Hrev_master


Dear Editor,
In his essay “Considerations on Tasso,” published in 1793,

Galileo Galilei described Tasso as a man poor in concepts and
lacking in knowledge, who resorted to literary subterfuges and
“abstruse” literary techniques, thereby emphasizing the signifi-
cance and centrality of knowledge and comprehension as integral
components of communication.1 Although Galileo Galilei made
his comments 230 years ago, we can still learn from them as we
consider the importance of communication and the challenges of
developing a trustworthy doctor-patient relationship. Paragraph 8
of Article 1 of the Italian Law 219/2017 (2) states that “The time of
communication between doctor and patient constitutes a time of
care”. We fully agree, yet we do not believe that communicative
and relationship problems in healthcare are simply related to time
constraints. Indeed, the lack of guidance, orientation, and support
for healthcare professionals in the delicate and crucial process of
the doctor-patient relationship should also be addressed. To the
majority of healthcare workers, knowing how to be and how to
communicate with a patient and/or his/her family in the critical and
complex situation of an emergency is still an obscure subject.
Specific education in this field is usually undergone only by the
few who gain awareness — often after experiencing recurrent
emotional burnouts — that effective communication is one of their
major professional responsibilities.  The Italian School of
Medicine curriculum does not include communication tutorials,
and this occurs only in a few cases in the Bachelor of Science in
Nursing. This conveys the message, “I teach you the most impor-
tant things you need to heal and care. Since I do not teach you
effective communication and positive relationships, you should not
consider these among the essential tools you need to have in your
toolbox”. Navigating without a compass is risky. Caring without

the right words is equally so. As a consequence of this articulate
premise, the emergency department of our hospital felt the need to
address and improve communication skills at the end of life, not
only from a theoretical point of view but also from an experiential,
practical, and emotional one. To do this, we asked that the
Palliative Care Unit lead a training intervention for the medical
and nursing staff of the emergency department. “Difficult
Communication in the Emergency Room. Communication and
relational skills at the end of life” was the name of the training
course, which was articulated in modules of increasing complexity
to allow for the practitioners’ progressive emotional and practical
engagement. The first part of the course covered a broad theoreti-
cal framework on effective communication in healthcare, such as
what bad news is, how it is delivered, and what effects it has; what
the most common communication barriers are; how to deal with
our counterpart’s emotional expression; and which possible effec-
tive communication methods are available. Through the viewing
and analysis of movie sequences, a classroom debate on the com-
municative and relational effectiveness of the actors was made
possible based on what was learned at the theoretical level. The
second part of the course was entirely focused on simulations,
which were carried out thanks to the participation of a professional
actor, who alternately portrayed patients and/or family members in
the emergency department based on scripts created in collabora-
tion with the psychologist. The trainees (doctors and nurses)
enrolled in the simulated exercise were asked to put what they had
learned during the training course into practice to handle commu-
nication and relationships functionally and successfully. Each skit,
which lasted approximately 5 minutes, was then discussed with the
psychologist, who discussed the critical points, mistakes, success-
ful communication techniques, and emotions. The role of the actor
was undeniably important, not only during the simulation but also
during the subsequent discussion and analysis phase. His feedback
on emotional experiences, feelings, difficulties communicating
and relating with his interlocutor, and perceptions of being listened
to and understood were extremely valuable. This course was fol-
lowed by other educational initiatives, including clinical case dis-
cussion meetings on the topics of appropriateness and proportion-
ality, ethics, communication, and relationship errors. The efficacy
of this training modality cannot be demonstrated through scientific
data and statistical formulas, but we cherish the words of a young,
previously doubtful nurse who said: “You know, I thought it was
the usual compulsory training... instead, it was hard, it was real,
and it was revealing. I am now aware of what I did not know and
what I still need to learn. It is only the beginning”. Certainly,
Galileo Galilei would approve.

References
1. Galilei G. Considerazioni al Tasso, Venezia, 1793.
2. Italian Government. LEGGE 22 dicembre 2017, n. 219 Norme

in materia di consenso informato e di disposizioni anticipate di
trattamento. (18G00006) [LAW No 219 of 22 December 2017
Rules on informed consent and advance treatment arrange-
ments. (18G00006)]. (GU Serie Generale n.12 del 16-01-
2018). Available from: https://www.gazzettaufficiale.it/
eli/id/2018/1/16/18G00006/sg

                                              Emergency Care Journal 2023; volume 19:11466

                                                                         [Emergency Care Journal 2023; 19:11466]                                                        [page 83]

Learning to communicate. The experience of an Italian emergency
department
Valentina Vignola, Davide Cassinelli, Raffaella Bertè

Palliative Care Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy

Correspondence: Raffaella Bertè, Guglielmo da Saliceto Hospital,
Via Giuseppe Taverna 49, Piacenza, Italy. 
E-mail: R.Bertè@ausl.pc.it

Contributions: the authors equally contributed to the manuscript,
approved the final version, and stated the integrity of the whole work.

Conflict of interest: the authors declare no potential conflict of inter-
est, and all authors confirm accuracy.

Received: 15 May 2023.
Accepted: 21 July 2023.
Early access publication 31 July 2023.

This work is licensed under a Creative Commons Attribution 4.0
License (by-nc 4.0).

©Copyright: the Author(s), 2023
Licensee PAGEPress, Italy
Emergency Care Journal 2023; 19:11466
doi:10.4081/ecj.2023.11466

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