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February 2023, Volume 73, Issue 2

Letter to the Editor

The necessity for the education of medical students’ communication skillsin the preclinical years of their MBBS programme

Esha Rafique  ( 4th Year MBBS Student, Jinnah Sindh Medical University, Karachi, Pakistan. )

Madam, As the Father of Modern Medicine,

Dr. William Osler, once said, "It is much more important to know what sort of a patient has a disease than what sort of disease a patient has,". Effective communication skills are very crucial to the establishment of a rapport and reliable connection between doctors and patients inside the healthcare sector. It not only aids in the management of challenging clinical interactions but also minimizes both the doctor's and the patient's frustration in circumstances involving temper tantrums. Above all, It enhances patient outcomes and adherence while also minimizing medical errors.1,2

On the other hand, two recent incidents reported in Nepal, both in 2018, when poor communication led to gravely subpar health consequences, reveal that doctors do not appear to be particularly good communicators. The first case involved a 50-year-old woman with rheumatoid arthritis who was treated in the intensive care unit after being given methotrexate once daily for 11 days. The second case involved a 40-year-old man with ileocecal tuberculosis who was prescribed anti-tubercular therapy and prednisolone but who failed to take the medication because of poor communication and arrived at the hospital with symptoms of disseminated tuberculosis. These were situations that could have been avoided easily if the doctors had communicated more effectively.3

Emerging nations, such as Pakistan, are more likely to commit these types of medical missteps due to numerous barriers in healthcare communication, such as language and Cultural diversity, patient overload, the absence of effective team management, and many more. One exploratory study carried out in the Combined Military Hospital (CMH) and Jinnah Hospital Lahore, Pakistan, was particularly focused on addressing these constraints as shown in figure.4 These obstacles frequently lead to the use of a broad list of expensive and dangerous investigative tests, which have a drastic impact on the success of the therapy and the adherence of the patients. Therefore, it is very crucial for healthcare workers here to have strong communication skills.



An effective approach to achieving that goal is by providing communication skills training to medical students from their first year of study as they have more free time during that period, which is a scarce resource in medicine. Additionally, a study revealed that medical students' communication skills deteriorated the most during their preclinical years and that training in these abilities earlier in the curriculum was more beneficial.5 This can be accomplished by integrating communication skills development modules and courses early in the medical curriculum, involving simulation medical consultations and a systematic evaluation of medical students' interpersonal abilities. These two tactics also turned out to be the most efficient way to accomplish that objective.5,6 Additionally, several courses have improved much further when taken again.6

In Pakistan's traditional medical education curriculum, teaching technical information is frequently given more priority than teaching communication skills and several research have revealed that due to poor communication skills, technically skilled healthcare professionals struggle to effectively communicate with their patients about their symptoms and advised treatments.7,8 Since Pakistan's healthcare resources are limited, it is essential for healthcare professionals to have strong communication skills so they can increase the quality of the data they obtain from medical consultations and enhance the accuracy of their diagnoses. This is especially true during a pandemic when social distance and protective gear lower the quality of medical interviews. Therefore, a conscious effort needs to be made to improve the communication skills of medical professionals in Pakistan from the moment they step into medical school.


Disclaimer: None.


Conflict of interest: None.


Funding disclosure: None.




Submission completion date: 09-05-2022


Acceptance date: 08-09-2022




1.      Ranjan P, Kumari A, Chakrawarty A. How can Doctors Improve their Communication Skills? J Clin Diagn Res 2015;9:JE01-4. doi: 10.7860/JCDR/2015/12072.5712.

2.      Tongue JR, Epps HR, Forese LL. Communication skills for patient-centered care. The Journal Of Bone & Joint Surgery(JBJS) 2005;87:652-8.

3.      Tiwary A, Rimal A, Paudyal B, Sigdel KR, Basnyat B. Poor communication by health care professionals may lead to life-threatening complications: examples from two case reports. Wellcome Open Res 2019;4:e7. doi: 10.12688/wellcomeopenres. 15042.1.

4.      Junaid A, Rafi MS. Communication barriers between doctors, nurses and patients in medical consultations at hospitals of lahore pakistan. Pak Armed Forces Med J 2019;69:560-5.

5.      Hausberg MC, Hergert A, Kröger C, Bullinger M, Rose M, Andreas S. Enhancing medical students' communication skills: development and evaluation of an undergraduate training program. BMC Med Educ 2012;12:16. doi: 10.1186/1472-6920-12-16.

6.      Bosméan L, Chaffanjon P, Bellier A. Impact of physician-patient relationship training on medical students' interpersonal skills during simulated medical consultations: a cross-sectional study. BMC Med Educ 2022;22:117. doi: 10.1186/s12909-022-03171-7..

7.      Choudhary A, Gupta V. Teaching communications skills to medical

students: Introducing the fine art of medical practice. Int J Appl Basic

Med Res 2015;5(Suppl 1):S41-4. doi: 10.4103/2229-516X.162273.

8. Feinmann J. Brushing up on doctors' communication skills. Lancet

2002;360:1572. doi: 10.1016/S0140-6736(02)11592-3.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: