Archive for Communication

If somebody had a crystal ball: The paradox of a self-defeating health policy.

When I was a new graduate student of health policy, I was once asked by a professor whose class I took, why I had left clinical practice to study health policy. I replied naively, ‘I migrated from clinical practice because I don’t like the idea of working in a place where I can make one mistake and kill a person.’

‘I see,’ he said, ‘so you decided to come over to policy and kill thousands?’

His response, delivered in jest, was tacitly instructive about the importance of getting health policy right, because of the scale at which the impact can be felt. Indeed, one of the central tenets of governance in healthcare is the identification and rectification of problematic policies (WHO, 2017).

Even after learning at graduate school that policy work tends to be an arduous, convoluted and often contentious process, I still intuitively considered policy work to be safer, more elegant and less stressful than clinical work. It was experiences ‘from the trenches’ that revealed otherwise. Within a year of completing my masters, I was battling to pilot an intervention aimed at mitigating the undesirable effects of a well-intentioned health policy that has outlived its relevance in its context; a process which was the diametric opposite of ‘elegant and less stressful’!

 

When a health policy endangers health

Pharmacies in Zimbabwe, a low income country in Sub-Saharan Africa plagued by a protracted economic recession and a dilapidated health system (Meldrum, 2008), are prohibited by law from advertising their inventory to the general public unfettered like conventional businesses do (Health Professions Act, 2004; Medicines and Allied Substances Control Act, 2001; Pharmaceutical Professional Conduct Regulations, 1989). Given the information asymmetry characteristic of a typical healthcare market, and the potential severity of the consequences of such asymmetry, advertising restrictions are rightly intended to protect members of the public from product claims they are unequipped to evaluate objectively. However, to the extent that advertising restrictions interfere with information provision and transparency when accessing health care, they themselves are a health hazard and this is what the medicine advertising regulations in Zimbabwe have become. The fine line between availing information about care and protecting the public from exaggerated claims should be carefully navigated. Interventions which mitigate the deleterious effects of health information control policies can and should be developed.

In well-served health systems, restricting advertising in and of itself does not constitute a problem because a patient can reasonably expect to find the medicine(s) s/he requires after only one stop or at most few stops at pharmacies in his/her vicinity. However, in Zimbabwe today, systemic economic challenges are causing generalised medicine shortages. These challenges are, in the main, beyond the control of the pharmaceutical sector. As a result, the largest referral hospitals suspended elective surgeries (United Bulawayo Hospitals, 2016; Harare Hospital, 2016). Pharmacies that happen to have a particular medicine that is in short supply everywhere else, are precluded from overtly advertising this fact. Patients therefore have to rely on door-to-door enquiries at multiple pharmacies, serendipitous coincidences, intuition and the benevolence of some pharmacists who sometimes offer to help by contacting colleagues within their professional networks on behalf of patients. Electronic prescribing is not yet widely used in Zimbabwe so patients or their carers are the ones tasked with transmitting prescriptions between prescribers and the pharmacies that will ultimately dispense them. They therefore bear the transaction cost of this process and have to trudge from one pharmacy to the next until they eventually get to a pharmacy that can fill their prescriptions. When pharmacists turn away prescriptions but offer no additional information about where patients can get those prescriptions filled, they become the human face of a system that seems unresponsive to the plight of the ill. Once, I remarked to my colleagues, ‘If somebody had a crystal ball, they would be the oracle that informs patients where exactly to go to get their prescriptions filled and reduce the burden of medicine access.’

 

The intervention: Controlled democratisation of pharmaceutical inventory information

Accessing medicines should not depend on unsystematic methods of search and we most certainly shouldn’t have to look to clairvoyance to make health systems more efficient and transparent – especially when advances in health informatics and Web 2.0 coupled with the ubiquity of portable information and communication devices have increased the interconnectedness of actors and rendered faster sharing of information across large networks possible. After a content analysis of the statutory instruments governing the practice of pharmacy in Zimbabwe, with the view to finding a legal workaround for the advertising rules, I discovered a loophole. While advertising inventory to the general public is prohibited in Zimbabwe, advertising to another health professional is not. Therefore, if a vertical search engine that is populated by real-time crowdsourced inventory data from retail pharmacies all over the country was set up, and if the back-end of that search engine was managed by a pharmacist, then it could be used by that pharmacist to advise patients, on a case by case basis, even remotely via the internet, about the exact locations of pharmacies stocking specified medicines. A prototype meant to achieve this was designed and the three statutory bodies that regulate healthcare practice in Zimbabwe were approached for approval before launch.

