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Keys to communication

Breakout session highlight - Ian Gilmore and Antoni Gual

Breakout Gilmore Gual - Keys to communication

Ian Gilmore:  Tony, I was saying to you beforehand that every time I see a patient in my liver clinic with alcohol problems, I look back to the last letter and the doctor has said, ‘I told Mr X to stop drinking.’  Every junior doctor says, ‘I told him to stop drinking’.  How do we convey this message that we need to be asking open-ended questions and helping the patient to think about their own future, rather than trying to lay down rules?  We seem to be failing.
Antoni Gual:  When you told me that, you reminded me of the first time I became engaged in the process of evaluating patients with liver transplants.  The hepatologist started saying ‘you must stop drinking’, and the next thing was, ‘once he has a new liver, for sure he will not drink any more, and there is no need to do anything else.’  What happened, however, was that they had high relapse rates with those patients and then they started asking us to start with the evaluation of them.
There are many issues but one of the key things we tend to forget is that addiction is an illness which makes people shift the balance in the wrong way.  Addiction makes you pay a price which is much higher than the price you should pay to get your drug, in a way, and you pay not in money but in family life, in work and in health.  It is just not realised that the ambivalence underlying that needs to be worked out and needs to be discussed and the patient needs to be able to overcome this ambivalence before he moves forward.  This is a key issue and certainly no one can change his ambivalence by someone just telling him what he has to do, because he already knows it.
Ian Gilmore:  Our medical students all seem to go through communications training now, but it doesn’t stop them doing it.  We need to find better ways to do communication training.

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