Reflection on inter-professional communication in medical practice

Having an effective communication channel between doctors and other healthcare professionals has
recently been highlighted as one of the major obstacle of achieving medical excellence (Sheldon and
Hilaire, 2015). In fact, it has been flagged as one of the major issues in compromising patient safety in
healthcare context (Amudha and Hamidah, 2018). According to Amudha and Hamidh, the main
challenges faced by healthcare workers are having a standardised structure and tool to enhance the
communication skills among different professionals in the hospital. The main concern is that,
different individuals from different department hold various perspectives and agendas due to the
nature of their job and the goal as well. To make things more complicated, NHS in the UK involves
many more different department and compared to other developed countries, it can be seen as one of
the most bureaucratic organisation in the world (O’Dowd, 2011). As a doctor it could be a nightmare
to navigate and use the right language to deliver our message and achieving the ultimate healthcare
objective in our practice, that is to provide a world class care to our patients. In fact, the overall
quality of patient care that we provide are directly related to the effectiveness of communication
channels between physicians and nurses (Sheldon and Hilaire, 2015). During a study from
Schmalenberg an Kramer in 2000, they interviewed 20,000 nurses on their strategies on developing
good relationship and communication with the doctors in the hospital. Different styles and areas were
highlighted in the research, but the conclusion of the research suggested that a successful nurse-doctor
communication is not much different from any successful relationship in a non-healthcare setting. The
keys lie on mutual trust, equal distribution of power, respect from both side and maintain friendliness
in their relationship. (Schmalenberg and Kramer, 2000). In this reflection, I will be applying Gibbs
Reflective Cycle model (Markkanen et al., 2020) for my reflection on the inter-professional
communication during my medical practice. According to Gibbs’s model, the reflection will be
devided into six parts, namely description, feelings, evaluation, analysis, conclusion and action plans.

Description
As discussed different roles in the hospital often have different agenda and objectives when doing our
jobs. There were occasions when the nursing team and the allied healthcare professional teams (multi-
disciplinary team) hold different opinion to the doctors. For example, there was an occasion when the
multi-disciplinary team believe that it will be the best interest for an elderly patient to be sent to a care
home for the safety of him and his family members who may be taking care of him. However, during
a long and thorough discussion between the doctors and the patient and his relative, it has been
communicated clearly that they do not wish to be discharged to a care home deal to their personal
experience and beliefs. As a doctor, our job often requires us to balance the legal requirement and the
wishes from the patients. It is therefore, as long as we believe that the patient is medically capable of
making a decision on their own, we will not add any of our personal belief or judgement to their
decision making process. However, during this event, the multi-disciplinary team disagree with our
judgment that the patient is medically capable of making his own decision. They believe that the
decision of not going to a care home is a sign of lack of insight on the seriousness of their own health
condition and therefore we should be acting out based on their best interest. The conversation between
us and the nursing team escalated quickly and it seems like neither of us are willing to compromise
and decided to stand onto our ground. Eventually, the medical director of the hospital had to step in
and decided that we should be acting based on the best interest of the patient, which means we will be
unfortunately sending the patient to the care home against his will. After the incidence, the nursing
team file complaint against the doctors, as they think that we were not being receptive and therefore
hinder the communication between us.

Feelings
Needless to say, it was not a pleasant conversation and an unpleasant feeling to receive complaint
from the nursing team. As a doctor, I believe that the primary goal of our practice should be based on
patient’s wishes as long as it is within the medical legal capability. More importantly, during
disagreement with other team members, it is important to raise our perspective instead of simply
follow others’ point of view to avoid conflict. In fact, these types of communication behaviour has
been considered as one of the hazard of causing patient safety issues (Johnson et al., 2018). But in
terms of communication, I feel there are a lot of mistrust between doctors and other multi-disciplinary
team members and it seems like we are unable to think in other people’s shoes anymore, even though
that should have been our strength in medical practice (Stepien and Baernstein, 2006).

Evaluation
This experience is overall positive despite of the negative feelings. And it is very needed for me to see
the inadequacy in inter-professional communication in our hospital. I did not have the chance to speak
to the nursing team afterwards to discuss about the incidence, but it is a great opportunity for me to
understand the prospective of another team member in the same ward.

Analysis
The doctor-nurse relationship define the culture within the unit and therefore it is vital for achieving
cooperative and functional relationship (Amudha and Hamidah, 2018). Few studies have suggested
that the main reasons for nurses failed to understand the perspective of doctors are due to the deficit of
their knowledge in the specific specialty discipline (Brown and Crookes, 2016) (Gough et al., 2009),
in this case, it will be medical law and ethics. While doctors usually fail to deliver the message in a
more diplomatic and communicative manner which often becomes the trigger of argument (Kelley
and Brandon, 2012). It is suggested that nurses could benefit greatly by attending some transition
programmes to fill in the gap of the knowledge that they may find inadequate (Mooney, 2007). On the
other hand, doctors may benefit from attending various types of leadership, communication courses,
so that we will deal with similar conflicts better (O'connor et al., 2016).

Moreover, involving senior doctors more often also has been shown to improve teamwork within the
unit, as senior members can act as a collaborator to mitigate any dispute between different members
(Clay-Williams, 2013). Interprofessional shadowing has also been shown to improve doctors’
understanding on the role and challenges faced by nurses, at the same time enhance doctors’
perception on the division of responsibility within the team (Shafran et al, 2015). At the medical
education level, providing simulation session that involves different multi-disciplinary members could
also allow everyone to learn how to work as an effective team member and to deal with specific
scenario, such as a medical legal scenario mentioned in this reflection (Kneebone et al., 2004).

Conclusion
In order to develop a healthy working culture within the unit, a well balanced doctor-nurse
relationship is essential. (Sheldon and Hilaire, 2015) In fact, the shortage of healthcare workers in the
NHS create a lot of extra challenges and stress to inter-professional communication (O’Dowd, 2011).
The first step of any effective communication should be listening to each other’s perspective instead
of stating our own point of view (Pugach and Johnson, 2004). This is not only important to create a
healthy working environment, but also vital for patient safety and providing quality care. It should not
be taken lightly, nor should it be resolved by simple solution. It requires complex strategies and most
importantly, effort from both sides on fostering an environment where teamwork and empathy
towards our teammates are glorified and welcomed.

Action plans
1. Speaking to the mutli-disciplinary team who were involved in the scenario to ask for their
feedback and how they felt after the argument.
2. Seek advice from the senior team member, asking what they would do in a similar scenario.
3. Attend some leadership and communication workshop to be able to deal with inter-
professional conflict in a more diplomatic manner.
4. Contact human resource department to seek any opportunities for inter-departmental
shadowing to enhance my understand on the challenges and duties faced by other health care
workers.
5. Use this reflection as an example in my medical teaching workshop for medical students to
learn the importance for enhancing the communication channels between other team members
and us.
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