Free Health Essays - Interpersonal communication in a healthcare setting is no different from interpersonal communication in any other setting – with one significant exception. Someone’s life could depend on the ability of the health care professional to communicate effectively
Simply put, interpersonal communication is an exchange of content or ideas between two or more people. More explicitly, it is a combination of verbal and nonverbal interaction with a transmitter (speaker) and receiver (listener). But effective communication is also dependent upon how the people involved interpret the context of the exchange, the role they see themselves in, how clearly they articulate their ideas, how well they listen to the other and synthesize the new information into their own knowledge, and then how they act upon that information [Husband and Hoffman; Edwards and Shepard, 2004; Cegal et al, 1997; Parvis, 2002].
Let’s say for example that I wanted to know what a friend thought of a particular movie. To elicit his ideas, I’d ask him about the movie and about his feelings about it. If we were engaging in effective interpersonal communication, he might take a moment to gather his thoughts, then he would use words and likely hand gestures to tell me his ideas. I would need to listen and watch his body movements to make sure they did not belie his words. Then, if his monologue were long enough, I might paraphrase what I heard him say to be sure I understood before I took issue with any of his ideas. Then I could explain what I thought and how my opinion differed; he would listen, and the cycle would continue.
However, in a healthcare setting there is often a goal other than just sharing ideas. The goal may be to develop a new treatment plan or to educate a patient about the need for a particular something. Here, the clinician needs to be aware of the tasks involved in effective communication, which, as Mock and Seidel both explained, include engagement, empathy, education and enlistment [Mock, 2001; Seidel, 2004]. According to them, engagement is connecting on a personal level, by asking about home or work life, before working on the patient level. Education involves asking questions to determine what the patient does and does not know, therefore determining what she or he needs to know. Enlistment is the art of getting the patient to buy into his or her medical plan in the hopes of ensuring adherence or compliance [Mock, 2001; Seidel, 2004]. But perhaps it is the ability to be empathic – achieved in part, for instance, by me paraphrasing to my friend in the above example - that most tells whether the communication will be effective.
Empathy is “a mode of perception, which includes carefully listening, observing gestures and body language, and trying to understand the patient's unique medical situation” [Switankowsky, 2004]. The benefit in being empathetic appears to be enormous. Riley suggested that when patients perceive the communicator as being empathetic, they were more receptive to what was being taught [2000, p. 134], which would mean most often a better health outcome for the patient. Switankowsky went further than Riley and said that empathy was a “foundation for the balance” between “biological-scientific-medical components” and “psychological-emotional-social components’ both of which must be taken into account for an accurate diagnosis and treatment [2004]. Clearly then, if one desires to treat the patient in the best manner possible, being regarded as empathetic to the patient and his or her concerns becomes important.
To be perceived as an empathetic communicator, the clinician must engage in what communication experts call active listening so that he or she really hears the patient, which helps emphasize the clinician’s sincerity in wanting to help the patient [Mock]. Reflective listening is a part of active listening. In reflective listening, the clinician uses his or her “own words to mirror the essence of the patient’s last statement, [which] involves paraphrasing and reflection of feelings” [Maguire, 2002, p. 292]. In other words, the practitioners reflect back to the patient what they thought they heard which demonstrates that they were indeed listening and do indeed want to understand. The goal of this type of active listening, according to Riley “is to offer a verbal reflection that is accurate, with no exaggeration or minimizing of what [the clinician is] being told” [2000, p. 133].
Behaviors of listening reflectively “include adopting a physical posture of attentiveness, making direct eye contact, and using facial expressions to convey a genuine attitude of respect and attention” [Duffy]. Then, once the patient has finished speaking, the clinician should reflect or mirror back what was heard – using the language of the patient rather than clinical jargon [Seidel, 2004]. In addition, he or she should “acknowledge the other person's thoughts and feelings” [Rider] such as frustration or concern, since this indicates to the patient that he or she really has been heard and heard well. Both behaviors can let the patient know that the practitioner was listening, but they can also point to a communication breakdown – if one exists - that can then be fixed because “the speaker [patient] has the opportunity to expand, deemphasize, modify, or correct the message or paraphrased statement” [Richardson].
For instance, if the patient says, “No, that’s not what I said,” the clinician can say, “Okay, tell me again so that I can make sure I do understand.” Or if the patient says, “well, that’s part of it,” the clinician can ask for more details. And even though this process takes time, it can save time later and perhaps reduce recurrent visits by getting to the heart of the problem initially and dealing with it then, in part because the use of reflective listening “may encourage the speaker to provide more information, to disclose more about the issue or him- or herself, or to make midcourse adjustments in what he or she is saying in order to achieve the desired objectives” [Richardson].
Of course, reflective listening is not the sole component of effective interpersonal communication. One must be able also to ask effective questions in the medical interview to elicit accurate and telling responses. However, even here, reflective listening should also be used to ensure the clinician heard the patient’s answers accurately. But there is even more to effective interpersonal communication – particularly in our age of such pluralistic societies where different cultures have different ways of speaking and acknowledging those in authority positions, which brings us to the part of communication that deals with understanding the context in which the communication occurs and the roles that those communicating play.
A 2005 study recently reported that interpreters in healthcare settings found three particular problems in interactions between patients and healthcare professionals: “(1) ideas about the patient's health problem; (2) expectations of the clinical encounter; and (3) verbal and non-verbal communication styles” [Hudelson, 2005]. For instance, if a clinician focuses solely on treatment regimes and believes that is why the patient is in the office, he or she might miss some of the other problems going on in a person’s life. For example, a diabetic not adhering to a treatment plan might be doing so because of depression or cost of supplies, but no one asks why. Or perhaps a Muslim may not receive chemotherapy because it interferes with prayer routine but no one thinks to ask about lifestyle or convenience [Weissman, 2003]. And although these examples are not necessarily indicative of cross cultural barriers, the use of verbal and non-verbal communication styles is a definite area where problems in effective communication can arise. Some cultures learn not to maintain eye contact with people in authority; other cultures learn never to come directly to the point they want to make given that it is considered rude; and still others have a faith in which the role of clinician – no matter what he or she says – is secondary to what their religion may emphasize.
Thus, given potential barriers, it becomes even more important to gain trust by being empathetic, by actually listening and then reflecting to ensure that what was heard was actually said. Doing so also allows the clinician an opportunity to observe the patient’s actions and attitudes and perhaps make adjustments in communication style to create more ease with the interchange.
According to Travaline and other communication researchers “effective patient-physician communication can improve a patient's health as quantifiably as many drugs” [2005, p. 13.]. If this is indeed the case, it would seem readily apparent that understanding how to communicate effectively would be as essential to healthcare providers as is knowledge of disease states and treatments. It would also seem just as important to recognize the importance patients place on their perceptions of whether the health care provider was empathetic or not and do what they can to be perceived as such.
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