Communication is a vital part of every doctor's role - no matter the specialty or where you work.

The King's Fund estimates around 600 million patient contacts occur every year, along with countless encounters with other healthcare professionals, third-sector organisations and relatives - so it's important to communicate well.

Engaging patients and gaining trust

Many consultations involve patients and their supporters who may be anxious, very ill or face additional communication challenges. They may be in unfamiliar surroundings and unaccustomed to dealing with healthcare professionals.

For international medical graduates (IMGs), navigating these interactions be particularly challenging due to differences in cultural norms and communication styles.

There were 229, 458 written NHS complaints in England in 2022-23 according to NHS Digital, with communication being the largest subject area at 16.6%. This shows how essential good communication is for a strong doctor-patient relationship, so that patients feel that they can be open and honest.

Without trust, patients may withhold relevant information, making safe care more challenging to provide - and potentially leading to complaints.
When we get communication 'right', it leads to better relationships with colleagues and patients. When we get it wrong, it can have negative consequences for both patient care and doctors.

GMC guidance on communication with patients

The second domain of the General Medical Council's (GMC) core guidance for doctors - 'Good medical practice' - is all about patients, partnership and communication.

It emphasises the need to work collaboratively with patients and for doctors to show clear and effective communication. Doctors should provide evidence-based advice and demonstrate good listening skills.

The guidance reminds doctors to consider potential barriers to communication and to avoid using technical terms without checking understanding, especially under pressure. It also stresses the importance of recognising individual needs and avoiding assumptions.

GMC guidance on communication with colleagues

The third domain on colleagues, culture and safety echoes the previous guidance on patient communication. It states that "you must treat colleagues with kindness, courtesy and respect."

The guidance deals with the need to communicate clearly and respectfully. When this does not happen, it can be difficult to work in teams, and can be a source of complaints from colleagues to the employer or even the GMC.

There is increasing evidence to show that well-functioning teams with good communication improve patient outcomes and create a better working environment (see here). Doctors often need to lead in clinical situations, so calm and effective communication is crucial.

Watching good colleagues communicate with their team and patients can be very helpful.

Common communication challenges

Language barriers. Accents, idioms and medical jargon can complicate communication, even with proficient English speakers. Regional dialects and slang can also hinder understanding. Medical jargon and acronyms can be confusing, so be careful to avoid them when communicating with patients, colleagues and external agencies like coroners.
Body language. Cultural differences may influence concepts of personal space, touch and eye contact. Be mindful of this. We see patients raise concerns around being touched 'inappropriately' but often this arises from not understanding what an examination will involve - so a lack of communication, rather than any ill intent.
Additional communication needs. There is no 'one way' for all patients. Help from colleagues, support from relatives, translators and written materials can help you ensure communication is effective. 360 feedback from patients and colleagues can also identify strengths and what we can do better.
Apologising. For most doctors, running late and being interrupted is the norm. Don't underestimate the power of saying, "Sorry I’m running late," at the start of an interaction to defuse frustration.
Patient-centred approach. The UK's approach to consent and decision-making focuses on a partnership with patients. The GMC prioritises listening to patients and shared decision-making, recognising that different patients will have different concerns about their health.

Tips for top-tier communication

Familiarise yourself with your medico-legal and ethical obligations (GMC).
Engage with continuous learning (CPD) and ongoing language training if needed, especially colloquial English.
Explore enjoyable ways to improve language skills, like films, television or social media.
Prepare for difficult conversations, such as breaking bad news, and ensure you won’t be interrupted.
Use clear language and check that patients understand the consultation and instructions.
Ask colleagues who have worked locally about any unusual terms or slang words that you might hear.
Always apologise if you're running late - setting a tone of mutual respect at the start of a consultation can be very helpful.
Find local support groups with other IMGs to help you adapt to cultural and language differences.
Reflect on your own journey; many IMGs have faced challenges, and this gives a unique, valuable perspective.
Practise active listening - remember, two ears, one mouth!
Be mindful of your own needs; being HALT (hungry, angry, late or tired) can affect communication.
Share experiences and reflect on feedback.
Recognise that we are all works in progress.

Key takeaways

International medical graduates bring a wealth of valuable experience and cultural knowledge of cultures to medicine. We all learn every day when we practise medicine and by observing good colleagues.

Seek out positive role models while developing your own style and strategies. Celebrating successes is crucial; significant events often focus on less desirable outcomes, but it's just as important to acknowledge cases where we have got things right.

Remember the importance of documentation. Clear, accurate and effective records support decision-making and patient care. Read more in our guide.

Good communication in healthcare: why it matters

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