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Thursday, May 23, 2002


/Classes/Semester_1_2002_Discussions_and_Announcements/Discussion/Medical Course Discussion/Open Discussion/Rant: Issues with
communication skills

Chih Kiat Gan (ckagan)
Semester_1_2002_Discussions_and_Announcements (Semester_1_2002_Discussions_and_Announcements)
21/5/2002 6:57:36
Rant: Issues with communication skills

(Personal gripe)

I have issues. I have issues with the imparting of *communication skills* as is taught in the medical field worldwide. There is an unspoken rule
(akin to the zeroth law of thermodynamics) that the more information, the better for the doctor, and the *ideal* consultation would involve the
patient telling all to the doctor, within the time available. Patient background is important, but this implicit assumption is intimidating to patients.

Would I be more comfortable with this if the assumption is clearer? Scarcely.

I recognise the importance of contextual history, of snippets of background that confirms a diagnosis or identifies a genetic predisposition to
some disease (yes, genetics the tool of choie of our era). But I maintain that the expectation (by the doctor), that the patient should share
everything, is flawed. The patient has the right to withold information, as the patient has the liberty to accept or reject forms of treatment. And
the pedantry of bedside manner should recognise this.

As patients have a right to autonomy, they should have the right to refuse (or withold) information they are not comfortable with sharing with
their doctor, particularly if such action could put the doctor in a position whereby he is obliged to conduct a breach of confidentiality. An
individual who admits to homicidal thoughts and pre-meditated murder will be turned in by his doctor; a paedophile may be requested by his GP
to see another doctor in the future, for fear that the former may harass the GP's other clients.

(I draw a distant (and possibly irrelevant) parallel to the US army's "don't ask, don't tell" policy with regards to sexual orientation amongst its
recruits. Okay, so that wasn't so relevant after all)

As a medical student, I struggle to cope with the paradigm of a profession which holds more respect, more influence, more responsibility, more
expectations, than I had expected. That we would enter this profession providing maximal care, support and dignity to every patient is
impropable, but it is something to aspire towards.

(Actually, I also maintain all medical students should undergo coursework in medical humanities- people are not just flesh and bone- as well as
training in counselling. )

-- andrew --
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