To the Editor:

I read with great interest the recent article by Tongue, et al, (1) in the March, 2005, issue of American JBJS on how communication skills, especially in orthopaedic surgeons in training, can be possibly improved. I whole heartedly agree that clear communication between doctor and patient is key to the delivery of effective healthcare. Here in the UK, and in the US, as I am led to believe by Dr. Tongue's article, the general perception of orthopaedic surgeons within any hospital, is that of a branch of medicine not famed for interpersonal skills its with patients.

As in the US, steps are being taken in the UK to address this problem. I have previously worked at institutions during my training that have utilised formal techniques to gauge how well trainees (and consultants) communicate with their patients. A tool that has been used is called "The Doctors Interpersonal Skills Questionnaire" or "DISQ". This is a validated questionnaire(2)consisting of twelve questions that patients are asked by a nurse to fill out anonymously after their consultation with their surgeon. The questions relate to varying facets of the meeting including, listening ability of the surgeon, clarity of explanation, as well as overall satisfaction with the surgeon. The surgeon's performance with respect to each of these facets is scored by the patient on a scale of 1 (Poor) to 5 (Excellent). This questionnaire is simple and quick, providing the surgeon with immediate reflective feedback on their communications skills and areas to target for improvement, as well as forming part of their annual professional appraisal.

Furthermore, for several years now, there has been a station dedicated to communication skills (comprising professional actors who act out clinical vignettes) in the clinical part of the MRCS examination (3), that surgical trainees have to sit prior to their entry into residency programs.

Yours Sincerely,

Sunil K. Pai, M.A. M.B.B.Chir M.R.C.S.(Ed.)

Research Fellow

Wrightington Hospital, Wigan, UK.

References:

(1) Tongue JR, Epps HR, Forese LL. Research-based, easily learnt techniques for medical interviews that benefit orthopaedic surgeons and their patients. J Bone Joint Surg Am. 2005;87(A)(3):652-658.

(2)Greco M, Cavanagh M, Brownlea A, McGovern B. Validation Studies of the Doctors Interpersonal Skills Questionnaire. Education for General Practice. 1999;10:256-264.

(3)The Royal College of Surgeons of England, Clinical Communication Skills. www.rcseng.ac.uk/surgical/trainees/surgical/examinations. Accessed 17 July, 2005.

To the Editor:

I read with interest and pride the article by Tongue, Epps, and Forese on Communication Skills for Patient Centered Care. The AAOS is to be commended for its involvement in "communications"; for setting up the "Council on Communications", which is unique in organized medicine, and for training 25 Orthopaedic surgeons regardless of the cost to teach Patient-Physician Communications skills.

Very early in the Academy's involvement, it was apparent that Orthopaedists wanted to be taught by other Orthopaedists trained in communication skills rather than Behavioral Psychologists. To date, over 2,000 Orthopaedic Residents and Fellows of the Academy have taken part in these skill sessions and as it gains popularity more will sure to be trained.

Newer, exciting techniques to communicate well with the patient and yet save time in the office are being developed.

Finally, the Academy has had lots of help with this program and I would like to commend the JBJS for publishing the article and its role in helping popularize the Patient-Physician Communication Program.

Sincerely,

S. Terry Canale, M.D.

To the Editor:

As one of the 25 AAOS members trained by the Bayer Institute to mentor communication skills, I was pleased…and proud…to read the article by John Tongue and colleagues, Communication Skills for Patient-Centered Care: Research-based, Easily Learned Techniques for Medical Interviews that Benefit Orthopaedic Surgeons and Their Patients (J Bone and Joint Surg 87-A:652-658, 2005). In this educational process, I have learned a great deal about the nature and importance of communication skills. I have learned even more about myself!

Since beginning the program in 2001, mentors have conducted more than 100 workshops for practicing orthopaedic surgeons and house staff across the country. Not only the literature, but also our intuitive experience reinforces the importance of communication in patient management. Benefits include the efficient collection of information to reach an appropriate diagnosis and enlistment of the patient as an informed partner in their medical or surgical management. These endpoints would, by themselves, be sufficient motivation to hone our communication skills. In addition, physicians with excellent communications skills become popular in the market place, for all the right reasons, and they greatly reduce their exposure to litigation.

Patients benefit from our improved opportunity to share information, and they find the process much more satisfying and with less anxiety. The same is true for physicians.

I have also found a renewed pleasure in my communications with patients. Part of this epiphany has included a more empathetic encounter, better understanding the concerns and crises that cause patients to seek our help. These same skills have been remarkably rewarding in dealing more effectively with difficult patients, who used to take longer for me to evaluate and, at times, were sufficiently contentious to make the interview very unsatisfying for all concerned.

Enhanced communication skills come with no down side.

Gary E. Friedlaender, M.D.

Wayne O. Southwick, M.D.

To the Editor:

I read with great interest the paper concerning Communication Skills for Patient-Centered Care by Tongue et al. (2005;87:652-658). I agree with the authors that “we can improve our performance in the medical interview”, which should lead to increased patient satisfaction and improved clinical outcome. However, the authors do not describe the specific difficulties surgeons may encounter in improving their communication skills, and I would appreciate the authors’ point of view concerning this question.

Jackson (1) wrote that “surgeons often gain the most recognition and satisfaction from working in a busy surgical practice”. This attitude may be difficult to combine with optimal patient communication and could suggest that communication is not a priority for surgeons, or that they do not like to communicate with their patients.

By the nature of the specialty, orthopaedic surgeons may experience a great deal of stress, anxiety, and fear. These accumulated, unpleasant, and unexpressed emotions may make it difficult for the surgeon to recognize the patient as a suffering person and thus block effective communication. Is it possible that the lack of communication and failure to recognize the patient’s emotional state is not simply an omission, but rather an attitude that orthopaedic surgeons utilize to protect themselves?

In this context can we make the hypothesis that better recognition and acceptance of the surgeon’s emotions, not only by each surgeon but by the orthopaedic community as a whole, could enhance communication and empathy with our patients?

Reference

1) Jackson DW. The Orthopaedic Clinician-Scientist. J Bone Joint Surg Am. 2001;83:131-135.