The physicians who speak with me want to be more conscious of their language. They know communication is important, and they want to know more about how language works, so they can be better doctors. That’s often why they’re talking with me.
Their questions take different forms:
- What do I need to know about communication to be better at it?
- When communication breaks down, why?
- When communication is successful, why? (One physician put it this way: “I do some of the right stuff you’re talking about, but I don’t know how I do it.”)
- What am I saying that is not contributing to patient care or safety?
They want some communication tools more meaningful and effective than good ol’ trial and error. They’re also not interested in some grab bag of tricks.
This makes sense. In this article, I’m sharing some ancient (and not-so-ancient) wisdom on spoken language. The ideas here have endured for millennia; I suspect it’s because they’re deceptively simple and efficient, while being comprehensive. And you can use them to break down and assess your own communication, today. Starting now.
A time-tested approach
You know communication is important. Study after study show the influence of provider-patient communication on patient satisfaction, compliance, and clinical outcomes. Whether it’s medical interviewing or patient education, building relationships or making shared decisions–getting a grip on your spoken communication is essential.
What I’m sharing here is based in classical rhetoric, with some more modern approaches layered on.
In 2014, the editor of Developmental Medicine and Child Neurology argued that:
Classical rhetoric could promote “excellence in reasoning and in communication with the patient” as physicians regularly “utilize a range of devices that have been identified, classified and refined since Greek antiquity under the discipline of rhetoric.”
Providers’ awareness of and practice in classical rhetoric also been suggested by one study as promoting women-centered midwifery care.
You probably experienced the formalized communication associated with classical rhetoric in your medical education, through the oral case presentation. Classical rhetoric has also been used in data analysis: of scientific metaphors used with the public, of historical vaccine skepticism in the US, of the ethical obligations of health care systems toward informing patients’ expectations, and in a meta-analysis of epidemiological research.
(More background for the communication research fans: Of course there have been numerous adaptations and criticisms of classical rhetoric. I deal with some of these by layering in some discourse analysis, for its attention to interpersonal interactions and communication. I also include some New Literacies Studies for its attention to context and modality.)
Rhetorical elements graphic
You may have seen something like this figure before; it’s sometimes called the ‘modified rhetorical triangle,’ after the three elements first identified as a triangle by Aristotle. There are a few variations on this graphic (go ahead and google ‘rhetorical triangle’). Briefly, here’s what the five parts mean.
| Speaker | Who’s doing the ‘producing’ i.e. talking, writing |
| Audience | Who’s doing the ‘consuming’ i.e. listening, reading, viewing |
| Message | The meaning or purpose of the communication |
| Context | There are many contexts around any given communication. Time and space, also: cultural, economic, political, social, emotional, linguistic, etc. |
| Mode | The way meaning is communicated. Speech, written text, graphics, video, signs, etc. Any combination of modes is called ‘multimodal’ |
To keep it easy today, we’re going to consider the ‘mode’ as speech. But this graphic works for all modes as well as multimodal texts.
I’m offering you, along with this graphic, a way to use it. A kind of mental checklist, built on these 5 elements. Each of these elements matters in communication, separately and together. The point is to remind ourselves of that fact. The rest of this article tells you how.
How to use this graphic
First, pay attention to a famous person talking
An easy way to begin to see how this graphic works is to focus on someone else’s communication.
The next time you listen to a radio personality, talk show host, or news anchor, think of this graphic.
Then, try out these questions:
- Who does this speaker think he/she is? How does their language reveal this?
- Who do they think you are? How can you tell through their language?
- Can you discern a central message? What do they think is natural, normal, or important about this issue? What did they say that reveals this?
- What is their attitude toward a particular context they’re in? How can you tell? (Time can be an easy one to spot, or the political/economic/social climate).
Now, it’s your turn: a mental checklist
This mental checklist is based on the 5 rhetorical elements. It helps you get clear on some basic questions. It does this by drawing your attention to how your language is shaped by your thoughts about yourself, your patient, your message, and your contexts.
The next time you are about to speak to a patient, think of the graphic. Then, consider these questions:
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What kind of a person am I trying to be or sound like? How is my language reflecting this?
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What kind of a person do I think my patient is? How is my language reflecting this?
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What is my central message? What am I assuming is most important in that message? How is my language reflecting this?
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What contexts am I paying attention to? How is my language reflecting this?
This quick checklist allows you to assess the most important factors of any communication, even during or after your conversation. The focus is on becoming aware of your language in relation to each of the most important factors. (Yes, there were 5, but remember right now we’re considering ‘mode’ to be speech.)
Increase the chances your words will have the desired effect
This is a case where knowing more about language can help you do better with language.
Assessing in the moment is something you all do. This graphic, plus the mental checklist, is designed to help you assess your own language, by applying tools that have been used for over 2500 years.
Communication is about more than imparting information. You’re also hoping to show yourself as a particular kind of person. You seek to influence people (though not in a creepy manipulative way). You also use language to build and maintain good relationships.
This is one mostly-ancient way to consider separately the interconnected elements of spoken language. By looking at each, individually, you can see where you are–and aren’t–living up to your own goals for your language use.
Consider engaging some trusted colleagues in looking at your language use together. Share with each other–and with us, here in the comments–what you’re learning about getting a grip on your language.
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