Communication in the time of COVID-19

The COVID-19 pandemic has led to a massive, and almost overnight, transformation in Australian general practice, most notably with the rapid rise in telehealth. What does effective communication via telehealth look like?

“Much of the art of general practice lies in the ability to communicate”

So writes John Murtagh, grandfather of Australian general practice, in his ubiquitous self-titled textbook (1).

Being able to communicate effectively defines the good doctor. Effective communication builds rapport and the therapeutic relationship, it facilitates trust, it contributes to positive health outcomes, it enhances doctor and patient satisfaction, and it reduces error. Communication skills development is a fundamental plank of GP training in Australia. Good communication is good general practice.

The prism through which general practice has traditionally viewed communication has been the time honoured face-to-face consultation, the doctor sitting at a desk with the patient opposite. But over time, with advances in technology and understanding and pragmatism, we have refined the way we communicate. Patients have moved location to now sit alongside us, not across from us. And their changed position is not just geographic, but also authoritative - they are now equal partners in the decision-making process. Use of interpreter services is mainstream. We have embraced electronic records, FitBit data, patient education YouTube videos, and smart phone images (sadly over-represented by photos of discoloured baby poo). These changes have thus far been adaptive, gradual, non-threatening.

But the prism has been smashed.

The COVID-19 pandemic has led to a massive, and almost overnight, transformation in Australian general practice, most notably with the rapid rise in telehealth. Our patients now consult us from another suburb. And, depending on the technological platform and the vagaries of the internet, the non-verbal cues that we have thus far relied on in our face-to-face interactions (body language and gesticulations and which footy jersey they are wearing) may be invisible.

COVID-19 has turned the traditional consultation on its head and communicating remotely is the new black.

So, what does effective communication via telehealth look like? Unfortunately, the literature doesn’t help us much. A 2017 Cochrane review (2) found there was no evidence available to guide an effective approach to training clinicians in telephone consultation skills. The authors concluded that such skill development has therefore to be guided by face-to-face communication models.

Thus, it’s back to basics. Suddenly all that jargon we learnt in ‘Communications Skills 101’ from medical school – active listening, reflecting, use of silence, chunking, summarising – is meaningful again. Speak a wee bit more slowly. Use open-ended questions. Remember that you get most bang for your buck from history-taking, so spend a little longer here. Summarise back to the patient – ‘so what I have heard is…’. Ask the patient to repeat key aspects of management back to you to ensure they have understood it.

But perhaps also be innovative and use the new telehealth medium to your and your patient’s (communicative) advantage. Ask the patient what the problem is and then switch to ‘mute’ (you can’t interrupt them when you’re muted!). Ensure that they have nothing else to ask before you hang up – there’s no scope for a doorhandle ‘Oh, and there’s one other thing doctor…’ in telehealth. And if you want to close your eyes to concentrate, you can, without giving the impression that you have drifted off.

The ‘art of communication’ has been described as effectively adapting core communication skills to suit the patient and their context (3). As GPs, we already have these skills. And the patients are no different. So, while telehealth may a new context, by applying old tricks to a new dog we can continue to successfully communicate with our patients.

References

1. Murtagh’s General Practice

2. Vaona A, Pappas Y, Grewal RS, Ajaz M, Majeed A, Car J. Training interventions for improving telephone consultation skills in clinicians. Cochrane Database of Systematic Reviews 2017, Issue 1.

3. Warnecke E. The art of communication. Aust Fam Physician. 43: 3; 156-158.

{{commentCount}} comment(s). You must be logged in and AHPRA verified to view and comment. Log In here.

Dr Simon Morgan

Simon is a GP and Medical Educator based in Newcastle, NSW.

The latest healthcare news from medcast

A tree change is in the wind
A tree change is in the wind

Change seems to be the theme of 2020. In our region, as with many in Australia, it started with bushfires, before a jump to the left into ‘COVID Capers’.

Writing your COVID worries away - (with Andrew Gan and Dr Jet)
Writing your COVID worries away - (with Andrew Gan and Dr Jet)

COVID and all its attendant inconveniences (I guess some would say “tortures”) has forced many of us to revise our personal wellbeing plans and dig out some old strategies that we haven’t used for a while. It’s also made some of us realise that ma...

Malignant Hyperthermia
Malignant Hyperthermia

Malignant Hyperthermia is a rare and potentially life threatening genetically inherited condition that can be triggered by drugs commonly used in anaesthesia. If it is not recognised and treated in its early stages, MH can be fatal.

