24 HOW TO TREAT: COMMUNICATING WITH PATIENTS
24 HOW TO TREAT: COMMUNICATING WITH PATIENTS
13 FEBRUARY 2026 ausdoc. com. au
Figure 7. Infant with Sturge-
Weber syndrome presenting a unilateral left-sided facial port-wine birthmark and glaucoma.
How to Treat Quiz.
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1. Which THREE are required for counselling through good communication to be credible? a A correct diagnosis. b The ability to speak a second language. c An appropriate management strategy. d The skills to carry out the management strategy or the ability to refer the patient appropriately.
2. Which TWO activities aid communication and convey empathy? a Ensuring there is a barrier, such as a desk or a computer, between you and the patient. b Showing interest through verbal behaviours. c Repeating or paraphrasing statements as a way of verifying understanding. d Brushing aside fears, as these are generally not realistic.
3. Which THREE statements regarding emotionally charged interviews are correct? a The doctor’ s affect when communicating bad news is at times more effective than words in getting their concerns across to the patient and / or parent. b Breaking bad news is always stressful for all concerned, especially if the diagnosis is unexpected and serious. c Patients presenting with a particular symptom that results in a diagnosis do not feel relieved in that their concerns have been vindicated. d Patients may feel guilty if they ignored a symptom and caused a delay in diagnosis and a poorer outcome.
4. Which THREE may be part of a grief reaction? a Asking more and more questions focusing on the details of the diagnosis, investigations and treatment. b Denial / disbelief. c Guilt / shame. d Resolution / reconstitution.
5. Which THREE statements are correct? a Any anger that is felt needs be contained to maintain ongoing contact with the patient / family to allow for optimal care. b The angry patient may see the clinician as all-knowing and omnipotent. c Here it is important to learn of the ego strengths of the dependent patient to help them better cope. d It is important for the patients to maintain their ego strengths particularly if they have to contribute to any decision-making if provided with more than one option.
6. Which THREE statements regarding the non-presenting symptom are correct? a An astute and / or thorough clinician may recognise the so-called non-presenting symptom, over and above the patient’ s presenting complaint. b Medical students are generally better at identifying a hidden agenda than consultants are. c If the hidden diagnosis is unrecognised, some patients may leave the consultation quite unhappy and others may seek further opinions. d If parents repeat themselves and are still not heard, they become mute.
7. Which THREE statements are correct? a Transference is a conscious phenomenon in which the feelings, attitudes and wishes originally linked with important figures in one’ s early life are projected onto others who have come to represent them in current life. b Countertransference is largely determined by the clinician’ s inner needs rather than the patient’ s needs. c It is important to be aware of the basis of transference but guard against working in transference. d If countertransference is expressed, it may reinforce the patient’ s earlier traumatic history.
8. Which THREE are part of a non-directive interview approach? a Establishing a therapeutic relationship. b Asking closed questions to obtain as much information as possible.
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COMMUNICATING WITH PATIENTS
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CC BY / bit. ly / 4reZv51 / Joslyn KE, Truver NF, Comi AM. Molecules. 2024; 29( 22): 5279. the left 5th cranial nerve. The seizure and its pathogenesis were fully explained to the mother and then subsequently to both parents. Not unexpectedly, it reawakened the earlier grief reaction that the parents experienced when greeting their newborn daughter, who had a very obvious birthmark.
Appropriate antiseizure medication was started, but the seizures continued. Further imaging confirmed the involvement of the superficial layers of the left cerebral hemisphere. Reports had surfaced at the time that possible‘ peeling’ of the surface of the part of the brain affected by the capillary haemangioma might reduce both the frequency and severity of the seizures, while at the same time reducing the progression of an evolving right hemiparesis, and potentially allow for normal development. After much discussion with colleagues, including the chief neurosurgeon at the children’ s hospital, it was decided to continue with conservative management.
Gradually the frequency and the severity of the seizures were controlled. However, the mild right hemiparesis persisted beyond the immediate postictal phase. In
c The clinician listening and observing. d The clinician offering general direction but allowing the patient / parent to guide the process.
9. Which THREE statements regarding the RACGP’ s GP registrar education program are correct? a All GP trainees undergo identical communication skills training. b Communication skills are a key feature in all regional and local educational programs. c Registrars are involved in educational interactive activities to practise these skills in simulated clinical scenarios involving patients of all age groups and demographics. d Most GP registrar learning occurs in clinical placements.
10. Which THREE statements regarding additional mental health training for the GP are correct? a Balint-type groups provide a forum to discuss problematic patients and how best to manage them. b Apprentice learning, as opposed to supervision, is generally the norm in psychiatry. c Being supported while acquiring psychological skills may help reduce the likelihood of burnout or leaving clinical practice altogether. d Personal therapy helps in the understanding of issues that are particularly meaningful to the clinician and may further influence the care of their patients. addition, it became increasingly apparent that Janice’ s cognitive development was slowing. Throughout this time the parents were supported, their questions answered and their concerns addressed. The family GP and local allied professionals were included in Janice’ s ongoing care.
Some four years later during one of the review appointments, with Janice’ s seizure control improving, her mother confessed the longstanding guilt that she had felt following the birth of her daughter. While she was pregnant with Janice, she was playing peek-a-boo with her sister’ s infant and covered her own eye with her left hand. Her own mother rebuked her, saying:“ Don’ t do that! You may hurt your baby.”
It took four years for Janice’ s mother to finally volunteer this information. In her own mind she had caused Janice’ s problem with all its immediate and long-term complications. Had she been able to express these concerns early on in the course of Janice’ s initial presentation, it may have been possible to more adequately deal with and help resolve the numbing guilt that she experienced.
It may also be that the clinicians themselves, focusing on the major clinical problems experienced by Janice, had paid less attention to the parents’ emotional needs— a salutary lesson for all. The hidden agenda had finally surfaced. It was Janice’ s mother’ s reality and was not even remotely considered by the attending clinicians.
The mother subsequently left her family, leaving Janice’ s father to raise her on his own. As a young adult, Janice was generally free of seizures but had a slight limp from a persistent right hemiparesis, and mild intellectual disability.
‘ DOCTOR, YOU SPEAK GOOD ENGLISH’
ONE final example of effective communication: an Italian mother with limited English gave birth to twin sons. I advised her that one had a serious congenital heart abnormality that would require intervention. I then explained the diagnosis to her in simple English, avoiding jargon and using line diagrams, allowing her to slowly accept that the abnormality was not her doing, and that it was treatable with a good outcome. While still distressed, she volunteered:“ Doctor, you speak good English.”
We can only hope that through our endeavours all our patients will echo the same sentiment.
CONCLUSION
UNDERSTANDING the importance of better communication reinforces the need for all clinicians, whether generalist or specialist, to be psychologically oriented. Not only does it improve our therapeutic effectiveness, it provides increasing professional satisfaction. Acquiring and growing such skills is a lifelong task and likely to permeate everyday practice. To become a better communicator with patients, one must first become a better listener.
Declaration of conflict This article was presented in part to the Royal College of Physicians in 2006.
References Available on request from howtotreat @ adg. com. au