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Communication with patients,
colleagues and the public
A pragmatic ethical approach
Professor Vivienne Nathanson
University of Durham, WMA and BMA
Communication
• Trust is at the heart of the
therapeutic relationship
• Communications that work for both
parties are essential to establish
trust
• Communication needs hard work
and commitment
• Communication is highly specific to
each relationship
What are communications?
• With patient
– Diagnosis. Treatment options etc
• With colleagues
– Investigations, advice
• With family members/friends
• With other actors
– In relation to treatment/diagnosis
• With government/authority
– advocacy
Communication
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•
•
•
•
Planned
Routine
In emergency
Verbal
Other
Taking a history
• First communication
• Sets the scene for interventions
including tests etc
• Establishes specific trust between
patient and carer/doctor
• Establishes basic facts about
medical/health need or want
At diagnosis
• Establishing parameters for Rx
• Establishing expectations
• Establishing rules, norms and limits
• Establishing who else should know
and what they should be told
Communicating with other health
professionals
• Need to know
• Related to diagnostic or treatment
process
• Amount of information shared
depends upon reason for sharing
• Patient consent needed. Type of
Consent?
Communicating with next of kin
• Only with permission
• No “right” to know
• No “right” to decide what patient
knows
• What if the Diagnosis puts them at
risk?
• What if patient refusing treatment?
• What if patient may not be
conmpetent?
Communicating with others
•
•
•
•
For example driver licensing, police
For example public health authority
For example employer
For example the media
In emergency
• Talk to family
– Find out what patient would
want/expect
– Find out past history
• Not talk to media
– Right to privacy
• Sometimes talk to authorities
– Real and immediate risk to others
Media intrusion
• Common place in emergencies
• Media in emergency rooms
• Conflict of right to privacy with need
to explain outcome of an incident
• Desire of government to know more
Advocacy
• What is advocacy?
• For the patient or the
public/patients?
• Is advocacy an ethical requirement?
• Is advocacy a professional
requirement?
• Can requirement be transferred to
others
• Avoiding shroud waving
Communicating through the
media
• Mass media gets information to
parliament as well as patients
• Message can be immediate or about
broader health policy
• Evidence based
• Not shroud waving
• Not breaking confidentiality
Promoting treatments
• From Hippocrates on…..
• Do not promote specific medical
treatments….
• And yet… done every day
• Depends upon evidence base
• Depends upon clarity of role
• Depends upon clarity about why
pressing this treatment
Breaching confidentiality
•
•
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•
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Vehicle licensing
Police
Others
Proportionality
Relevance
No alternative
Public safety
Merci beaucoup!
www.wma.net