The most important thing your doctor should do

I recently had to have a medical procedure to check if the cancer I'd had treated six years ago had returned (it hadn't — thank goodness).

It involved using a camera to look for abnormal growths inside my bowel.

But, lying on the operating table waiting to be put to sleep, I suddenly realised the surgeon about to do the test hadn't introduced themselves.

Maybe they would speak to me afterwards, I thought.

But I was mistaken — not even a quick "hello".

The relationship between patient and doctor is as old as medicine itself.

Despite advances in drugs, surgery and scans, the process of getting better always starts with a conversation.

Yet, this fundamental aspect of the doctor's craft is often neglected in their training.

I know this because I'm a medical student myself.

My journey to medicine started with a bowel cancer diagnosis at age 28.

After receiving the "all clear", I decided to become a doctor.

But, as my knowledge of medicine grows, so does my frustration about the things doctors don't talk enough about and yet can't afford to get wrong.

Communication 'an essential skill' for doctors

Taking a medical history — the process of noting down a patient's past and present, from symptoms to habits — is 70 per cent of the diagnosis.

But, as I've discovered in my almost-three years at medical school, students are so swamped by the endless stream of textbooks and tests, we have little time to hone perhaps our biggest weapon: the art of making conversation.

"I don't call communication a soft skill. I call it an essential skill," Nepean Hospital intensive care specialist and University of Sydney School of Medicine's head of clinical studies associate professor Stuart Lane said.

"Communication is not about what you want to say — it's about what you want to achieve.

"Bad communication … can lead to a major incident later.

"If you can't communicate as a doctor, you're not a good doctor."

Despite this, Dr Lane recalls plenty of times he's been required to ask a colleague to step aside during a critical incident because communication was going badly.

Of course, there's no shortage of barriers to doctors focusing on high-quality communication, US doctor and academic Danielle Ofri points out in her book, What Patients Say, What Doctors Hear.

There's crowded clinics, tight budgets, endless record-keeping and paperwork for a start.

Even so, doctors can't afford to compromise their greatest tool — connecting with the ill and engaging patients in a meaningful way, Dr Ofri argues.

Doctors' fears patients will 'ramble on' unfounded

If your doctor takes a little extra time to think about how they speak to you, the rewards are likely to be vast: a more accurate version of your medical history and knowledge of the treatment options and outcomes that matter most to you as an individual.

This in turn means you're more likely to end up with therapies you can follow and, therefore, a better outcome.

Yet, when I talk about communication and query how we explain medical matters to patients, there's often eye-rolling among my colleagues.

The biggest complaints are "there's no time" and "you can't afford to let patients ramble on".

But research suggests otherwise.

In a 2002 Swiss study, when doctors were told to ask an initial question and then let patients answer it without interruption, the average time a patient talked was a mere 92 seconds — not the hours of chatter doctors fear if they listen more and cut in less.

Despite this, doctors are infamous for muscling in.

They interrupt patients on average 23 seconds into their first answer, another study showed.

This leaves patients confused and feeling their fears haven't been listened to and their needs not met.

Indeed, a 2005 study done at a hospital in New York City found fewer than half of patients discharged from hospital knew their diagnosis.

And less than one in five hospital patients could name the doctor in charge of their care, another study from the University of Chicago found.

I don't believe it's different here in Australia.

My fellow student Rachel Langford told me just the other week a patient came in for a test, but was clueless as to the reason.

"They didn't understand what they were having or why … No-one had told them anything," she said.

Thankfully, there are some encouraging signs the tide is slowly turning.

Doctors preparing for final emergency medicine exams, for instance, now practise communicating with patients, as these skills are commonly examined.

And trainee paediatricians are often required to role play typical explanations for anxious parents, such as what's involved in sampling fluid from the spine of a newborn.

This is reassuring, because reflecting on how to communicate with patients is as valuable to doctors as assessing new diagnostic tests and treatments.

How can you communicate better with your doctor?

But communication is a two-way street. Patients, too, must come to the table open to dialogue.

To help this process, Dr Ofri suggests you:

  • Set goals for the appointment ahead of time, by making a list of issues you want to discuss and prioritising them
  • Rehearse and refine what you want to say, so you can use the limited time efficiently
  • If your doctor interrupts you, politely ask for a little more time so your questions can be answered
  • Don't be afraid to ask for clarification

This makes me wonder, when I had my colonoscopy, should I have spoken up and asked to meet the doctor before the anaesthetic started dripping into my arm?

I'm an experienced patient and also a student doctor, used to working in hospitals.

If couldn't muster the courage, what hope do others have of telling doctors what they actually want and feel?

Yes — there are things patients can do to aid communication, but I believe the responsibility begins with doctors.

And surely that starts with a simple "hello".