Abstract
The Person-Centered Clinical Communication (CCCP), in current clinical practice, is a first line tool for the physician to get clinical objectives. However, to consider it as tecné should not hide aspects such as: the type of truth it reveals, the reality of the patient (as a human being and person) to which is focused or the consequences of implementing in practice. This essay intends to clarify these aspects highlighting that the CCCP and the practice of medicine although they are usually considered from eminently pragmatic approaches, carry presuppositions that overcome scientific truths and consider the patient as a complex, unique, multidimensional reality and with different potentialities; in which the clinical encounter points out the moral imperative of medicine (and also of the CCCP) of acting for the benefit of the patient. In the face of such a challenging practice, the physician’s education should prioritize the development of his/her reflexive ability, which includes the own apprentice him/herself (“personal search”), demanding a comprehensive education that incorporates educational strategies for helping the learner to make sense of that searching.
1. Introducction
Along with medical knowledge and clinical practical skills, communication skills (CH) represent an essential component of medical competence. These skills have been found to contribute significantly to positive patient health outcomes (Silverman, Kurtz, and Draper, 1998; Stewart et al., 2000; Di Blasi, Harkness, Ernst, Georgiou, and Kleijnen, 2001) and modulate professional attitudes. Thus, clinical communication (CC) has been accepted as a formal ingredient of medical curricula, and recognized as an essential competence by both international accreditation bodies (ACGME, 2004; Frank, 2005; Van Herwaarden, Laan and Leunissen, 2009) as Spaniards in medical education (Aneca, 2005), legislating in this regard (Ministry of Education and Science, 2008). This has made in Spain in recent years many universities are introducing, with different methods, dedication and results, the teaching of communication. Evidence clearly demonstrates that students can be trained in these skills and that the methods that use experiential learning are the most effective (Berkhof, Van Rijssen, Schellart, Anema, and Van Der Beek, 2011; Henry, Holmboe, and Frankel , 2013). This type of teaching requires specific training that cannot be obtained through the traditional master class model. For its teaching to be effective it is required that the student rehearse with “simulated patients” under direct supervision and observation, and receive specific and personalized feedback. This in turn requires a small group teaching program, taught by medical professors specialized in the subject, in an integrated manner with the rest of the clinical skills throughout the curriculum. Likewise, for such a subject to be meaningful and have an educational impact, it must be rigorously evaluated using appropriate evaluation formats (Aspegren, 1999; Yeddidia et al., 2003; Smith et al., 2007). All this requires an important effort on the part of the medical schools that are introducing the teaching of the CC, which until now has had variable results (Ferreira Padilla, Ferrández Antón, Baleriola Júlvez and Almeida Cabrera, 2014). In the last 7 years, the School of Medicine of the Francisco de Vitoria University (UFV) has incorporated this teaching following the aforementioned recommendations. Elsewhere we have described the details of the UFV CC curriculum (Ruiz Moral et al., 2017).
In the introduction of CC teaching in medical and other health sciences schools, an aspect that is not usually considered, however, at least with the depth of analysis that it requires, are the consequences that its incorporation into the corpus For the aspects derived from the type of “truth” that medicine pursues, educational as well as the anthropological conception that supposes a practice that uses HC, with the ethical implications that its use entails. We consider that these issues are not minor and that their clarification contributes to reinforce not only the suitability and justify the teaching of CC beyond a merely utilitarian application, but also to better define the scope of medical practice itself. Thus, in this article I intend to clarify the epistemological and anthropological assumptions on which CC is based, as well as the ethical consequences of its application in clinical practice, offering in turn the basic assumptions of its teaching in the UFV medical degree. .
