Communication is a fundamental piece of health care education and has been shown to improve health outcomes, patient compliance, and patient satisfaction. Quality health care emphasizes knowledge and utilization of communication skills. Health care professionals often express anxiety and lack of confidence and are deficient in a creating a situations that are conducive to open and candid communication with patients (Kameg et. al., 2009).
Effective communication involves gathering information, establishing a relationship or connection with a patient, and supporting the person through words and other non-verbal forms of interactions. Effective communication involves not only the interactions between the staff and the patient but also the interactions between staff and the interactions between the staff in front of the patient. Many times the high demand for services in a health care facility cause the staff to overlook the importance of good communication skills and enables situations to arise that can be uncomfortable for all parties.
Communication failures are increasingly being implicated as factors influencing patient safety. Today medical care involves shorter hospital stays, increased patient acuity, and coordination of care by numerous specialists. These complex changes affect both health care professionals and health care educators and have made it necessary to ensure that health care possess the knowledge and skills to effectively communicate with patients, their families, and other members of the healthcare team (Kameg et. al., 2009).
Clinical psychologist Larry Nadig (2010) notes that expressing our wants, feelings, thoughts and opinions are clearly only half of the communication process. The other half is listening and understanding what others communicate to us. When a person decides to communicate with another person, he/she does so to fulfill a need. The person wants something, feels discomfort, and/or has feelings or thoughts about something. In deciding to communicate, the person selects the method or code which he/she believes will effectively deliver the message to the other person. The code used to send the message can be either verbal or nonverbal. When the other person receives the coded message, they go through the process of decoding or interpreting it into understanding and meaning. Effective communication exists between two people when the receiver interprets and understands the sender's message in the same way the sender intended it.
A third aspect of communication is non-verbal. Non-verbal communication involves those non-verbal stimuli in a communication setting that are generated by both the source (speaker) and his or her use of the environment that have potential message value for the source and the receiver (listener). Essentially it is sending and receiving messages in a variety of ways without the use of verbal codes (words). Non-verbal communication can be both intentional and unintentional. Basically there are two types of non-verbal communication, messages produced by the body and messages produced by the broad setting that is time, space, and silence (Segal, Smith, & Jaffe, 2010).
Communicating through the Environment
The interior design of a doctor's office conveys many messages to the patients. Since the interior of doctors' offices are the first things patients see, the space needs to express the professionalism and expertise of the doctors and make the patients feel comfortable. The right kinds of furniture, pictures and lighting can reduce the stress of the visit. Decorations such as beautiful artwork, photographs, calming paint colors, and comfortable furniture can help to put patients at ease. Interesting objects such as aquariums and plants can also be soothing, distracting patients from their possible aliments (Shea, 2007).
Vivian is a woman of undisclosed age who has been suffering abdominal pains for approximately one week. She has just taken a new job with health insurance and is able to an appointment with the doctor. Upon her arrival she finds the office decorated with gray walls, black chairs and two notices on the wall instructing patients to "Turn off cell phones" and "Have co-pay ready."
After signing in she is begins to tell the receptionist about her medical concerns, but is interrupted and instructed to have a seat. Immediately thereafter another patient is called to the receptionist's desk. Eventually Vivian gets in to see the doctor, Walls, who "talks as if he is in a race." Dr. Walls quickly examined Vivian without allowing her an opportunity to fully explain her symptoms. He then gives her a possible diagnoses, an ulcer, with no explanation of her prognosis, prescribes medication for pain, and instructed to set up another appointment for an ultrasound. As the doctor starts to exit the examination room he asks if she has any questions. However, the pace of the examination has left her little time to formulate her thoughts and the doctor leaves without allowing Vivian ample time or opportunity for a consultation.
Key Player's Perspective
This scenario involves three individuals, Vivian who is a patient, the receptionist, and the doctor, Walls. Each is motivated by unique set of needs and circumstances. We will examine their perspectives in the order they appeared in the scenario.
It is safe to assume that Vivian was a little apprehensive about her visit to the doctor's office. One may infer that since she had just started her new job and received her new health insurance that she had limited previous experience in this environment. Upon entering the reception area he notes the drab colors and the signs telling her that she can't use her phone, and she must have her money ready. Neither the ambiance of the room nor these messages are designed to lesson her stress level. Her first human communication in the office, with the receptionist, can be characterized as one sided exchange. She signs in and reaches out to the receptionist in the hopes of establishing a connection, but is rebuffed and instructed to take a seat, thus furthering her apprehension. Furthermore, Vivian could easily interpret this action as arrogance on the part of the receptionist. From Vivian's perspective her communication with the doctor was unsatisfactory as well. Her examination was a quick, predominantly one sided exchange, which left her feeling "a bit overwhelmed." She could easily feel discounted as a human being by the method the doctor employed to communicate with her.
It appears that the receptionist feels pressure from the volume of her work load. It is difficult to say whether this is a situational or chronic condition. Regardless, from her perspective the method and style of communication is secondary to the successful achievement of her duties and that patient's enquiries and needs are not a priority.
Dr. Walls seems to be overwhelmed by the volume his work as well. His communication with Vivian is short and quick and to the point. From his perspective he is providing quality health care; he's making diagnoses and treating symptoms in order to enhance his patient's health. However, it seems obvious that he is clueless as to how his method of communication is perceived by his patients, and conceivably it may not matter to him.
Health communication includes the study and use of communication strategies to inform and influence individual and community decisions that enhance health care. It connects the domains of communication, and health and is increasingly recognized as a necessary element of efforts to improve personal and public health. Health communication can contribute to all aspects of disease prevention and health promotion including: 1) health professional -- patient relations, 2) individuals' exposure to, search for, and use of health information. 3) individuals' adherence to clinical recommendations and regimens, 4) the construction of public health messages and campaigns, 5) the dissemination of individual and public health risk information, 6) images of health in the mass media and culture at large, and 7) the education of consumers about how to gain access to public health and the health care system (Health Communication, 2010).
In the above mentioned scenario, both Vivian's perception of the physical environment of the office and her contact with the receptionist and doctor could potentially exacerbate her condition. The objectification of Vivian by both the receptionist and Dr. Walls does little to encourage her to seek further medical treatment. Her future expectations of the entire health care system could easily be shaped by the lack of support she experienced in Dr. Walls' office. This could lead to unwillingness to divulge information that might be helpful in future visits to the doctor to properly diagnose illnesses or other medical conditions. The negative social and physical context as well as the verbal and nonverbal communication which were not conducive to her well being, might very well result in a reluctant attitude, inhibit compliance, and manifest trust issues with personal information which may be vitally important.
An Appropriate Resolution
It is evident that Dr. Walls' receptionist has adopted his persona. In order to improve his practice the doctor must gain an awareness of the needs and expectations of his patients, and he then must decide that the effort to meet these needs and expectations is worthwhile. The culture in the office must be…