Restless Leg Syndrome - Podcast
Restless Leg Syndrome - Podcast

Restless leg syndrome is a common presentation in General Practice characterised by uncomfortable sensations in the legs. These sensations are associated with an irresistible urge to move the legs to relieve the symptoms.

Telehealth Fatigue
Telehealth Fatigue

My patients are loving telehealth. They love it so much that most of them are saying they don’t want to come back to face to face consultations. You probably need to bear in mind that my patients are long-term therapy patients that I know very well.

Paediatric Advanced Life Support Standards
Paediatric Advanced Life Support Standards

In order to achieve these standards, it is essential that medical and nursing staff who work with paediatric patients receive specialised education to manage a paediatric cardiopulmonary arrest.

Would learning something new wash your Acedia away?
Would learning something new wash your Acedia away?

Is Acadia running your life right now? Are you, like the solitary monks who used that term in the middle ages, suffering from the combination of boredom, frustration, agitation and lethargy that comes with physical isolation?

COVID conspiracies – should we ignore them?
COVID conspiracies – should we ignore them?

Like me, you probably spend a lot of time talking to people about how they feel about the COVID 19 pandemic, but do you talk to them about their thoughts and beliefs about it?

Medication Spotlight: Paracetamol
Medication Spotlight: Paracetamol

A frequently used medication in community and hospital settings is paracetamol (named acetaminophen in some countries). It has less adverse effects than other analgesics, as it has no effect on platelet functioning and allergies are very rare.

Helping prevent suicide among Australia's Indigenous Youth
Helping prevent suicide among Australia's Indigenous Youth

Suicide in Australia amongst Aboriginal and Torres Strait Islander peoples occur at twice the rate of the general population. Young Aboriginal and Torres Strait Islander people are at even greater risk, those aged 5 to 17 years, suicide is the le...

COVID-19 – A Clinical Update Webinar
COVID-19 – A Clinical Update Webinar

SARS-CoV-2 pandemic is having an unprecedented impact on global health and economics. Australian GPs are on the frontline and they are forced to make decisions in a medical landscape where the parameters for testing are changing daily and many pa...

Why should we be laughing?
Why should we be laughing?

Right now, most of us are a bit upset in one way or another. Some of us are very upset. Stress, frustration, grief, anxiety, sadness, isolation, loneliness, worry about the present, worry about the future – all these things are rising to the surfa...

Aging Well – a personal perspective
Aging Well – a personal perspective

At 65 and a half (yes, it’s come to that. I’m actually counting the months again!) I find myself reluctantly looking down the barrel of a shotgun labelled “old age”.  It’s OK, don’t panic – I’m not unwell. It’s just that my body hurts and people k...

The CHIME GP study
The CHIME GP study

Clinical and Healthcare Improvement through My Health Record Usage and Education in General Practice

Muuuum, I’m bored!!!!
Muuuum, I’m bored!!!!

Has anyone heard that or a variation of it recently? I’ll bet you have! Many years ago, before I had kids of my own, I used to hear my brother-in-law saying to his bored and whining kids “Come on then, I’ll give you a job. I’ve got plenty for y...

What’s your COVID number? A simple way to keep everyone safe and comfortable
What’s your COVID number? A simple way to keep everyone safe and comfortable

A friend mentioned a really great way for managing this which I have been using and sharing with others. As people are going to have different comfort levels when it comes to spending time together, she told me about sharing her COVID social comfo...

Being Well in Difficult Times - Talah
Being Well in Difficult Times - Talah

It’s always helpful to hear how other people cope.  Over the next few weeks we are dedicating the Being Well blog to a series called Being Well in Difficult Times.  In this blog post we speak to Talah - a a Gumbaynggirr/Yaegl young person who shar...

We’re listening at last to Aboriginal and Torres Strait Islander Voices in Mental Health
We’re listening at last to Aboriginal and Torres Strait Islander Voices in Mental Health

Whilst significant progress has been made in incorporating these voices generally, there is a call for diversity in these Lived Experience voices, namely Aboriginal and Torres Strait Islander Lived Experience.

Being Well in Difficult Times- Zoe
Being Well in Difficult Times- Zoe

Zoe is a registered nurse working in theatres. She has elderly parents and a young son. How is she staying so positive in the face of CoVID-19?

Eating Disorders in Adults: Assessment & Treatment Options
Eating Disorders in Adults: Assessment & Treatment Options

Eating disorders, broadly defined by disturbances in eating behaviour and distress centred on food, eating, and body image, affect nearly one million Australians. This blog covers the assessment and treatment options for various conditions.

Join Medcast. It's free and you'll get instant access to essential healthcare news, research and more.

Already a member? Log In