The unfavourable response received from them, was unexpected. An email communication was circulated to all the registered practitioners, cautioning them against what the chief regulatory institution considered an ‘illegal project’ that was tantamount to advertising. I was explicitly informed that I was risking censure by setting the ball rolling with it and was sufficiently intimidated. Of all the illegal things a health professional in Zimbabwe can do, outside of malpractice, experimenting with advertising is considered the most negligent because it is so easy to avoid. It is seared onto our minds right from pre-qualification training that advertising by health professionals is simply not acceptable, so it is almost a reflex response for healthcare providers to stonewall anything that bears advertising connotations.

Regulators were re-engaged because their endorsement is crucial. Without this it is not possible to persuade pharmacies to volunteer the essential crowdsourced data needed to populate the vertical search engine that drives the intervention. Although they acknowledged unreservedly the existence of the problem that the advertising policy has given rise to, regulators remained steadfast in their position that the proposed vertical search platform solution was illegal and ‘was not in the best interests of the public’. The judiciary arm of the state was therefore invoked in the hope that it could rule on the legality of the proposed intervention.

The intermediate goal became to obtain a court judgement that would compel the regulatory bodies to allow this intervention to be tried. A High Court application (Herald, 2016a) citing the health minister and all three relevant regulatory entities as respondents, was filed. We currently await a judgement pronouncement but continue to keep the discussion about the matter alive, for example through the press (Herald, 2016b). Meanwhile, one of the regulatory bodies has responded to our court application with a counter-suit for costs because according to it, we ‘brought a case before the Court prematurely.’

 

The Future

Towards the end of 2016 a press announcement notified the public of the healthcare regulators’ intention to relax draconian advertising policies (Herald, 2016c), having recognised the need for the public to access information about healthcare providers and services. I count this a small victory and look forward to the green light to implement the ‘Crystal ball’ project with much optimism. Lessons from its implementation could bode well for health systems facing similar governance problems.

Determined to build my credibility with policymakers and take forward my academic studies, I enrolled for a PhD with the Global eHealth research group at the University of Edinburgh and am now 10 months into a three-year programme. Taking this parallel pathway, whilst continuing to fight the case for better information sharing about community pharmacy stocks in Zimbabwe, has forced me to critically examine my assumptions and proposition and to mentally separate my personas as an objective researcher of eHealth innovation and as an innovator/entrepreneur. It has provided an opportunity take an in-depth look at the technical and legal feasibility of alternative approaches, and their ethical, legal and governance implications, as well as to study a wider range of innovative digital approaches for supporting pharmacy practice and strengthening health systems. This transition has been guided and encouraged by my PhD supervisors Dr Claudia Pagliari and Dr Raluca Bunduchi, who have kept my feet on the ground and combine expertise in health technology assessment, health policy and innovation studies. Our new opinion piece in BMJ Global Health (June, 2017), aims to draw wider attention to the challenges facing Zimbabwe and seeks ideas and opinions from researchers, policymakers and practitioners facing similar problems elsewhere in the world.

 

By Dudzai Mureyi, Global eHealth PhD student

Dudzai Mureyi is a first year PhD student on the Global eHealth programme at the University of Edinburgh, supervised by Dr Claudia Pagliari (eHealth Research Group) and Dr Raluca Bunduchi (Entrepreneurship and Innovation Group).

 

