COMMUNICATION - Full extract 

Sue and Garry became patients of mine about five years ago when they shifted from Sydney to Melbourne. Their retail business was expanding and they were doing very well. Several months ago Garry collapsed at work from a major heart attack, and died before reaching hospital. 

Although totally devastated by her husband's death, Sue was battling on fairly well. She recently came in to see me complaining of headaches and general tiredness. 

A careful history and examination did not reveal any physical problems. When we spoke about how she was coping since Garry's death, it became evident that she was under considerable stress. " To tell you the truth I feel more anger than sadness," she said. " I always resented the way Garry told me nothing about the business, not that I ever said anything. Now that he's gone it upsets me even more." 

When she came in for review the following week I referred her to a psychologist for some counselling. She has a lot of feelings to work through but she is confident about getting on with her life.

Communication is simply the passing on to others of what we know and how we feel. It's something for which most of us have no training. Not surprisingly, it's a skill that many people never develop. 

Effective communication skills have become almost a pre-requisite for those in business, including doctors. These days all medical undergraduates receive detailed instruction in communication. They are taught how to help patients give a clear history of their symptoms, how to pitch the consultation at the right level, and to overcome any language barriers. Part of this training is with simulated consultations that are videotaped and played back for further discussion. In recent years there has been a pleasing improvement in the communication skills of the students we supervise in our own practice. 

The emphasis on communication is continued into postgraduate study as well. GP's are also aware of how important it is for consultants to adequately explain to their patients what their health problems are and the various options for treatment. 

Within personal relationships, difficulties in communication often involve several factors. It might be due to being brought up in an environment where one's own parents did not communicate. Sometimes there can be an underlying fear of rejection or of provoking anger and mistrust - a fear that may be quite justified. For whatever reason, it is surprising how many people never get around to telling those closest to them how they really feel. 

As a result, some people go through life with a lot of emotional baggage, pent-up feelings that would have been better unloaded years ago. It might be a feeling that a brother or sister is loved more they are, or a feeling that their parents thought they were dull and unlikely to succeed. 

These feelings can often run deep and may need specialist counselling to deal with. Some GP's have a particular interest in counselling and can help. Otherwise, referral to a psychologist or psychiatrist may be advised. 

Interestingly, some people have difficulty telling those closest to them how much they love and appreciate them. Being able to express our feelings clearly and honestly is so important, whether it is at home, with friends or at work. 

Some people have problems saying to their partner what they enjoy most sexually. People can spend years never feeling confident enough to express how they feel and may become quite anxious or depressed as a result. 

Good communication within the family is so important and should be encouraged from an early age. It has to be two-way communication and as parents we need to listen to what our children are telling us...by their words, body language and behaviour. Some families have a regular open forum where everyone can say what they feel in a relaxed setting, for instance after a meal. This gives parents an opportunity to discuss issues such as use of the telephone, and family activities that are coming up. Children might want to talk about watching more TV or going out on weekends. These matters are better openly negotiated, rather than being the subject of a stand-up argument before work or school. 

There are some basic communication hints that are worth keeping in mind. Being honest is one. Accentuating the positive is another. " I love those occasions when we can get a babysitter and go out for dinner " is much easier to hear than " We hardly ever go out any more." Likewise, " We are so pleased with the way you are knuckling down to your study this week, " is more positive than " It's about time you woke up to yourself and got some work done." 

Good communication is fundamental and the lack of it causes so many problems.

Health Tip:
* If the way you are communicating with those around you is not working, get some expert advice. It is a learnt skill, and one we can continually improve.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001