitable arrangements have been made for your patients’ medical care when you are off duty. These arrangements should include effective handover procedures, involving clear communication with your colleagues.

The effectiveness of handovers will depend on the accuracy and completeness of the information, and whether it is received clearly and understood by the recipient. Here are some guidelines:

- Patient name and age
- Date of admission
- Location (ward and bed)
- Responsible consultant
- Current diagnosis
- Results of significant or pending investigations
- Patient condition
- Urgency/frequency of review required
- Management plan, including “what if…”
- Resuscitation plan (if appropriate)
- Senior contact detail/availability
- Operational issues, eg. availability of intensive care unit beds, patients likely to be transferred
- Outstanding tasks

Bridging the primary-secondary care gap during handovers

One of the key areas where error can lead to patient harm is the loss, or poor transmission, of pertinent medical information during transfer from one team or place to another. There are many situations where this may occur that are largely specialty – and site – dependent. Transmission of relevant facts to GPs (and perhaps not too much else) is vital for patients being discharged from hospital after seeing specialists in clinic or following inpatient intervention. Once you are settled in your job, it might be wise to review the way that you communicate with GPs in various scenarios and ask whether there is a better way to do it.

Any such process should canvas the views of GP colleagues as to how information can best be transmitted, and what information is needed. Do you provide your GP colleagues with enough information for them to be expected to subsequently attend to more complicated ongoing management? Is the standard clinic letter really of use in documenting developments in outpatient care, or can the information be better systematised for the benefit of all?

It is important to ensure that patients recently discharged from hospital have summaries of their care rapidly transmitted to their GPs, perhaps using electronic means, with appropriate confidentiality safeguards. Giving patients their own, appropriately worded and adapted copy of discharge summaries can be useful if they are subsequently seen by out-of-hours community services. It’s important to listen carefully to GPs who take the time to flag up a problem in your communications with them and try and find a better way to avoid any significant problems.

Whatever system is in place, it should be monitored and reviewed regularly, and be responsive to the comments of all those who are involved, to make sure that it is working both for patients and for staff.

During your induction or shadowing period make sure you’re clear on how handovers are to be conducted in your role and, if you have any concerns, speak to the consultant as they have a vital role in the leadership of teams and the way that they communicate and follow patients in their journey through modern healthcare systems.

References

WHO Collaborating Centre for Patient Safety Solutions, Communication During Patient Handovers, Patient Safety Solutions, 1 (3) (May 2007), p 2.

Haggerty, J, et al, Continuity of Care: A Multidisciplinary Review, BMJ 327:1219–21 (2003)

About the author

Dr Emma Green is a Medicolegal Consultant and has worked at Medical Protection for 6 years, previously working exclusively on medical claims. She has experience in delivering advice on all case types and regularly writes medicolegal articles and provides teaching on a range of subjects. She has worked in the NHS as an emergency medicine clinician up until 2021 and has worked closely with IMGs in the emergency department and when teaching advanced life support. Dr Green is also a GMC associate for the PLAB examination.