  1. Harare Central Hospital (2016). Internal memo: Suspension of Elective Lists-Drug Shortages. Harare. [WWW] Available from https://zimnews.net/zimbabwe-suspends-surgeries-harare-hospital/ Accessed 06 February 2017.
  2. Meldrum A, (2008). Zimbabwe’s health-care system struggles on. Lancet 371(9615); 1059-1060.
  3. Parliament of Zimbabwe (2001) Medicines and Allied Substances Control Act [15:03]. Harare. Parliament of Zimbabwe.
  4. Parliament of Zimbabwe (2004) Health Professions Act [27:19]. Harare. Parliament of Zimbabwe.
  5. Parliament of Zimbabwe (1989) Statutory instrument 232 Pharmaceutical Professional Conduct Regulations. Harare. Parliament of Zimbabwe.
  6. The Herald (2016a). Pharmacist Seeks Court Order for private pharmacy stocks database. [WWW] Available from  http://www.herald.co.zw/pharmacist-seeks-court-order-for-private-pharmacy-stocks-database/  Accessed 06 February 2017.
  7. The Herald (2016b). When regulation is outpaced by technology. [WWW] Available from  www.herald.co.zw/when-regulation-is-outpaced-by-technology/ Accessed on 06 February 2017.
  8. The Herald (2016c). Zimbabwe: Govt relaxes Medical advertising rules. [WWW] Available from http://allafrica.com/stories/201611280215.html Accessed 06 February 2017
  9. United Bulawayo Hospitals (2016). Internal memo: Cancellation of Elective Surgical Operations. [WWW] Available from http://www.africanews.com/2016/10/15/drug-shortage-hits-zimbabwe-hospitals-suspends-some-surgical-operations// Accessed 06 February 2017.
  10. WHO (2017) Governance. [WWW] Available from http://www.who.int/healthsystems/topics/stewardship/en/ Accessed 06 February 2017.
  11. Mureyi D, Pagliari C, Bunduchi R (2017) Drug advertising riles and the patient safety paradoc in Zimbabwe. BMJ Global Health (Opinions), June 8th 2017 http://blogs.bmj.com/bmj/2017/06/08/dudzai-mureyi-et-al-drug-advertising-rules-and-the-patient-safety-paradox-in-zimbabwe/ Accessed on 10 June 2017

Health in the Eastern Mediterranean Region

The vast complexities of the Middle East and surrounding regions cannot be understood without bringing health into the battleground of analysis. In this context, the Global Health PhD Network organised the event “Health in the Eastern Mediterranean Region” on 28th of October, 2016 with the funding of the University of Edinburgh’s Global Health Academy. The event was framed as a series of four short conferences on diverse topics related to Health in the region, and two networking recesses at the venue’s foyer at 7 Bristo Square, where delicious kenafa was served by the University’s Middle Eastern Society.

The first speaker was Dr Runa MacKay. She studied medicine at the University of Edinburgh at a time where it was not usual for women to go this further in their studies. In 1955 after qualifying in medicine, Dr Mackay arrived at the Edinburgh Medical Missionary Society Hospital in Nazareth, now in Israel, which has served the Arab population there for more than 150 years. Dr Runa Mackay spent around fifty years working across Lebanon, Palestine, and Israel for the betterment of health conditions among the Palestinian population who live within Israel, either in health policy or as a practitioner in war torn Beirut and West Bank. Today, back in Edinburgh, she has written the book “Exile in Israel”, where she tells her personal experience throughout those years which have taken her to state, as she did in the event, that she feels more Palestinian than British.

As the second speaker, Khuloud Alsaba, researcher from the Syrian Center for Policy Research and a final-year PhD candidate in International Public Health Policy talked about part of her research project: “War in Syria: Political Determinants of Health”. In a very critical and insightful way she explained how within the discourse of “The War on Terror” health facilities and health care workers have become a legitimate target. However, turning access to health into a weapon of war has brought unexpected hardships for the population. Khuloud argued that polio, once an eradicated disease, has reappeared in Syria as a consequence of a thrashed and weakened public health system. She concluded by stating that these war tactics are not only militarily and economically inefficient, but also (and most importantly) a violation of the human rights of Syrians.

After a short networking recess, the event carried on with the third talk. Via videoconferencing, Ben Clavey, a young medical student and the co-coordinator at Medact Arms and Militarisation Group, gave a concise explanation about this NGO and its work in the Middle East. Medact is an organisation where health professionals can go beyond the clinic and actively engage with the search for solutions to the most pressing global health issues. Through analysis, lobbying, and education, it aims at having an impact in policy on four main areas: peace and security, climate and ecology, economic justice, and health and human rights. Regarding the Middle East, he added that Medact’s activity in the region has been extensive. It has worked in Iraq and Palestine performing in ground analysis and campaigning for the respect of human rights and adequate health policy for the victims of armed conflict in both countries. Recently, it has worked on warning and lobbying against airstrikes by the British military in Syria and also against UK arms sales to Saudi Arabia, who has been involved in the destruction of Yemen’s health system and the targeting of its hospitals and other healthcare facilities. Finally, Ben invited us to become part of Medact’s effort in taking health as a human right into policy either by donating or joining the organisation. A stand with further information for those interested in participating was set on the venue’s lobby as well.

