As you might expect, I often talk with providers about their patient communication, and sometimes those providers are physicians. As with any providers, physicians have their own reasons for seeking some communication support.
For instance, one physician put it to me this way: “I do some of the right stuff you’re talking about, but I don’t know how I do it.”
Another physician told me about how a resident saved the day, by stepping in and doing a much better job of communicating with a patient than he himself had done. He was embarrassed at the time, but he laughed about it as he told me.
He said, “Maybe I should be more reflective.”
Their goal is pretty much the same: get better at patient communication, because it matters. As the provider, and the holder of the expert information, you know there’s quite a lot on the line, communication-wise.
In the spirit of these stories, I’m offering here prompts that you can use to reflect on your communication.
Specifically, I offer here some possible ways of approaching the issue of communicating with patients through questions that deal with how you think about patients, yourself, and the language you use to communicate.
A quick note about reflective practice. Reflective practice is a broad spectrum that covers many different understandings of (and approaches to) reflection. I highly recommend two literature reviews for references on reflective practice in health professions: This literature review points out the variation in what reflective practice means, and how it is facilitated and assessed, in medical education. This literature review deals with pharmacy education, pointing out the conflicting interpretations and applications of the term ‘reflective practice.’ and as you might guess, I’m a reflective practitioner.
When it comes to professional communication, reflective practice is valuable because it can help us see some of what we take for granted. This is an important endeavor in part because much of what we do with language escapes our conscious awareness. We rely on assumptions, and ways of talking, acting, and being, that we use almost automatically.
For all of these, it will be helpful if you have a recording of yourself actually talking. If you can’t audio record yourself, take the first chance you get to write everything you can remember saying. Certainly involve colleagues who can tell you what they hear you say. But if you really want to take it pro, you will get serious and find a way to record your actual speech (even in a simulated encounter).
Let’s dive in!
- What is your central message? What are you assuming is most important in that message? To what extent does your language reflect this?
- Are you saying what you mean to be saying? That is, do your actual words and phrases match your intent? (You may laugh, but try it.) While you’re at it, notice what you say that helps get the effects you want.
- A deeper dive: What kind of a person are you trying to be or sound like? How is your language reflecting this?
- Are there times you are unsure of what you are communicating to a patient or colleague? How do you deal with this?
- Are you expecting to have one-size-fits-all messages? It sounds seductive, but it’s misleading when it comes to human communication. Don’t put pressure on yourself to have it all figured out about a group.
- How often do you use figurative language? Everyday speech is full of similes, metaphors and analogies. So is clinical communication. The fact is, they are powerful language tools. But you want to make sure you’re having the impact you want to have. That’s tricky because figurative language can unintentionally require knowledge or experiences that are specific to a social or cultural group.
- While we’re talking about meaning, significant communication trouble comes when you and your patient do not share an understanding of the meaning of a word. And this is easy to do, because we are generally surrounded by folks who more or less do share our same meaning. What particular meaning and significance of a word or phrase are you assuming your patient knows?
- What kind of a person do you think your patient is? How is your language reflecting this? What do you tend to think of people in this social group? To what extent do your conversational dynamics interrupt–or reproduce– biases or stereotypes?
- What do you tend to assume ‘normal’ people do in terms of reading, language use, learning, keeping healthy? What you would consider ‘normal’ displays of intelligence, concern, curiosity, commitment, and so on? Make explicit to yourself how you name and define ‘normal.’ Really tease these meanings out. Have standards, but be ready to look closely at what yours are, and at what it means to hold those standards rather than others.
- How about you–what’s your normal? You can’t help but speak from your own position, from the blend of the personal and professional cultures you’re a part of. We’re all reading situations from a certain perspective, but our perspectives can become invisible to us. We all can fall into the trap of thinking that our ways of seeing things are normal, or natural, or common sense. Remember where you stand, how you’re seeing, and how you got there. Bonus points if you acknowledge (out loud, to someone else) your own position and what you take for granted.
- While we’re talking about you, how aware are you of your body language and tone of voice? You know that you are having an emotional impact on your patient simply by your presence. How you enter a room, your body language, your tone of voice and facial expressions, how close you sit to the patient. All of this counts.
- What emotion are you hoping to elicit? Often, providers are seeking not only to communicate information but to have an emotional impact. What is the emotion is that you’re hoping you can lead someone to feel? What are your expectations? Identifying the emotion you’re going for can sometimes be tricky, so be patient with yourself.
- While you’re at it, why are you hoping for this emotion? In other words, you hope a patient will feel a certain emotion for a reason. What is that reason?
In health care, as in everyday life, verbal communication is never simply a relay of information.
When we speak with another human being, we are strengthening (or weakening) our relationship. We are revealing our perspective. We are making a case for our priorities. And more.
When it comes to communicating across cultures, we don’t get it right, or arrive, or know it all. It’s a process.
No one, including me, can ‘empower’ you to respond appropriately to the myriad cultural differences between you and the patients you encounter across your professional career.
Rather, I argue that only you yourself can interrogate your communication—including the assumptions underneath your words—and then choose the appropriate words and actions for your specific context.
This process can be aided and supported with expert help, outside information, and additional resources. Involve patients and patient representatives in developing communication guidelines, as this study team did. If you’re on a large scale project, reach out to your patient advisory board. Stay curious. Consider joining (or starting) a community of practice with some like-minded colleagues, or some smart people outside your institution.
And of course, contact me.
