Summary: This piece reflects on lessons learnt about how student interactional style can influence patient engagement during a communcation skills training session involving service users as actors in clinical scenarios. Description: Giving time to care

Whilst facilitating a session for two groups of physiotherapy students, as part of a pre-clinical communication skills training module, we noticed a marked difference in the manner an invited service user responded to each group. She appeared reserved and unmotivated, giving limited answers to questions with one group but with the other she offered plenty of useful information, engaging enthusiastically and willingly. When asked, afterwards, why she gave different ‘performances’ to each group, she reported sharply and succinctly ‘because I wanted to’: She exercised her choice and voted with her feet.

Reflecting on the session differences, we noted the patient responded positively where students expressed greater interest in her life, apparently valuing her as an individual. Non-verbal communication including warmth, eye contact, and time available to listen to the patient all helped create a climate centred on the person rather than the task. The other group’s interaction tended to be more ‘interrogative’, with students asking questions centred on achieving responses to their agenda. Little interest was demonstrated in the patient as a person beyond the task. Non-verbal communication was more distant, lacking warmth or encouragement. Dialogue with the students afterwards indicated that they were unaware that the patient’s response in this instance was sub optimal.

This experience demonstrates that ‘going through the motions’ can have unintended consequences impairing therapeutic outcomes. Further, these impoverished interactions may go unnoticed as we struggle to deliver service within busy departments. Evidence from counselling and psychotherapy literature indicates that best outcomes are achieved when the quality of client’s participation in therapy is high (Cooper 2008). This suggests that physiotherapy outcomes may also be enhanced by ensuring that the interaction between therapist and patient allows the patient to be heard, valued and fully included in the process. Given the findings of appalling standards of care in the UK National Health Service reported in the recent Francis Report (Francis 2013), all health care professionals are required to re-evaluate the quality of our interactions to ensure that compassionate and safe care are delivered. Going through the motions in our interactions may put barriers between us and our patients. Giving generously of ourselves in our interactions has the potential to reap dividends in the quality of care we offer.

Andy Soundy and Carolyn Roskell, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK. E-mail: [email protected]

References 1 Cooper, M (2008) Essential Research Findings in Counselling and Psychotherapy: The Facts are Friendly, Sage: London
2 Francis, R (2013) Report of Mid Staffordshire NHS Foundation Trust Public Inquiry, The Stationery Office: London