Professional Development
Professional 5: Communication, shared decisions and difficult conversations
Strengthen patient and colleague communication by making decisions, uncertainty, risk, expectations and escalation explicit.
Clinical safety: Use current guidance, local policy and patient-specific judgement.
Learning objectives
Explain communication as a two-way professional process rather than information delivery alone. Apply shared decision-making principles to treatment discussions. Communicate uncertainty and material risk in understandable terms. Structure difficult conversations with colleagues while preserving respect and clarity. Document decisions and unresolved concerns proportionately.
Core reading: communication should change understanding
Good communication is not demonstrated by the amount of information delivered. The test is whether the other person has had a reasonable opportunity to understand the decision, relevant options, material risks and uncertainties, and to express their own priorities or concerns. With patients, shared decision making requires dialogue. Clinicians bring clinical knowledge and options; patients bring values, circumstances and what matters to them. Time pressure may affect how the discussion is organised, but it does not remove the need to communicate material information and support a decision. With colleagues, the same discipline helps in difficult conversations: describe the issue rather than the person, use specific examples, explain impact and risk, invite the other perspective, and agree the next action. Where safety remains unresolved, respectful communication does not mean avoiding escalation.
Communicating uncertainty
Uncertainty is common in clinical and organisational work. Hiding it can create false reassurance. A useful formulation separates what is known, what is uncertain, what matters now, what signs would change the plan, and when review will occur. Documentation should capture the decision and its basis proportionately. It need not reproduce the entire conversation word for word, but it should allow another professional to understand what was decided and the important information supporting that decision.
