Your anonymous correspondent (letters, pages 20-21, 25 May) has hit the nail on the head. The annual reports of the health service ombudsman demonstrate the level of dissatisfaction with communication in the NHS.

I was recently a member of an independent review panel on a complaint against a trust. The complaint had already been through a normal complaints procedure, and this panel involved a chair, a local community health council representative and a secretary, as well as three independent assessors from outside the area, and three consultants called as witnesses.

Although there were medical and administrative elements to the complaint, these were no different from the problems which can arise in any busy department.

The key element in the complaint, however, was the communication between the consultant and the patient (now deceased) and family.

The financial cost to the NHS and the emotional costs to both relatives and professionals could have been saved if a few basic rules of courtesy had been observed, and if time had been spent listening to the family and understanding their concerns.

The culture of regarding the consultation as a social interaction, in which everyday rules of engagement are observed, can only be introduced at consultant level. Our work with consultants in this field confirms that they see themselves as training their juniors in this field as well as in purely medical matters.

Those who see communication as inherently less important than 'clinical work' will unfortunately perpetuate a culture which leads directly to expensive and time consuming complaints. A good case can therefore be made for including communication in the scope of clinical governance.

Gay Walker Researcher Lynda Jackson Macmillan Centre Mount Vernon Hospital Middlesex


1 Walker G, Bradburn J, Maher J.Breaking Bad News. King's Fund. London. 1996.