Self-Reflection in Communication

Original Editor - Robin Tacchetti based on the course by Marissa Fourie
Top Contributors - Robin Tacchetti, Jess Bell and Tarina van der Stockt

Introduction

Effective healthcare communication is believed to have specific benefits for patients, including reduced pain and anxiety, increased satisfaction, improved vital signs and treatment outcomes and increased participation in interventions. In a successful two-way dialogue between provider and patient, both parties speak freely and are listened to without interruptions. Both parties should be able to ask questions for clarification while feeling open to expressing their opinions.

Since patient-centred communication can facilitate positive health outcomes, providers must be responsive to each patient and consider their individual needs. It is necessary to acknowledge and accommodate different cultures, languages, values and beliefs in patient interactions. Providers must be mindful of personal values and beliefs that might create barriers to patient communicationand reflect upon their implicit biases that could affect patient care and communication.

Implicit Bias

“Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person based on irrelevant characteristics such as race or gender.”

Implicit biases are unconscious and can impact patient communication and level of care. Because we are unaware of these biases we need self-reflection, introspection and awareness in order to start addressing them.

A clinician's implicit bias can negatively impact patient care by affecting interpersonal communication and treatment decisions which in turns lead to mistrust and lack of commitment from the patient, resulting in poor adherence and outcomes.

Values

Values are described as "abstract, context-independent and stable goals which people strive to achieve in life". They are fundamental convictions that shape an individual's attitudes, behaviours, interests, and needs. They define what we consider right, good, moral, and desirable.

Values guide peoples' perceptions, behaviour and attitudes. While they are related to norms, attitudes and beliefs, they are also distinct from them. Values are relatively stable, but as Russo et al. note, they can change spontaneously over time or voluntarily in response to a specific intervention.

Examples of values include conscientiousness, honesty, pride, financial stability, altruism, health, transparency, respect, etc.

Ten Basic Values

Shalom Schwartz identified ten basic values that are each characterised by a different motivational goal in his Theory of Basic Human Values.

1. Power: dominance over resources and people, social status
2. Achievement: personal success according to social standards
3. Hedonism: gratification or pleasure for oneself
4. Stimulation: novelty, challenge or excitement
5. Self-direction: independence in action and thought
6. Universalism: understanding, welfare and concern for all people and nature, tolerance
7. Benevolence: increasing the welfare of people you are close to
8. Tradition: commitment and respect to religious or cultural ideas
9. Conformity: restraint of actions that may harm others or violate social expectations, maintaining the status quo of the group
10. Security: stability and safety of relationships, self and society

Relationship of Values

From these ten basic values, Schwartz devised four subsets.

1. Openness to change, which consists of:
   • hedonism, stimulation, and self-direction
2. Conservation, which focuses on:
   • security
   • conformity
   • tradition
3. Self-transcendence, which consists of values relating to:
   • universalism
   • benevolence
4. Self-enhancement, which relies on values of:
   • achievement
   • power

Beliefs

While values identify what people feel are important and what goals they want to pursue, beliefs determine what people consider to be true and how they will pursue their respective goals. Beliefs offer a "causal explanation for observed behavior and perceived individual differences". Stereotypes and prejudice are specific behavioural and cognitive tendencies that are associated with beliefs.

• Stereotyping is when we associate and attribute specific characteristics to a group. It is the image that comes to mind when someone thinks about a particular social group.
• Prejudice is an attitude (often negative) that reflects an overall evaluation of a group.
• Discrimination is biased behaviour toward, and treatment of a group or its members, based on your beliefs about this group.

Self-Reflection

Healthcare providers must understand that their values and beliefs can hinder effective patient communication. Providers who examine and explore their personal attributes and perspective through self-reflection will gain insight on how they can improve in the future.

In order to begin the process of reflection, we need to recall, reconsider and reevaluate our own experiences. Intentional reflection on actions, emotions and experience is critical to informing our existing knowledge base and making contextually appropriate changes. Reflective thinking should be learned and used continuously as part of professional behaviour and professionalism in clinical performance.

In addition to self-reflecting on values and beliefs, healthcare providers should be aware of other physiological cues they may be displaying that could influence an interaction with a patient. Providers should take note of their current emotions, thoughts, and non-verbal and physiological cues that could interrupt good patient communication. The following table includes examples of reflective thinking healthcare providers can try before a patient interaction.

Reflective Practice
Emotions	Consider your current emotions: are you feeling frustrated, angry, sad, or happy? Having a sense of your emotions before a patient interaction may help avoid miscommunication
Thoughts	Are you having ruminating thoughts? It may be difficult to stop a thought from invading your mind Be mindful of that thought and try to suspend it when you are with a patient
Non-verbal cues	Are your current emotions and thoughts causing you to display non-verbal cues? Be mindful of any non-verbal cues you might be exhibiting
Physiological triggers	Is your body trying to tell you something? Hunger, sadness, fatigue, etc Physiological cues can cause you to display non-verbal cues Be mindful of physiological cues and how they might shape your non-verbal cues
Environmental triggers	Do certain environmental triggers affect your ability to listen? Be mindful of subtle triggers such as foul smells, bright lights, and beeping machines that may affect your ability to communicate effectively

How to Self-Reflect

Clinicians can use various methods to learn how to incorporate self-reflection into their practice. The following actions might assist in self-reflection:

1. Connect with a mindfulness training programme or practise mindfulness skills to foster attentiveness and self-awareness
2. Join a professional development course where reflection and self-assessment are the core topics
3. Begin expressive writing to enhance your reflective capacity and critical analysis skills

Resources

• Personal Values and Beliefs
• Clinical Reflection
• Communication Skills
• Culture and Communication