Modes of Communication

Original Editor - Robin Tacchetti based on the course by Jason Giesbrecht
Top Contributors - Robin Tacchetti, Jess Bell, Naomi O'Reilly and Tarina van der Stockt

Introduction

Communication is defined as the method of sending and receiving messages to share skills, knowledge and attitudes.

Communication in the healthcare environment entails transmitting and receiving of information between clinician and their patients . Good communication is a fundamental clinical skill that establishes the therapeutic relationship between the clinician and their patients. Studies show that clinicians who explain, listen and empathise with their patients produce a profound effect on their patients health status and functioning as well as overall satisfaction in the medical care.

Historically, medical settings incorporated direct face-to-face communication to relay information. In this format, patients could not only hear the information, but were able to see facial expressions and body language to help better understand the meaning behind the words. Direct interactions are decreasing as indirect interactions like video conferencing increase. Technological advances have also aided written communication (emails, texts, etc) between providers and patients. Written communication in medical care has many advantages including:

• traceability

• patient preference
• medico-legal value
• easily and simulataneously distributed to required number of caregivers
• educational

Medical Communication

Medical communication entails exchanging of information by verbal, nonverbal, written or electronic means. The two-way dialogue between patient and healthcare providers should have the following components:

1. where both parties speak and are listened to without interruption
2. exchange of information
3. ability to express their opinions
4. ask questions for clarity
5. exchange of information

Clinical communication interactions should be respectful to enhance patient engagement in decision making, increase patient adherence to treatment, increase patient satisfaction and reduce anxiety and uncertainty.

** The environment for verbal communication should be in a caring surrounding. This allows the patient to feel physiologically and psychologically safe.

Communication Delivery

Communication is delivered through the combination of verbal and nonverbal components. Verbal communication is delivered through spoken words or written language. Nonverbal communication conveys emotional information through reactions of the voice, body or face. . Both modes of communication can be influenced by a number of factors:

1. volume and pace of the interaction
2. exchange of glances
3. spatial proximity
4. extent or limits of physical contact
5. style of communication: friendly or authoritative

Verbal

Verbal communication encompasses both written and oral forms. Written communication is generally used to relay information in a permanent manner. With advances in technology written communication has increased over recent years. Examples of written communication include:

• emails
• reports,
• text messaging
• social media platforms
• discussion forums
• electronic medical records

Oral communication, also known as spoken communication includes:

• telephone calls
• face-to-face interactions
• video conferencing
• public speeches
• in-person meetings

** Effective oral communication requires active listening.

Listening

Effective oral communication requires active listening. In order to provide good communication, the clinician must pay attention and demonstrate good listening skills. Active listening is a critical component of good communication that involves giving the speaker your full attention. In order to be an active listener, the following steps should be performed:

1. Reflect: to confirm your understanding, paraphrase or repeat what they have said
2. Clarifying: to get a better understanding of what they said, ask questions
3. Summarise: provide a brief summary of what they said
4. Empathise. try to understand their speaker's feelings and perspective
5. Non-verbal cues: pay attention to body language, tone of voice and facial expresions
6. Avoid interruptions: allow them to finish without interruption
7. Avoid distractions: do not multitask or get distracted while they are speaking

Non-Verbal

Non-verbal communication is a way of conveying information without using words. It encompasses a wide range of physical cues such as:

• facial expressions
• tone of voice
• body language/posture
• gestures
• eye contact
• shrugging
• pointing

Non-verbal communication can help provide additional information or even contradict the spoken message. To respond appropriately to non-verbal cues, one needs to be an active listener noticing subtle cues. Equally important is to note your own non-verbal cues and how they might be interpreted by others.

** Note that individual and cultural differences can impact non-verbal communication due to different norms

Barriers

Depsite understanding good communication practices, there are always barriers to good communication within the healthcare environment. These barriers are generally related to one of four categories listed below:

1. healthcare or institutional practices
2. communication related
3. environment related
4. personal and behavioural related hinderances

Healthcare or Institutional Practices

Within the healthcare system there are many factors which can challenge good communication between clinician and patient. The most common barriers are listed below:

• staffing shortage
• high workload
• burnout

Communication Related

There are several different communication related barriers within healthcare, with the main one being miscommunication. Other communication related obstacles include:

• language
• poor communication skills

** Hiring translators and interpreters would assist with interactions when language barriers exist

Environmental Challenges

Environmental challenges are hindrances within the medical setting that impede communication. Some of these obstacles include:

• distance of health professional from patients' bedside
• noisy surrounding
• unkept rooms/beds
• lack of privacy
• lighting

** All of the above barriers can limit or prevent the patient from expressing their healthcare needs

Personal and Behavioural Related

Many demographic factors can play a role in hindering communication between clinician and patient. Some of the factors are listed below:

• lack of availability of patients or family members time that coincides with healthcare worker
• cultural background
• beliefs
• worldview about health and medicine
  

References

• Hall, M. L., & Dills, S. (2020). The limits of “Communication mode” as a construct. Journal of Deaf Studies and Deaf Education, 25(4), 383-397. https://doi.org/10.1093/deafed/enaa009