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Editor,—It is good to read the two papers in the journal concerning communication training for emergency department doctors.1, 2 As a trained general practitioner I feel that this is a subject that could be given more importance in the training of emergency doctors who spend a large part of their working day consulting with patients. I agree with the authors stating its importance due to; the number of communication based complaints and the stress/anxiety that dysfunctional consultations can cause the doctor. However, difficult consultations in the emergency department have the potential to be a source of huge job satisfaction. The key is in preventing it turning dysfunctional and ensuring that all issues are swiftly resolved from both patient and doctor point of view but culminating in two happy people, rather than two stressed and unhappy people with one of them likely to complain.
However, I wonder how much improvement in consultation skills can be gained at very junior doctor level before the necessary acquisition of hard medical facts and experience has occurred. General practice registrars spend their practice trainee year dedicating a lot of time to learning about and improving their consultation skills—but only after a minimum of two years spent in hospital medicine. Also as the authors mention; consultation deficiencies are not confined to junior doctors.3 A secondment to general practice would be the ideal environment for emergency doctors to improve these skills assisted by the teaching of general practitioner trainers who are by far the most experienced in this area. Time could be spent in studying various consultation models as described by many authors over the years (Balint M 1957/Byrne and Long 1976/Pendleton, Schofield, Tate, Havelock 1984/Neighbour R 1987) along with retrospective analysis of videoed consultations and joint surgeries. A secondment to a training general practice as part of any SpR training programme or even possibly as consultant continuing professional development would in my opinion be potentially invaluable.
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