INTRODUCTION

Since time immemorial, the aims of the physician have been to cure sometimes, relieve often, and comfort always. To “comfort always” and the ability to communicate effectively with patients are fundamental for clinicians (Jason 2000; Ong et al 1995). Evidence-based studies show that doctors’ interpersonal and communication skills have a significant impact on patient care and correlate with improved health outcomes and health care quality (Rider and Keefer 2006; Nobile & Drotar 2003; Stewart 1995; Stewart et al 1992). Effective communication is needed for doctors to make an accurate diagnosis, to facilitate compliance with treatment by creating a trusting relationship with chronically ill patients and their families, to cope with breaking bad news and dealing with angerand to establish harmonious relationships with colleagues (Royston 1997), support staff and superiors. Dissatisfaction of patients and the public is due more to poor communication than to any other pro-fessional deficiency among doctors (Anon 1993). Communication is a core clinical skill that can be taught and learned (Rider and Keefer 2006) and teaching com-munication skills is now part of the undergraduate medical curriculum in the majority of medical schools world wide (Lloid and Bor 1996).

The Medical Faculty of Universiti Kebangsaan Malaysia (UKM) started to teach communication skills formally from the year 2005 under the new integrated curriculum, consisting of 10 semesters in five years. Before 2005, UKM medical curriculum was more conventional and disciplined-based in which communication skills were not explicitly taught or assessed. The objective of this paper is to determine the perceptions of house officers of UKM from the old curriculum on their communication skills in different aspects. The study findings may also be utilized as base-line data to make comparisons in future research between the products of the new integrated curriculum where communication skills are taught and assessed.

MATERIALS AND METHODS

A cross sectional study was carried out on house officers at different hospitals in Malaysia who graduated from the UKM in 2004. Data was collected utilizing a standardized questionnaire containing both open and close-ended questions on different attributes of communication skills as competencies. In order to collect the data, questionnaires were mailed through the academic office to the home addresses of all 172 graduates. The questionnaires were posted at around the middle of their housemanship period. Only 32 doctors returned their questionnaires giving a response rate of 18.6%. The data was then compiled and analyzed.

RESULTS

Table 1 showed the abilities of communi-cation of graduates with different groups of people where 87.5%, 68.8%, 59.4%, 40.6% and 37.5% of the respondents communicated very well with peers, support staff, patients, patients’ families and their superiors, while 12.5%, 31;2%, 40.6% and 53.1% and 62.5% communi-cated reasonably well with the respective groups of people. Communication abilities of 6.3% of the respondents were not well at all with patients’ family.

Table 2 showed that 21.9%, 50% and 81.2% of the respondents were very well in breaking bad news, counselling patients and taking consent for procedures while 78.1%, 50% and 18.8% were reasonably well in doing so.

DISCUSSION

The majority of the house officers claimed to have communicated very well with their peers, support staff and patients. Moreover on comparison, communication with patients was the lowest (59%). Lack of attention was given to families of patients which were reflected by the low (41%) percentage of very good capabilities in communicating with patients’ families. Only 38% of the respondents claimed to have communicated very well with their supe-riors (Table 1), which seemed to be not enough. Breaking bad news to patients and their relatives is a difficult task for health professionals (Barnett et al 2007). Although it is an inevitable part of medical practice most of us worry about our ability to communicate sensitive and distressing news like loss of well-being, hope, health and relationships (Lloid & Bor 1996). The findings of this study revealed that only 22% of respondents perceived themselves to have very good capabilities in breaking bad news. Competence in patient counselling seemed better (50%) and competence in taking consent for proce-dures was also good (81%) among the respondents (Table 2). Different studies also revealed that the practicing physicians are themselves ill equipped with skills of communication (Zabidi 2000; Waitzkin and Stoekle 1972).

It is now established that patients’ satis-faction, compliance with medication and disease outcome are all associated with the quality of good communication (Royston 1997; GMC 1993; Simpson, Buckman & Stewart 1991; Ley 1982). Good communication falls into two categories: those of imparting clear information and those of relating empathically with the patient. Good communication is not easy; few can master it without special tuition and constant attention to its effectiveness. Communi-cating effectively involves the core skills of questioning, active listening and facilitating (Lloid & Bor 1996). Competency in communication skills is required at all levels of medical training (Rider and Keefer 2006; IIME 2002; Frank et al 2000; Whelan 1999; Klass et al 1998; LCME 1998). Indeed, the General Medical Council in its recommendations on basic medical edu-cation has rightly stated that “on graduation a student should be competent to commu-nicate effectively and sensitively with patients and their relatives” (Rees et al. 2002; Royston 1997; Stewart 1984).

CONCLUSION

The majority of UKM house officers’ of the old conventional curriculum have good communication skills in different aspects. However, the skills of communication with their superiors and the skills of when communicating sensitive and distressing issues like breaking bad news needs to be improved. The low return rate of questionnaires by the house officers and self claim data, with no verification of the claims is the limitations of this study. Further large scale studies are required to reveal more information. Educational managers should emphasize on improving communication skills in all aspects of future doctors during their educational management and planning.

ACKNOWLEDGEMENTS

The authors would like to express their sincere thank to Prof. Dato’ Dr. Lokman Saim, Dean and Director of UKM Medical Center for his support to this study.  Thanks are also due to the staff of the Academic Office and Medical Education Department of UKM Medical Center through whom data were collected and analyzed.