Has the COVID-19 Pandemic Changed Communication Training at the Medical Faculties in Spain?

Introduction

The coronavirus has generated new social and economic scenarios that must be explained based on a very complex health crisis. In the field of health, the pandemic has generated new routines for communicating bad news and accompanying the most serious patients. How should difficult diagnoses be communicated when isolation is imposed? During the pandemic, the media showed shocking scenarios in which families said goodbye to a loved one isolated in the ICU, thanks to the personal initiative of a doctor who provided them with a mobile phone. The medical protocols did not contemplate a situation like the COVID pandemic, and the training of the doctors suffered from this fact.

The Hospital Universitario 12 de Octubre (2020) from Madrid has been the first to publish its protocol to guide the communication of bad news by telephone during the pandemic. With the end of the crisis, we realized that the number of medical protocols has increased substantially in Spanish hospitals. It seems appropriate to study how health centers have updated their protocols for communicating bad news to patients. Therefore, the main objective of this work is to check if Spanish medical centers have increased and/or changed their protocols to communicate bad news because of the pandemic.

To study this issue, the existing medical protocols in Spain that regulate the communicative relationships between doctors and patients have been reviewed. Thus, both a review of the scientific literature and the medical institutions themselves have been used to check whether there are more protocols than before the pandemic and whether the new protocols include different communication scenarios, based on what has been learned due to the SARS-CoV-2 pandemic.

The harshness of the virus has caused, according to the data of Laboratorio de Psicología del Trabajo y Estudios de la Seguridad de la Universidad Complutense de Madrid published in ABC journal, in Madrid “three out of four health workers suffer from anxiety, 40 per cent are emotionally exhausted, and 53 per cent, just over half, suffer from post-traumatic stress” (Medialdea, 2020). The fear of infecting himself or infecting their family is the reason that explained the emotional situation suffered by the health sector. But in addition, medical professionals suffered from not having sufficient preparation to be able to communicate bad news and this is also a great source of stress, and it is not a new point. The pandemic unveiled the essential need for training in managing emotions within a high-risk, crisis-driven healthcare communication process. While the literature on health and communication addresses this studied topic, as referenced in the theoretical framework of this work, the truth remains that the emotional management of healthcare professionals during a real pandemic highlighted significant deficiencies in Spain.

Twenty years ago in Spain, as the family medicine doctors from Navarra, Ayarra and Lizarraga (2001), affirmed, the training of doctors in communication skills was almost nil: “Giving bad news generates anxiety and insecurity, and may even cause more pain than necessary when reporting” (Ayarra & Lizarraga, 2001: 55). It is a long-term trend: “We are not prepared for this situation, nobody tells us how and that is why we must be prepared by people specialized in the subject” (Sánchez et al., 2014: 23). Currently, the situation regarding the training of doctors in how to give bad news is still a cause for concern, since it is a skill that is not worked on sufficiently in the medical degrees, but even so, doctors are expected to acquire it (León-Amenero & Huarcaya-Victoria, 2019).

For all the above and to solve this issue, the research aims to review the existing medical protocols to discover if the former protocols have been adapted to the new reality produced by the outbreak of the pandemic.