A recent tragic medical incident has led to our discussion about health care communication in this issue. The case involved a Hong Kong immigrant at King’s College Hospital in the United Kingdom, where a patient was unplugged from her life-support machine despite her husband’s plea for an extra day so that her sons could have a chance to say a last goodbye. The sons took the first available flight out of Hong Kong when they heard their mother had been hit by a car, but when they arrived she was already dead. The husband said: "The doctor told me, ‘It’s not you who decide – it’s the hospital. We are turning it off in 30 minutes’." He claimed that the doctor had switched off his wife’s life support, despite the family’s plea to the contrary, in order to save resources. According to the husband, the doctor said the patient’s head injuries were so severe that she would never recover and the hospital is making the decision to switch off her ventilator because resources were overstretched and other patients needed the equipment.

Here, our scholars at the Faculty of Humanities (FH), including Prof. Huang Churen, Prof. Winnie Cheng, Prof. Dingxu Shi, Dr Foong-ha Yap and Prof. Christian Matthiessen, share with us their views.

Q: In this incident, do you think it is a case more about a resource problem, or about doctor-patient communication breakdown?

A: Possibly both. The description of the incident is not entirely clear, but the quality of communication between health care professionals and patients and their family members could have made a big difference. We could improve the system by providing chaplaincy care or its equivalent to prepare the family for this critical situation.

If indeed there is a resource problem, it needs to be handled with sensitivity so that the family of the patient can see that their loved one is contributing to the saving of other lives. The accident was sudden and the family is still grappling with the shock of this tragic incident; someone on the medical/healthcare team needs to be on hand to help provide emotional support. This includes the chaplain and/or nursing care professionals assisting distressed family members in their attempts to communicate with other equally distressed family members. Granted that the doctor has little time to spare, his few minutes will need to be quality minutes. How s/he breaks sad news to family members is important. It will also help a lot if supporting medical staff assists by creating an environment that is seen to be compassionate and empathetic.

Q: In this case, do you think the difference between the Western culture and the Eastern culture played a role, in terms of what is more important?

A: Yes, cultural differences probably played an important role in this incident, where bidding farewell to a dying parent is a filial obligation in the Chinese context, but more of an expression of emotional attachment in the western world.

Q: According to past studies, doctor-patient communication breakdown is a major cause in medical malpractice or accidents. What can we do to improve communication between doctors and patients?

A: Patients in a recent study noted that they often do not understand the medical procedures and the technical terminology used by clinicians. This study highlights that inadequate communication is a major source of ‘unsafety’ in health care. Many medical schools now have courses in place to train doctors to communicate more effectively. This includes maintaining eye contact and giving patients due attention when patients are talking. Patients get the impression that doctors are not listening to them when doctors are multi-tasking without maintaining eye contact.

Doctors with good communication skills also take time to explain not only the patient’s medical condition but also what they are doing. Communication helps to establish trust, which is essential for treatments requiring extended medical care and follow-up visits.

Apart from good communication skills, cultural sensitivities are also important in multicultural and multilingual communities. Often, the sick are also not in the best of moods; those who have been sick for extended periods are often depressed and easily feel slighted. For various reasons, including heavy workload, mountains of paperwork, and fear of litigation, doctors often are wary of offering hope, and instead often stick to standard pronouncements of possible risks to each medical prescription and medical procedure. The negative fallout from such protocols has yet to be researched, particularly within the Hong Kong context.

Discourse analysts (including conversation analysts and ethnolinguists) can play a significant role in this area of research. While some efforts are now being made to better train the medical professionals to communicate effectively, more resources for preventive/pro-active health care can also greatly help improve communication as patients themselves become more familiar with health issues and health care protocols. Part of preventive health care includes dissemination of digestible information to the public, and in this area language and communication researchers have an important role to play as well.

Efforts should also be made to raise the communication skills of patients. The quality of health care communication can be improved substantially when patients are able to describe their sickness more precisely. General guidelines to help patients know what to expect from the doctor and how to establish a good communication strategy will also contribute to effective communication.

Q: Health care communication will be one of the focus areas in teaching and research in the Faculty of Humanities in the future. Please let us know more about the plan.

A: We will focus on health care communication in multicultural and multilingual settings such as Hong Kong. A much needed study for Hong Kong that is currently being considered by FH is an ethnographic study—involving interviews and participant observations—of communication across different units within a medical institution, particularly since a breakdown at just one communication node could have tragic consequences. This study could replicate existing studies in other parts of the world including Australia, and could contribute to some reforms in communication practices in health care institutions.

Already in the planning stage is a collaborative research study with the School of Nursing which will examine the discourse characteristics of consultations between advanced practice nurses (APNs) and patients in the Mobile Integrative Health Centre (MIHC). An important goal of this study is to identify and propose effective interactive strategies to improve nurse-patient communication.

As part of our continuing efforts to build a strong research team in the area of health care communication, we will be recruiting 2-3 eminent scholars active in this area to complement our current research team of around 5 colleagues with expertise in related areas such as language translation and conversational analysis in the workplace.

Q: It seems that communication and health care are two very different disciplines, but the concept of a multi-disciplinary approach to personalized health care is now gaining currency. Could you talk more about this concept and its importance?

A: We need to recognize that successful personalized health care involves at least four crucial steps. First, we need to obtain precise health information about each individual patient; second, we need to ensure that this information is successfully accessed and correctly interpreted by the health care giver; third, we need to prescribe (or ‘design’) a personalized diagnosis, prognosis and treatment for each patient; and finally, we need to ensure that the patient cooperates and correctly follows the personalized treatment.

Communication plays essential roles in the first, second, and last step. That is to say, personalized health care cannot succeed unless there is effective communication between the patient and the caregiver. Health communication research can improve the quality of knowledge-interface in personalized health care encounters.