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J R Soc Med. 2005 April; 98(4): 185.
PMCID: PMC1079453

Difficult Conversations in Medicine

Reviewed by Nick Dunn

Editor: Elizabeth MacDonald
231pp Price £19.95 ISBN 0-19-852 774-8 (p/b)
Oxford: Oxford University Press.

To a greater or lesser extent, nearly all medical conversations can become 'difficult': there is always an element of unpredictability, and the more one listens to the patient the more one can become led off the comfortable, well-trodden path. 'Why do doctors find it difficult to listen?' asks this book very early on: time restraints are one excuse, but I suspect a feeling of loss of control may well be another. The book is an attempt to allow doctors to remain in control while still addressing the patient's (or other healthworker's) concerns as comprehensively as possible. This is not an easy agenda and it is to the editor's credit that she has managed to assemble authors who tackle the subject in an approachable and interesting way.

The book starts with the basis of good communication and works its way through most of the special situations that one can imagine—children, elderly, dying and bereavement, strong emotions, different cultural groups, failing colleagues and so on. There is a wealth of good advice, in many cases well illustrated by specific examples. At the end there is an appendix of transcripts of examples of actual conversations, which is particularly useful and is also a lively read.

The book is very much aimed at junior doctors in the hospital setting, and needs to be seen within that constraint. For example, there is very little input specifically from a primary care perspective, although much of the content is, of course, relevant. I would have liked to see something on how to deal with issues such as underage contraception, termination of pregnancy and poor communication between hospital and general practitioner. It is also disappointing that the chapter on 'Communication in a multiprofessional setting' does not acknowledge the importance of establishing strong channels of communication between primary and secondary care when dealing with patients with terminal illness, for example. Many embarrassing misunderstandings are caused simply by failure of colleagues to talk to each other or to fully inform the patient of the management plan. Some contributions sit uneasily with the title; for example, a chapter advising doctors on how to avoid 'burn-out' seems out of place and is somewhat trite. Nevertheless, this book is a really useful addition to the published work on communication skills and how this affects the doctor–patient relationship. It deserves to be widely read, especially by young doctors but also by students, consultants and GPs, all of whom might be spared sleepless nights mulling over conversations that somehow went wrong.


Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press