Hospital Doctors' Communication Skills : A randomized controlled trial investigating the effect of a short course and the usefulness of a patient questionnaire

Background The principles of good communication between doctors and patients are well known. We also know that learner centred training improves doctors’ communication skills. Most studies have, however, been done outside of hospitals or exclusively with oncologists. We have found no large-scale studies that have investigated the effect of communication skills training using hospital doctors, from all clinical settings, trained by the same course. Methods In a cross-over randomized controlled trial in a large Norwegian hospital we trained doctors for two days following the didactic model of the Four Habits approach to effective clinical communication. We assessed the doctors’ communication skills using videotaped encounters with real patients from different clinical settings throughout the hospital, rating the communication skills using the Four Habits Coding Scheme. Patients were recruited using a model developed by us, using SMS after 24 hours to confirm a preliminary consent. We investigated the patients’ experiences regarding the doctors’ communication skills using the Four Habits Patient Questionnaire - a questionnaire whose content was virtually the same as the coding scheme used to score the videos. Results We included 71 of 103 (69%) doctors asked and 497 of 574 (87%) patients. Doctors’ baseline communication skills were below scale midpoint. Their communication skills improved significantly when assessed with the total score of the coding scheme, and the doctors who had had prior training improved the most. However, the doctors reported it was hard to maintain the change in communication behaviour over time. 87.8% of the between-doctor variance was not detectable by the patient questionnaire. Conclusion Two days of training improved hospital doctors’ communication skills. A communication specific patient questionnaire was found to be unsuitable for the purpose of identifying doctors who had been assessed, by expert observers, as performing poorly. Following my findings I suggest that, instead of trying to identify poorly performing doctors in order to train them, all doctors should attend communication skills training sessions on a regular basis

Chronic fatigue syndromes: real illnesses that people can recover from

The ‘Oslo Chronic Fatigue Consortium’ consists of researchers and clinicians who question the current narrative that chronic fatigue syndromes, including post-covid conditions, are incurable diseases. Instead, we propose an alternative view, based on research, which offers more hope to patients. Whilst we regard the symptoms of these conditions as real, we propose that they are more likely to reflect the brain's response to a range of biological, psychological, and social factors, rather than a specific disease process. Possible causes include persistent activation of the neurobiological stress response, accompanied by associated changes in immunological, hormonal, cognitive and behavioural domains. We further propose that the symptoms are more likely to persist if they are perceived as threatening, and all activities that are perceived to worsen them are avoided. We also question the idea that the best way to cope with the illness is by prolonged rest, social isolation, and sensory deprivation. Instead, we propose that recovery is often possible if patients are helped to adopt a less threatening understanding of their symptoms and are supported in a gradual return to normal activities. Finally, we call for a much more open and constructive dialogue about these conditions. This dialogue should include a wider range of views, including those of patients who have recovered from them