The fourth and last speaker was Parisa Mansoori, a PhD candidate at the Centre for Global Health Research at The University of Edinburgh, who presented her research project on Iranian health sciences and academic literature production. According to recent data, Iran has had a dramatic increase in the amount of health related academic publications in the past few years. This stands out as a unique situation among the emergent economies, due to the quality of the articles produced in Iran, which have found their way into high impact international journals. Moreover, Parisa pointed out that practically a large proportion of this new literature has been produced by a small group of academics in Tehran University of Medical Sciences and few other Tehran-based institutions. By providing a thorough characterisation of this phenomenon, she expects to lay ground for further progress and development of Iran’s health sciences and their contribution to the global scientific arena.

In conclusion, the event managed to assemble in a couple of hours a wide range of experiences related to health in the Eastern Mediterranean region. Just as this region has been traditionally associated with armed conflict and violent political struggle, health has also been a very pressing issue both then and now, as Dr MacKay and Khuloud Alsaba exemplified. However, as Ben Clavey from Medact and Dr MacKay let us see, there are still spaces for hope and resistance, as well as moments for empathy and sharing. Furthermore, in spite of these difficulties, the region hasn’t stopped creating new knowledge. As Parisa Mansoori portrayed, the region is home for highly qualified and capable academics who contribute to the development of science and knowledge around the world. Lastly, thanks to the networking sessions and kenafa tasting we were reminded that, as in any other place, there are people living everyday lives in this region, where the creation and recreation of very rich cultures has made of it a quite unique and special place.

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Bernardo Moreno-Peniche, MSc Medical Anthropology, University of Edinburgh

 

Images taken by: Clàudia Serra Vinardell

Building our collaboration with Stanford

The event New Perspectives in Compassion held at Stanford University California on 16th March was the first academic collaboration between CCARE and the Global Health Academy (GHA) following the launch of our Compassion Initiative in September in Edinburgh by the Principal. We are very grateful to Dr Monica Worline , deputy director, and Professor Jim Doty director at CCARE for their impeccable organisation. It was attended by just over 200 individuals including Edinburgh and Stanford faculty, students and alumni, and those living in the Bay Area and provided a series of short presentations by Stanford  and Edinburgh academics from a number of disciplines in the sciences and humanities.

New Perspectives in Compassion Panel

New Perspectives in Compassion Panel

 

http://ccare.stanford.edu/events/perspectives-on-compassion-new-thinking-from-stanford-university-and-the-university-of-edinburgh/

It was part of the Edinburgh University’s pop-up week in the Bay area of California, which also included events on big data, veterinary medicine, and history.

We were really fortunate to have the active engagement of the Principal, Sir Timothy O’Shea for the afternoon. After an introduction by Jim Doty and Liz Grant, the first session included a short talk and reading of a poem by John Gillies (written by a Stanford medical graduate) from the second edition of ‘Tools of the Trade’. This is a small volume of poems gifted to all new medical graduates in Scotland for the past two years.

Prof Paul Gilbert, an Edinburgh alumnus, and the psychologist who helped to kickstart research and education in compassion over two decades ago, gave an overview of his developing work including psychological tools to help people with moderate to severe problems of anxiety and self esteem.  Monica Worline introduced the theme of compassion in the workplace, the importance of shifting the balance of efficiency and effective measures from material linear outputs to relational outputs, the satisfaction, the ability to enjoy work, the opportunity to grow and flourish in a work environment. Following Monica was one of CCARE’s research partners, Professor Anne-Birgitta Pessi, a visiting Professor of Church and Social Studies from Finland. She summarised a novel approach based on Ricoeurian theory and using specific training to improve compassionate behaviour in leadership and workforce in large corporations in Finland, based on a novel approach called Co-Passion training -http://blogs.helsinki.fi/copassion/copassion-seminar/

The second session had a recorded contribution from Dr Paul Brennan, Co –Director of the Edinburgh GHA Compassion Initiative on the effects of neurosurgery on compassion in patients. Brian Knutson, associate professor of psychology at Stanford spoke on the neural basis of emotions, and we finished with a fascinating talk by associate professor Firdhaus Dhabhar , a Stanford psychiatrist who spoke about the ill effects of chronic stress on immunity and accelerating ageing, and how these can be mitigated by social support, mindfulness and meditation.

