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medical world GAMSAT the importance of communication

Learning to communicate in the medical world

by , 07 November, 2016
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With the GAMSAT® Exam coming up in March next year and medical school applications due shortly after the release of their results, you might want to start thinking about why you are on this journey. You may not realise it, but medicine involves learning a lot more than just science and clinical knowledge. You need to be able to adopt a whole new language and method of communication. If you have ever watched an episode of House, you’ll notice that all communication regarding their patient is formalised, structured and to the point. Although many aspects of House are completely dramatised, they do get a few parts right, one of which is structured communication in handovers. When we speak to our friends and family, we never go into the conversation with a structure in mind, we simply say whatever we want to say (and often regret it later in family arguments). In the medical world, structure is everything, and only recently have I come to appreciate this.
 
In order to be taken seriously by doctors, nurses or any other medical related staff, you must have a clear focus when you walk into a conversation. Your sentences must be detailed but efficient and at the end of the conversation, you have to be certain that the information you passed on was completely understood and absorbed. Whilst this seems like pretty standard workplace practice, in medicine unlike in retail or office jobs, miscommunication can cost lives... You need a structure, and hence I present to you the medical student’s guide to communication - ISBAR.

ISBAR is a mnemonic that assists in the communication of important patient information in clinical conversations; face-to-face, on the phone and in writing (emails and letters).
 
        Identify – Who are you and what is your relationship to the situation?
       Situation – What is going on?
       Background – What is the clinical background/content?
       Assessment – What do you think the problem is?
       Recommendation  - What should we do from here?
 
The information you pass between people is often sensitive, and you must ensure that you are not passing on any misleading, ambiguous or inaccurate data. By identifying yourself and the person or thing in question, you accept accountability and put context to your position in regards to them. Situation stands for information regarding the circumstances that had brought the patient to you. Background is any information about conditions/events prior to the current health crisis that may influence how it plays up. This is obviously  a crucial step in disclosing any relevant medical history that may affect further treatment or diagnosis. The assessment lets the person know what you have done and what you have concluded from your time with the patient and finally, your recommendation (which they may take, or not) gives them a next step.
 
You can see that the ISBAR structure covers an abundance of  information that is essential to clinical handovers and patient transfer. But you can also see how having a structure improves the efficiency in what you are saying on a day-to-day basis. For example if you were returning something to the shops and needed to be quick and concise, you could try using ISBAR:
 
“Hi I’m Sarah (Introduction) and I bought a jacket from your store 2 days ago (Situation/Background). The size isn’t quite right (Assessment) and I have my receipt so I’d like to swap it for a different size if it is available (Recommendation)”
 
In two sentences, you have sorted out your problem and have made the job of the sales assistant 100 times easier. Having this structure helps to eliminate the potential for unnecessary mistakes. In a 2004 study, poor communication was a major contributing factor in 60-70% of adverse events.
 
I was once under the guidance of a rural paediatrician with a fantastic reputation: people would actually come all the way from Sydney to see him. So I thought to ask him what piece of information he thought was most valuable to his success – his answer was ISBAR. Through efficient communication he explained, not only did his patients have complete trust in his ability, but doctors, nurses and other clinical staff alike all knew that when they were dealing with him, they could trust he would be efficient and thorough. As a doctor, your ability to communicate is of utmost importance and it requires adapting a different set of rules to our everyday life. It is one of those valuable life lessons you will learn as a medical student and carry through till you retire – so why not learn it now? Good luck with your GAMSAT® Exam preparation!