“Technical progress is useless without better communication.”

UNI NOVA: Physicians often seem rushed and don’t listen to patients properly during consultations in the office or at the bedside.

HUNZIKER: Studies show that, on average, a physician waits just 90 seconds before interrupting their patient for the first time. This means we miss out on valuable information that could help us form a hypothesis as to the causes and rationale behind their complaints. But this isn’t simply a question of impatience on our part. Mounting financial pressure and time constraints leave us with less time to talk to the patient. For example, we know that medical residents spend most of their working hours on admin and reports. On the other hand, it’s also true that if a patient talks a lot, the most important thing often goes unsaid, and that you can have a useful conversation in a short time. Our students learn how best to structure a conversational situation – that is, how to communicate professionally. Appropriate techniques exist for doing this. You just have to know how and when to use them.

UNI NOVA: You are a professor and Deputy Head of Psychosomatic Medicine and Communication. How does a surgeon respond when you tell them what you do – do they take it seriously? Do they even listen to you?

HUNZIKER: Naturally, I sometimes encounter a degree of skepticism, but I’ve witnessed a growing acceptance of the significance of communication in medicine over the last few years. In the 1970s, the topic was still seen as something exotic. Today, the medical profession is more receptive to and interested in the idea of structuring conversations professionally, and there’s growing awareness that a good physician should not only have sound medical knowledge but also good communication skills. Our patients have come to expect this. That’s why I don’t like to see communication described as a “soft skill.”

UNI NOVA: Skills have to be strengthened based on empirical evidence.

HUNZIKER: We’re striving for what is known as evidence-based communication. In other words, our research is based on randomized studies. We demonstrate causalities: If the physician uses technique X, this results in Y for the patient. For example, research is currently underway into whether it’s better for patients if we first discuss the case outside the room and then give a patient-friendly version inside – or if the medical rounds are conducted entirely at patients’ bedsides. The rationale for this is that we devote a lot of time to the patient that they aren’t actually aware of. On the other hand, they might find the academic discussion intimidating or unnerving, or they might notice mistakes on the part of the medical resident and wrongly conclude that they’re incompetent. This is a key question that still needs to be answered.

UNI NOVA: Which option do you prefer?

HUNZIKER: Our patients are confronted with a huge amount of new and unfamiliar information. This may be exacerbated by academic discussions at the bedside if they don’t understand all of the terminology, leading to potential misunderstandings. That’s why I prefer to have a discussion outside the room and then give a patient-friendly version. I’ll know more once we’ve finished the study.

UNI NOVA: We often hear that physicians don’t explain findings to patients in a way they can understand – that the wording is too dense and littered with technical jargon.

HUNZIKER: When it comes to professional communication, explaining our knowledge to patients calmly and clearly is just as important as being able to deal with strong emotional responses, such as anger, disappointment, and sadness. Studies show that many physicians rely on providing information as a way to distract attention away from emotions – including their own – or to prevent them from rising to the surface. We’re trained to communicate using facts. But if the patient cannot express themselves and the physician overloads them with information, communication breaks down. The problem – the disease or illness – is not addressed. Research has shown that it’s virtually impossible to make amends for serious communication errors over the course of the physician–patient relationship, and that these errors have a major impact on patients’ health and well-being.

UNI NOVA: If the patient breaks down in tears after receiving a cancer diagnosis, for example, do you use physical contact to comfort them?

HUNZIKER: There’s no hard and fast rule in this situation. Some physicians place their hand on the patient’s arm, but others find that too intimate. The key thing is that the response should be authentic. When delivering bad news, physicians are addressing serious and often life-changing issues. As well as providing the medical information, it’s vital that they have a capacity for empathy. Being diagnosed with an incurable cancer, for example, has an enormous impact on the patient’s quality of life. Their outlook on life and future prospects change from one moment to the next, and so what we communicate – and how we communicate it – is particularly important. In a recent study, we found that the family’s communication with the treatment team was a key factor in determining how often the patients who had suffered a cardiac arrest and required resuscitation developed post-traumatic stress disorder, depression or anxiety disorders.

UNI NOVA: What do you teach your students to do in cases such as this?

HUNZIKER: You have to prepare for the conversation thoroughly so that you’re aware of all the findings and have an idea of how much the relatives and patients know. You should communicate the information briefly and clearly, and it’s essential that you address any emotions and give patients space to deal with them.

UNI NOVA: Studying medicine involves a lot of cramming – if you don’t learn enough of the material off by heart, you won’t even be accepted onto a degree course. But there’s no test of patience or social skills. Does the selection process miss the mark?

HUNZIKER: It’s not easy to identify good candidates. In Switzerland, the numerus clausus tests above all intellectual abilities as part of the admission criteria but ignores social and communication skills, unlike in the USA. I can see communication skills being tested as well in the future. On the other hand, a medical degree – and indeed the medical profession – is very challenging from an intellectual perspective. It takes considerable hard work and ambition to pass. Later, as physicians, the students will need to cope with stress factors – and so it’s important that they learn to do so from an early stage. At the University of Basel, we have a course of studies that teaches communication and social skills for the duration of the degree and is therefore unique throughout Switzerland.