 

Professor James Doty, Dr Liz Grant, Dr John Gillies

Professor James Doty, Dr Liz Grant, Dr John Gillies

The second half of the afternoon was a distinguished panel, moderated by Jim Doty on The Compassionate Robot: myth, nightmare or solution. We selected this subject because of the rapidly developing technology around robots and their increasing use in healthcare and social settings across the world.  Principal Sir Tim O’Shea suggested that while a non human robot could not provide truly human compassion, it could provide ‘artificial compassion’ where that would be of utilitarian benefit. However, human compassion also had its inauthentic side as well, he suggested. Rev Professor Jane Shaw, Dean of Religious Life at Stanford gave a Humanities based perspective on what it means to be human: having what Adam Smith called ‘fellow-feeling’ or sympathy. In society today this she argued is often characterised by the shared construct we know either as compassion (which is based on a Buddhist model) or grace ( the word that encapsulates compassion emerging within the Christian tradition). Our understanding of compassion in robots can be much enhanced by looking through the lens of arts and humanities.    Alastair Boyle, Global Client partner of Google and head of strategy at the company Essence looked at compassion in advertising, illustrating this with the ‘Dove’ soap campaign which purposefully set out to make women feel better about themselves. He admitted that the strategy used by all companies now of tailoring advertisements though individual’s internet searches could in fact provide inappropriate and unhelpful targeting at times. He also touched on the ‘uncanny valley’ problem of life-like robots making people feel uncomfortable.

Jon Oberlander, professor of Epistemics here at the University of Edinburgh talked about robotic developments which enabled them to perceive and respond to human emotion, also the benefits and problems associated with robotic carers providing ‘care’ but reducing interaction with human carers. Ultimately, he said, ‘robots just don’t care’, in the metaphoric sense, however the responsibility to care lies not with the robot but with the creator.

The afternoon provided both a breadth of disciplinary approaches and, at times, a surprising depth of insight into the rapidly developing area of academic work on compassion. There was a great deal for our Global Health Academy’s Global Compassion Initiative to build on for the future; much more to come!

 


Dr John Gillies,  Senior Adviser Global Health Academy, Co-Director GHA Compassion initiative

Dr Liz Grant, Director, Global Health Academy, Co-Director GHA Compassion Initiative

The world is changing – will your PhD matter?

At the dawn of the Sustainable Development Goals (SDGs) – which ushers in 17 new goals in a global agenda to “end poverty, protect the planet, and ensure prosperity for all”, most countries will be realigning their national development goals to be in tune with these global goals to realize specific targets over the next 15 years. As a researcher, one thing will soon become obvious in the midst of this global effort to bring about change – that is future research grants will be awarded primarily around these 17 SDG goals. An important question – “how your research fits in this global agenda?” arises for you and other PhD researchers who will soon be applying for these grants to drive your respective fields forward with whatever piece of the bigger science puzzle you will be solving.

It will not be an easy task to find one’s footing in the fast changing terrain of global goals and priorities, and Dr Liz Grant of the Global Health Academy at Edinburgh University is not shy to point this out. But, thankfully, not without some pointers to a way forward. Dr Grant has had extensive research experience at the level of Global Health with her many years of research in palliative care around the globe. In her talk on the ‘Impact of PhD Researchers on Global Health’ which she delivered at the Global Health PhD Network event in October 2015, she had a lot to share.

In a talk that was neatly supplemented with real life examples of her own research, Dr Grant carefully led the thoughts of the PhD researchers in the room on a number of issues, which in her opinion will soon become important in their researching career in the light of the new SDGs.

Top of her list was the need for PhD researchers to start thinking of where to find other pieces of evidence for their research. “What matters in your PhD”, she said, “is pulling materials from connected disciplines and connected areas and making sure you draw them in – use the materials out there…network pieces of information together”. In truth, that is how science works in our day through extensive bridge building across multiple disciplines and you probably have come across this a number of times already in your field. The rewards of this approach is long term and may not be immediate which in the little time space of a PhD makes it appear impractical. But in Dr Grant’s view, your research questions are still questions because there have not been enough conversations around them for others before you to have answered them. This is a brilliant way to look at things because in a way it challenges you to start expanding the discourse around your research to span more than just the area of your interest, to generate interest in other relevant fields.

But what good might all that knowledge you obtain as a result be, if not for the good of mankind. “Knowledge for knowledge sake is wonderful”, she says, “but knowledge to make a difference is why you are here and why I am here and why the university is here”. The message here is pretty simple – don’t let your PhD be only just another addition to the vast collection of information sitting on shelves around the world and only collecting dust. But it should be one that works and makes a difference. And she thinks you can achieve this by starting to think about your PhD research in terms of who the constituents are (i.e. those directly affected by what you are doing), how you will engage the public on important issues like the burden of the problem you are dealing with or trying to help solve, and also the economics involved and equally importantly why your research needs to be prioritised in the face of other competing research.

