Three keys to good communication between doctors and patients

In my previous post, I wrote about the importance of good communication between clinicians and patients, mentioning some of the initiatives designed to help doctors and nurses in this area. In this post, I’d like to highlight three things which, in my experience as a patient, seem to be critical to good clinician-patient communication: culture, coordination and continuity of care.


At first hand I experienced a radiography team, which, from the receptionist through to each radiographer, understood that it was united by a common commitment to putting people first in all they did. The leaders of that team have instilled a culture which is focused on the needs of the individual. I suspect that if you looked deeper, you would find that the team's recruitment, performance management and training all include a strong emphasis on the skills and understanding to deliver care and support which works for individuals and their families. One incident captured this approach: after my final session of 33, I went to say my goodbyes and I came across a radiographer whom I knew was not on the morning rota. But he had chosen to come in early to wish me well. Things like that don't happen by chance. They are the product of a culture shaped by strong leaders and reinforced by team work.


Second, I think there is much to be gained from smoothing the way patients move between teams and disciplines. In any process, in any organisation, hand-offs are a point of potential weakness. When the process is as complex as a modern care pathway and the organisation as bewildering for a newcomer as large hospitals, the risks at hand-offs are exacerbated. Here I believe we already have the answer: Clinical Nurse Specialists. They have a unique role in helping people navigate the system, coordinating responses and saving patients from the gaps which can otherwise open up between different teams and specialisms. But not all hospitals I have used – and that is now quite a number – use Clinical Nurse Specialists in this way. Those which don't place greater reliance on the patient's skills at finding his or her way. The articulate and the self confident will generally rise to the challenge, but what of those without those qualities?

Continuity of care

My third point is shaped as much as anything by the needs of clinicians as by the needs of patients. How can anyone hope to have a satisfactory conversation, literally about matters of life and death, with somebody one has not met before. It is asking the impossible of clinicians. I recognise that this is a big ask, but we need to work towards a situation where there is continuity of care: where patients see the same health professional at the key points in their treatment, allowing trust and understanding to develop. I hear the protests about costs and logistics, but how else are we going to foster better, richer conversations about the questions that really matter to patients? So there you have it. My three-point solution based on my experience: changes to culture, to coordination and to continuity of care. It is intended as a provocation to debate. What is your solution? Let us know by joining the discussion at #AboutMe. Find out more on our About Me web pages and share your experiences with us #AboutMe.


By Andrew McDonald Former Chief Executive of the Independent Parliamentary Standards Authority Andrew was, until April 2014, Chief Executive of the Independent Parliamentary Standards Authority (IPSA). He was diagnosed with Parkinson’s disease in 2007. In 2010, he was diagnosed with prostate cancer which has since been determined to be incurable. On 24 June 2014, Andrew delivered a lecture exploring his experiences of living with an incurable condition. Here he reflects on what he has observed and learned from his many interactions with health services and health professionals. Andrew McDonald pic 3 resized