B.A.R.D. – In The Practice

Citation

(2006), "B.A.R.D. – In The Practice", International Journal of Health Care Quality Assurance, Vol. 19 No. 5. https://doi.org/10.1108/ijhcqa.2006.06219eae.001

B.A.R.D. – In The Practice

This title has previously been highlighted in recent publications; and has been reviewed by Simon White who used the publication as part of the development of workshops for General Practitioners working in the Russian Federation.

B.A.R.D. – In The PracticeEd WarrenRadcliffe PublishingISBN: 1 85775 665 7

Communications, or the act of communicating, is something that we all need to be aware of in terms of how important it is from the individual’s needs to the development of whole societies.

The NHS in England and Wales Guiding Principles state:

Communication is not just about talking to people, it covers a number of skills that need to be recognised, understood and developed to help improve patient care.

What we have here is an excellent book that sets out in a very clear manner, some of the ways in which the author, a British GP (family doctor in a wider context), has developed his own consulting skills with his patients over the years and wants to share them with others.

Dr Warren’s views and beliefs in the importance of skilled communicators in the consulting room is echoed by several eminent clinical professionals in forewords – Philip Evans, former president The World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (Wonca), Mike Pringle, Professor of General Practice, University of Nottingham, and Mayur Lakhani, Chairman of Council, RCGP. They also recognise the need for good consultation skills to improve not only the patient’s experience, but also the physician’s.

Following a general introduction to B.A.R.D. and the role of a family doctor, the book gets to the crux of Dr Warren’s messages. The title of the book refers to four aspects – behaviour, aims, room and dialogue – that encompass his views and ways of working to improve consulting with patients.

Dr Warren expresses his views of what works in a non-prescriptive manner and uses a questioning manner to elicit the reader’s interest through internal dialogue. This works extremely well as the subject matter presented by Dr Warren is about practical common sense that surfaces easily with the reader using this technique.

He is much more interested in exploring and putting over the “how” of communications that can be developed and improved, rather than the “what”.

In the “Behaviour” section he believes that non-verbal communications – “physical movements that a family doctor performs or the set of postures that she adopts while engaged in her professional work” are paramount. Various studies have shown that behaviour or non-verbal features account for 50 per cent of the received message (with words accounting for only 10 per cent!) which tend to bear him out.

He argues that working with the patients (and carers) in partnership on their needs, has a good impact on outcomes. Understanding various and sometime conflicting aims promote this. There are many aims; aims of the family doctor, aims of the patient, clinical aims, social aims, organisational aims, etc.. The important thing here, Dr Warren suggests, is to use these aims in such a way that defines the overall direction of the consultations and the relationship with the patient.

Dr Warren rightly spends sometime on the importance of space or “Room” for consultations. Physical environment can have a positive or negative impact on communications and consultations. Again, he is really pointing out the obvious, which we can all overlook in our busy lives. What we have come to learn to live with in our environment, a new eye might have a considerably different point of view of appropriateness!

On “Dialogue”, Dr Warren stresses the importance of understanding patient preferences concerning the kinds of things they expect or want to hear. Failure in this area can lead to lack of understanding by the patient with inevitable consequences.

Towards the end of the book some training exercises and tools for B.A.R.D. are documented, using as a basis Stanislavsky Seven Questions for Theatre Students. This provides a very useful insight into personal beliefs which can impact on communication effectiveness.

Lastly, there is a section on the ethics of B.A.R.D. which should not be missed out when reading the book. He makes the point that the medical profession can usefully learn non-clinical skills from outside the profession and the application of B.A.R.D. is “entirely consistent with patient-centred consulting”.

All in all, a very good book for all clinicians, not just family doctors, and medical students if they want to invest in improving their communication and consulting skills.