Medical message

November 21, 1997

Liz Frayn (THES, October 24) criticises both the new medical education courses which follow the General Medical Council's report Tomorrow's Doctors and the emphasis in some medical schools on teaching communication skills.

Medical curriculums have changed dramatically because it is no longer possible to include within a didactic, taught, course all the elements of science, technology, therapeutics etc which constitute modern medicine, and to include new diseases and treatments. The emphasis therefore has to be on developing doctors' ability to educate themselves throughout the whole of their career. Fostering a process of self-education is, perhaps, the key facet of the new programmes.

Many of us, like Ms Frayn, regret the reduced emphasis on some of the traditional pre-clinical subjects. However, we should all welcome and embrace this new emphasis as it is designed to educate doctors who will not stagnate with the knowledge they have accumulated at the time of graduation.

If Liz Frayn believes that communication skills are about "the practice of medicine being reduced to breaking bad news", then she has seriously missed the point. Communication is one of the most important elements of medical practice. If as doctors we cannot communicate, we cannot learn from patients about their medical problems, their psycho-social problems, their attitudes and those things that will colour and affect their decision-making and the acceptability to them of different treatment options.

We will miss diagnoses and we will fail to share with patients the information they need to make decisions about their future care. Communication is not a one-way process; it must always be in two directions. If this is not self-evident, the "new" curriculum is all the more essential.

Fiona Caldicott

Chairman British Medical Association board of medicine

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