Dr Phil Hammond, broadcaster and GP returner in Bristol

According to George Bernard Shaw, a medical degree is no substitute for clairvoyance, and I tend to agree. Some of my more consumerist patients, however, will not accept that doctors are not 'Mystic Megs' and we will not always get it right first time, every time. On the other hand, it is entirely healthy that traditionally reticent British patients are no longer prepared to lie back, think of England, and mumble 'Doctor knows best' before every operation, and 'Never mind, you've got to learn somehow' after it. These days, patients want a doctor to be compassionate, competent, honest, awake, sober, and, above all, a great communicator.

But can doctors really be taught to communicate? I sincerely hope so because I have spent 7 years having a bash at it, and I would feel a bit stupid if that were not the case. There is plenty of evidence that doctors can be taught the surface skills to make it look as if they care in a 'How to win friends and influence people' sort of a way—providing friendly seating arrangements, getting the patient's name right, waiting until the legs are out of the stirrups to break the bad news.

However, communication is as much to do with attitude as skills and, short of bringing in the thought police, attitudes are much harder to change. If you are sexist, racist, classist, homophobic, and power-crazy, you can put the chairs where you like—you will still be a dictatorial bigot.

Fortunately, students entering medical schools today are much more patient-friendly than the traditional hearty stereotype (drink 10 pints, drop your trousers, and pee in someone's flower-bed). And they now learn their anatomy from plastic models not dead bodies. Some of them complain they are missing out—dissection is the one rites of passage subject that makes doctors feel different.

By way of compensation, they are sent out into the community as first-year students to meet whole, living families with more problems than they could ever imagine. Some of them are shocked by what they see—'he was lying on a urine-sodden mattress with mouldy tea cups, no heating, and only a twenty watt bulb for light'—and some form lasting attachments with these families. If empathy can be taught, I suppose this is it.

The question is, can it survive medical training? Too many students still emerge from their final year burnt out and cynical. This, as much as anything, dictates how they talk to patients. Even those who survive into house jobs (or 'the foundation stage') with their enthusiasm intact find that hard to maintain at the back end of a busy shift.

One new house officer I know is already facing her first complaint. When, at the end of a Friday night in the casualty department, she was asked whether there was any guarantee her treatment would work, she replied, 'If you want a guarantee, buy a toaster.' That may be a great line, but all doctors need to learn that what goes down a treat in the coffee lounge, is not always appropriate in a consultation room. The real art of communication is knowing when to keep your mouth shut.

As for Shaw, he realised the importance of the motivation behind communication. 'That any sane nation, having observed that you can provide for the supply of bread by giving bakers a pecuniary incentive in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity.'

Reflect on that while you are chasing your QOF points.G