gms | German Medical Science

Katrin Rockenbauch, Olaf Martin, Ute Kraus, Christina Schröder, Elmar Brähler, Yve Stöbel-Richter (Hrsg)

Kommunikation in der Medizin

Psychosozial-Verlag, Gießen

year of publication: 2011, DVD with booklet

Available in German only at http://www.psychosozial-verlag.de

The video examples “Communication in Medicine” which were carefully selected for a DVD by K Rockenbauch are intended for teaching communication to medical students. Using 10 examples with physicians and actor patients, typical consulting and advisory situations are demonstrated which frequently occur in medical practice and are relevant to everyday routine work. These are accompanied by a small but indispensable booklet for use with the DVD; containing commentory on the situations and describing the potential uses of the DVD.

The side-on camera angle showing both parties gives a very good overall view. The two additional sections which are continuously displayed focus very closely on the faces in question. They allow close observation of the facial expressions and further discussion. Sometimes, however, this setting is not ideal because the only facial expression is shown. Occasionally a view over the shoulder would be better as this would allow better identification with the doctor or the patient’s perspective and permit better observation of the body language.

The first six situations are typical of general medical practice and address the following problems:

• diarrhoea (with a stress-related mental component),
• depression/fatigue/sleep disorder (primarily expressed through frequently occurring tonsillitis),
• neck pain (due to stress),
• suspected diabetes mellitus Type II (with patient showing little understanding),
• polymorphic light eruption (succession of old GP) and
• flatulence (suspected milk allergy).

This is followed by two situations with almost identical baseline (persistent cough for two weeks), two different models of treatment approach (illness- versus patient-centred) and with one evaluation session with an actor patient on how she perceived the discussion.

The examples conclude with a preoperative informed consent discussion prior to a tonsillectomy for the daughter of a mother who has checked out information on the Internet beforehand; and giving bad news (recurrence of breast cancer).

The conversations seem authentic and consistently exemplify underlying frequent communication problems. The people acting the part of the doctors are empathetic but tend to be paternalistic and directive. In this sense, they are therefore only suitable for self-study in terms of positive role models (e.g. poor demonstration of motivational interviewing by Rollnick) as potentially problematic conversational situations are enacted which must be critically examined with the students. However, the examples of teaching in small groups with communication specialists are well suited to analysing the behaviour commonly encountered in medical practices and to jointly develop and determine ways of improving, if necessary through role play or practise with actor patients. In almost all situations, only the discussion, not the examination, is shown. This is a pity because communication also takes place during examinations and by ignoring this, there is a danger that communication is seen, learned and practised separate from examinations. A highly positive role model is the example of conveying bad news using an exemplary guided discussion following the SPIKES model according to Baile et al. which is also quoted in the booklet.

Overall this is certainly a worthwhile purchase for communication classes, which – not only if no actor patients with rehearsed roles are available – are enriched by the examples shown and can gain in authenticity. The examples provide a wealth of potential discussions on communication in medical care in small group instruction but also as a supplement to lectures with examples which can be debated accordingly.

The author declare that he has no competing interests.