Huge task, but is it beyond you? Of course not. A big step forward in making any of the impact that would make your PhD research matter is through advocacy. Because the impact is kind of often seen through advocacy, she said, in doing things like, writing blogs, getting local workshops, and communicating what you are studying to people who have the connections to make things work. “People built systems and people can take it down,” she says in reference to the perpetual ‘brick walls’ of resistance that bureaucracies will mount on your path. Keep talking to as many people as possible and never ever underestimate the power of networking because you can change things in partnerships.

In bringing all this home, Dr Grant urges PhD researchers to think once again about their PhD and ask themselves what are the core components of what they are doing. For instance in her own research in palliative care then this would be about the core components of a health care system. Ask yourself if your research is around the core components. If not, what can you do to create the conditions necessary for change? Are you getting the right materials at the right time to create these conditions? And will these conditions support a sustainable system? Also what is the national architecture like in your country that will mean your piece of research can fit in. Answers to these questions and a lot more which couldn’t fit in this piece are what in Dr Grant’s expert opinion would make your PhD make an impact.

“Never forget why we research, you and I – it’s our communities, it’s our families, it’s people.” Dr Liz Grant

Dr Grant’s talk was preceded by a lively PhD poster session that saw four PhD students from the University of Edinburgh present their research work from four different regions around the globe. The first poster by Sara Valencia looked at vaccine trials in Southern and Central America (Colombia, Brazil and Mexico). A second poster that looked at the prevalence of Non-communicable Diseases and the entitlement to and the use of health services in the Gaza strip was presented by Majdi Ashour. Mkululi Wami presented the findings of a research work he carried out in Sub Saharan Africa in Zimbabwe which used antibody responses based on parasite egg counts to estimate infection prevalence of schistosomiasis in young children. The last poster was presented by Ai Oishi on a research that sort to identify patients for palliative care approach in primary care settings in Japan.

The Global Health PhD Network started, in October 2014, as a student-driven interest group within the Global Health Society, University of Edinburgh, with the express aim of bringing together like-minded postgraduate researchers from the three colleges in the university for research sharing, knowledge and skills exchange, networking and shared global health career development. The Network has hosted a series of events during the past year to bring together PhD researchers in the university to listen to and to share thoughts on important issues surrounding global health. And their most recent event (the one I just described) was yet another opportunity for the Network to reiterate its vision of creating an environment that supports and promotes cross-disciplinary networking by inviting PhD poster presenters from all three colleges of the university.

Again, looking back at some of the key points in Liz’s talk on the importance of networking and advocacy for PhD researchers, you realise that the Global Health PhD Network has its priorities well placed, doing things right as it should be and is already on the right bus into the future.


Richard F Oppong, Institute of Evolutionary Biology, University of Edinburgh

The Importance of Good Communication Skills

Good communication should never be underestimated at any time, however this is never more important than when communicating with someone in relation to their health. It is impossible to overstate the importance of creating good communication between health professionals and patients in optimising health care.

As a medical oncologist for over 30 years I have seen many examples of both good and bad communication, with a recent example coming to mind. I met an old friend who informed me that he had just been diagnosed with prostate cancer – highly intelligent, well-read but non-medical he told me that the moment he heard the work “cancer” his mind blotted out completely. He remembers nothing of the rest of the consultation and left knowing next to nothing of the proposed management or his future. This is a frequently reported occurrence and for doctors the process of explaining a cancer diagnosis, outlining investigations necessary for staging and possible options for treatment this is ever more challenging.

Over the years I have seen and participated in amazing progresses in the science of cancer and the ever increasing knowledge and understanding regarding individual cancers, not to mention the possibilities for investigation and more and more available treatments. Good medical practice carries with it a responsibility to explain as much as possible to patients, but how and when to do this requires training and expertise. Time is a major pressure with often too much to explain in a single consultation. Patients can only absorb so much information at a time, if any as my friend found.

Sharing explanations between doctors and nurses can help patients digest what matters most to them, and having a relative or close friend with them doubles the hearing/comprehension experience.   Hand-outs are no substitute for face-to-face conversation and doctors really have to work hard to develop the skill of “listening”! Thank goodness the art of medicine has not been totally replaced by science, but communication skills need to be practiced and continuously developed by all of us in helping patients to understand the complexity of a diagnosis of cancer.

 


Professor John F Smyth, Emeritus Professor Medical Oncology, University of Edinburgh

Communicating with Cancer Patients