It is good to talk: conversation in practice

The first patient-clinician interview is the chance to start a beautiful partnership, says Billy Mann

Health professionals fret far more than you might ever imagine about how they interact with patients. Many even struggle with the word patient. Other terms for the person being treated are ‘client’ and ‘service user’. They temptation to reach for the word ‘customer’ is never far away. 

Hold that thought while I tell you about a group I attended recently to work through the foundations of what will hopefully turn into a World Café around the subject of stroke. Briefly, the idea is to build the notion of a ‘conversation’ into the clinician/patient meeting point. Those present at the meeting, brought together by Tess Baird from Barts Health, all came from the health professions or from academia. Plus me, with my A-level in Geology and a diploma in stroke survival. 

So it goes without saying that my input was purely anecdotal. I told them all how, during stroke rehab, I stupidly urged an OT to coach me in getting in and out of the bath, only then to get stuck in the bath, robbed, as the stroke had left me, of the upper-body strength to lift myself into a bath-exiting position. I told other hilarious stroke stories, too, and watched as they all glazed over, but my one serious point concerned what I called the ‘partnership’ a patient needs to form with the health professionals charged with their care. 

I decided early in the exploration of my post-stroke world to ‘get people onside’. OK, confession, my wife told me to do it, in fairly blunt and unambiguous terms. But it worked, or at least it did for me. I talked in a friendly way to all professionals. I listened to their gripes. I learned that my physio was studying for a masters degree. I gossiped for Britain and passed on advice for vegetarians travelling in Italy. All of this seemed to bind our common purpose in a more meaningful and, yes, fun way. My wife now refers to me as a 'people person'.

I continued this crazy experiment once I had been discharged from hospital. First on the list for my newfound charm offensive was my GP. I learned about his family, about his specialist areas of medicine and tried to get him to bitch about bureaucracy and the tedium of top-down meddling in the nhs. He didn't crack, maintaining a steely resolve throughout. No confidential or compromising disclosures took place, but the very act of talking made, and continues to make, a difference to how we ‘work together’. 

Others in the group made serious points, too. Physiotherapist Volkmar Müller talked about the everyday realities of the physio’s job and how ‘had nice a chat with X’ would not be considered by his line manager as a suitable entry on that day's list of ‘work completed’. Stefan Cantore, a seasoned egghead in organisational behaviour at Southampton University, fleshed out the World Café philosophy and its potential. He also helpfully (for me) clarified the difference between conversation and dialogue. 

The small room in Mile End hospital fizzed with the desire to find practical routes towards better communication, but one theme emerged persistently: TRUST. Build trust. Professionals to trust patients; patients to trust professionals. It’s a two-way thing and demands active participation and a big old willingness to give it a go. And this is where we come back to THE CONVERSATION. 

Just for a laugh, I decided to do a quick search of synonyms for the word ‘conversation’. Top prizes go to: tête-à-tête, heart-to-heart, breaking bread, head-to-head, shoot the breeze, natter, confab, chit-chat, rabbit. In my head it's already starting to sound like two lines in a rap song, but whatever you want to call it, just get on with doing it, and at some point in the future maybe we will be able to state with confidence that to Talk The Talk and to Walk The Walk are exactly the same thing.