Table 7 Factor 3. Communication. Items: I need doctors to be more sincere with me; I need to have more dialogues with doctors; I need to be more reassured by doctors

Communication with the patient is hurried and fairly hermetic also for a person of average cultural background. Therefore given that this is an illness which has important psychological implications, communication in 'snatches' will not do.

Communications are given in a very formal context (the 'round'), but it is obvious that for the patient it is more difficult to ask for explanations from 10 doctors instead of just one.

They give the impression of speaking in abbreviations. They speak to one another about the results of tests in such a condensed way that it almost gives the impression they don't want to communicate to the patient at all; that the information is more or less for their own internal use. Sometimes they give contradictory information among themselves (depending on the doctor) and this worsens the situation. One time I said to one of them that because patients have so little time available (with the doctors) their 5 minutes of explanation in the morning is meditated on later on in the day, sometimes during the whole day, so they can try to interpret what was said. The doctor's reply was that they are so involved in a whole series of practical problems, urgencies, that they don't rate this aspect and that if they weren't made to observe it a second time they wouldn't even be aware of the damages that some of their words could cause to the patient. For me a more interactive, more simple and human situation needs to be created. First of all maybe it is necessary that there be one same version in the sense that sometimes three different doctors come and each one gives a different version of the same exam; this naturally doesn't help. And, apart from this problem, the way in which these communications are expressed is not like a dialogue, but like an authoritative lecture. And more often than not, it is expressed not for communication with the patient, but for communication among the specialists themselves in which the patient is lucky if he/she understands anything at all; otherwise... see you in another moment; maybe after three days.

Politeness First and Foremost

I have had the experience of being admitted to hospital wards in other institutions. There are enormous differences: in one of the two cases, no doctor came. Things were allowed a little to be like that. But a doctor coming and stopping for a time to speak to the patient is extremely important for me; otherwise people feel rather abandoned...I was there for what should have been three days; and then in one week I saw one doctor only pass by once. He was the consultant surgeon. The consultant surgeon didn't say hello; he didn't ask patients what they had. No – he asked the swarm of practitioners – young doctors who were learning – instead! I heard someone answer about my case: "He had a problem, but now it's been resolved!" But what problem? Why doesn't he ask me what I had? I was there for that mistaken experience .... Because they had made a mistake in a certain kind of operation... Then they moved on, without saying hello, without making eye contact.

This is lack of politeness first and foremost. I saw that they acted like this with all the beds in the room. This surely must be improved upon.

Sincerity

Sincerity is something one realizes subsequently; for, during the moment when it is verified that the things the doctor said really are what he said they would be, one understands a posteriori the sincerity of the doctor. A priori, a stronger act of trust is needed; for this it is important to have an empathetic rapport with patients.