A trip to the doctor can make you sick

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The way in which doctors talk to their patients can affect the course of their illness and in some cases determine its outcome, a new report says.

Insensitive or inept giving of bad news, such as a diagnosis of cancer, can have profound effects. One in five patients in cancer units develop full-blown psychiatric disorders and the main cause is the way in which bad news is broken, according to the report by the Royal College of Physicians.

The failure of doctors to offer sympathy or an explanation when things go wrong, mistaking this for an apology, is the main cause of complaints. In 90 per cent of cases dealt with by one of the medical defence organisations, failure of communication was a major reason for the complaint.

The report, "Improving Communication between Doctors and Patients", offers tips to doctors on how to conduct themselves and calls for better training for them. Bad news will be different for each patient, it says, and can be defined as information which drastically alters their view of their future.

"A pulled hamstring for most people would be painful and inconvenient, but it is a disaster for an Olympic runner on the eve of a big race," the report says.

It advises doctors not to talk down to patients ("sit on the same level - this is reassuring and courteous and signifies that you are `with' them"), not to talk too much ("spend the first part of the interviewing listening") and to express their "humanity and warmth".

With complainants, it says that feelings of "regretful sympathy" should be expressed even where a complaint may be unjustified. "A doctor who says that he or she is sorry that a patient has suffered is not admitting liability and should not fear possible litigation in simply expressing sympathy and regret."

Professor Sir Leslie Turnberg, president of the college and chairman of the working party that produced the report, said: "Poor communication is a very important cause of dissatisfaction among patients and this may impair the effectiveness of any treatment proposed. This report points to ways in which doctors can improve those skills."