In this article, we explore the role of ACEs in healthcare education and the importance of effective communication skills. We discuss the impact of active listening on building rapport with patients and avoiding miscommunication. Drawing insights from experienced pharmacists, we address the challenges of difficult conversations in healthcare. We also highlight the wisdom of Plutarch and the practicality of Anatol Rapoport’s rules for navigating such conversations. By emphasizing the collaborative nature of communication and its life-saving potential, we stress the significance of effective listening skills. ACEs and healthcare professionals are encouraged to prioritize listening as a foundational skill and utilize tools like the Rappoport Rules for improved communication.
How often do you hear what someone is saying but fail to truly listen? How frequently do you find yourself waiting for the person to finish speaking so that you can assert your own thoughts, often with a prepared speech centered around your own agenda, without genuinely addressing the original question? These are the subjects I intend to explore in my writing this month.
As ACEs (Associate Clinical Educators), it is necessary and important that we provide accurate feedback on students’ technical competencies. The feedback should, of course, be relevant and precise, enabling the students to develop as safe practitioners. Another essential aspect of our role is to assist students in developing effective communication tools to establish rapport and gain the trust of simulated patients. This becomes particularly relevant when students embark on their journey to master the art of effective history-taking, marking their initial exploration of the realm of effective communication.
I always emphasize to students that the essence of communication lies in the response one receives. This is crucial because failing to genuinely listen to the patient can result in miscommunication. Each party brings their own agenda to the conversation – the clinician and the patient have their respective goals. It is no wonder that communication can be seen as something of a dark art. Therefore, the role of the ACE is to carefully guide the students through the process.
Always remember that a conversation is a partnership. It is a collaborative process, led by the patients’ ideas, concerns, and expectations, with the clinician and the patient working together.
This topic emerged during a recent Clinical Pharmaceutical Team Meeting held at Dudley College, where my colleague Mark Reynolds and I were invited to speak about Enhancing Consultation Skills to a group of highly experienced Pharmacists. In addition to discussing generic communication skills, we presented a couple of scenarios illustrating poor and effective communication and engaged in discussions on the points raised.
One of the key themes that emerged from the pharmacists was the common problem of patients demanding specific drugs, such as antibiotics, and how to handle such situations. Another recurrent theme was the instances of angry patients being informed about the cost of prescriptions. In other words, the main focus of the discussion revolved around managing difficult conversations.
Effectively navigating a difficult conversation requires active listening, and most of the attendees were eager to hear our thoughts on this matter. Like any skill, it demands constant practice and simply paying attention to the conversation. However, finding the time to listen is challenging in today’s busy pharmacy or GP surgery, where restrictions are imposed on the duration of patient interactions. Nonetheless, learning this skill is vital.
In order to build rapport and gather important information, we allow the patient to talk and express their needs. This is of utmost importance.
Plutarch, the philosopher, writer, magistrate, and priest who lived during AD 46, extensively wrote about the subject of listening. It might be useful to briefly examine his views, as expressed in one of his letters to a young man about to embark on his studies. He discusses different types of listeners: the Lazy Listener, the Scornful Listener, the Excited Listener, and the overly confident listener.
The lazy listener is someone who only listens for information that interests them and shows no interest in what the speaker is saying. They wait for their turn to expand on their own interests, paying little attention to the speaker’s main topic of conversation. The scornful listener is judgmental of alternative ideas or beliefs, as they adhere strictly to their own set of values and beliefs. Plutarch notes that judgment is, in fact, a distraction of the mind, and these types of listeners tend to develop a distorted view of what is actually being said. It is better to have an open mind, he says – a sentiment with which I wholeheartedly agree. We must not let the speaker’s performance distract us from paying attention. Otherwise, we will quickly forget our purpose and potentially miss valuable information. Finally, Plutarch talks about the Overconfident Listener, who assumes they know what the speaker means right from the start and fails to listen for subtle, sometimes hidden, cues in the conversation. When this happens, it is important to step back and actively listen.
Even Plutarch recognized that a conversation is a collaborative process. The responsibility for the outcome of a conversation rests with the listener and with healthcare professionals. Achieving the correct outcome is crucial, and listening can literally save lives.
Throughout my experience as an actor, comedian, corporate trainer, NLP trainer, and associate clinical educator, I have employed various methods to teach communication skills to students in different fields of study. From armed response teams to salespeople, from actors to presenters, and more recently to physician associates, pharmacists, nurses, and young doctors, the process remains the same: learning to listen first and foremost.
At the recent Team Meeting in Dudley, I extensively discussed the use of Rapoport Rules as a valuable tool for communication skills. I encountered these rules a few years ago and have always wondered why they are not more widely known. Anatol Rapoport, a Russian-born American game theorist, developed a set of rules for handling difficult conversations:
- Clearly re-express your conversation partner’s position, defining your understanding of what they want. This ensures clarity in the conversation and prevents you from straying off course with your own assumptions.
- List points of agreement with your partner to develop rapport further.
- Always mention something you have learned from the person you are talking with, further building agreement.
- Only then can you proceed to disagree or compromise with the person. You can see how these rules can be helpful when patients hold fixed beliefs about vaccines, antibiotic use, or various other treatment-related ideas.
I encourage you to follow and practice these steps each time you engage in a difficult conversation. If you are an ACE, please be aware of these tools and pass these skills on to students during their history-taking sessions. The positive impact will be appreciated by everyone.
Next month, I will be talking about our work with Newcastle University PA program teaching musculoskeletal (MSK) examinations.
If you’re a Pharmacy Clinical Lead and wish to discuss working with Meducate Academy Ltd., we would love to give you a demonstration and a workshop at your institution.
Please contact: bobspour@meducateacademy.com or on 07870 611850
Professor Jim Parle
James Ennis
Kate Straughton
Uzo Ehiogu
Mark Reynolds (Host) Mark has been working as an ACE since 2008 having trained as a medical role player two years previously. Aside from teaching cardiovascular, respiratory and gastrointestinal examinations, his special interests in the ACE role include clinical communication, orthopaedic examinations and Mark is a leading educator in the male intimate examinations. Outside of the ACE role Mark is currently involved with various narration projects for the BBC Doctor Who franchise.
