EDITORIAL

Communication in the domain of health

Recently a report has been released by the General Council of Official College of Physicians prepared by the Medical Education Foundation: TO BE A PHYSICIAN, TODAY, CHALLENGES OF THE NEW MEDICAL PROFESSIONALISM IN SPAIN. In its analysis of the current situation, the report indicates that "In reference to the medical profession, one of the assertions universally accepted establishes this as one of its essential principles: supremacy of the patient well being, respect for his autonomy and promotion of social justice" which, as it is expected includes "an appropriate patient-physician relationship". From this starting point of view, the report "with the intention to link up the more traditional vision of the physician labor with the more current one" postulates what are considered as five essential tasks of the physician's work, among which includes "to maintain a good communication with the patient and its environment".

In the chapter on the challenges to the medical profession also, as expected, the report mentions the impact of the advances in technology: "The encroachment of technology impacts the conditions of the professional practice, as well as the behavior of the individual". In several parts of the report explicit and implicit references can be found to the importance of the physician-patient relationship and the need for development of communication abilities. The report acknowledges that it is merely a document of synthesis and reflection, and that it doesn't aim at introducing unknown factors. The reflection is expected to be carried out by all the stakeholders involved in health care, including academic institutions. One of the points for reflection is the lack of congruency between the importance of technical and relational competencies such as those related to communication.

The abundant literature on the importance of communication in the health domain and national and international documents on health sciences education has identified competency in this discipline as non-negotiable. Furthermore, many national and international surveys on the opinions of patients and consumers of health services are conclusive about the importance of communication as a competence that health professionals must possess.

It is accepted that through their curricula the Faculties of Medicine, have the responsibility to educate and train physicians providing them with opportunities to acquire knowledge, abilities, attitudes and values which would make an impact on the physician-patient relationship. However, up to date it does not seem evident that the learning of communication is a compulsory component of the educational program. In some cases, issues related to this area of knowledge are introduced, among others, in some isolated courses.

Considering the importance of this area of knowledge and the development of related skills, it must be added that there still are several important aspects to define, such as what, how, where and when the health professionals must learn the various aspects of communication.

The development of a Communication Space (CS) is congruent with the previous considerations. The mission of the CS, would be to favor strategies and programs directed to the improvement of the physicians' communication knowledge and skills, and a better understanding of the relationship among the stakeholders involved in health care, including citizens, professionals, academic institutions, professional organizations and health care institutions. The CS would have the appropriate professional advice of experts in communication in the area of health care which be intended to delineate the following objectives:

• To integrate the area of communication and health care relationship in the professional development of individual professionals as well as health care organizations.

• To introduce the learning and the evaluation of communication in the undergraduate, postgraduate and continuing professional development programs.

• To identify professionals who could develop leadership in health communication in the educational and health care institutions.

• To promote research to evaluate the effectiveness of the learning programs in communication and their impact on the relationship among the various stakeholders in the health care system.

• To emphasize and disseminate the benefits of communication and health care relationship at all levels, the individual, the organizational and the social level.

These objectives could be reached through activities in four domains:

1. Curricular. The basic activities to develop would be to introduce learning objectives to learn communication at all levels, i.e., undergraduate, postgraduate and continuing education, in the education of professionals. The most appropriate instruments to evaluate the achievement of these objectives must be identified.

2. Research. Activities directed towards carrying out research, including projects aimed at determining the effectiveness of the communication programs and their impact on the health care relationship would be carried out.

3. Publications. This domain would have the purpose of promoting the publication of articles in both specialized journals and magazines of general interest to the public, as well as books, manuals, etc.

4. Events. The main purpose would be to hold congresses, symposia, round tables, etc. to highlight the benefits of communication in health care.

It has been acknowledged that communication in the domain of health care has rigorous knowledge base which can be taught, learned and evaluated. However, the learning opportunities offered to the students and health professionals show worrying disparities, both in quantity as well as in quality. This disparities offer a challenge and an opportunity which should not be let by.