Communication Skills of Healthcare Professionals - Essay Example

Communication skills for the health care professional Introduction: Patients who avail of health care generally approach health professionals in a state of anxiety and inner stress, because they may be in pain or experiencing discomfort, which they are anxious to have resolved as quickly as possible. The type of communication used by health providers may play a significant role in influencing health outcomes. The ability to communicate effectively is vital within a healthcare system, if the quality of care is to be maintained at a high standard. When health care professionals are endowed with good communication skills, it can help to raise awareness in general among individuals about health risks and solutions that can be adopted to solve or mitigate those risks. It can also help sick individuals to find support from being a part of groups comprised of other patients who are also in similar situations and thereby influence or reinforce their attitudes to the illness and aid them in developing coping mechanisms.(NCI, 1989) Communication may be verbal, which is the spoken communication, or non-verbal which contributes meaning to the verbal expressions or may occur independently of verbal communication – such as the body motions and gestures, facial expressions, smiles, nods, which also function as a medium of communication. While communication itself is the process of transmission of messages and the interpreting of their meaning, during therapeutic communication, a care giver seeks to communicate with empathy and elicit such responses from the patient which will be beneficial to his or her well being. Therapeutic communication is geared towards promoting the well being of the patient through communication and interpretation of both verbal and non verbal cues. It is especially useful in the field of nursing and in the care of patients who may face chronic health conditions, because it is an aid in facilitating positive clinical outcomes. Overview of Scenario: The given scenario concerns the patient Vivian, who has been suffering form abdominal pains for some time but has not been able to avail of health services due to a lack of health insurance. However, as soon as she gets a job and secures health insurance, she schedules an appointment with the doctor. The décor of the waiting room is stark stark, with only two notices up on the wall – one stating “Turn off cell phones” and the other “have co-pay ready.” She signs in at the front desk but before she can even begin to state her problems and mention the pain she is in, the assistant tells her to take a seat and calls another patient who is waiting up to her desk. So Vivian has to sit and wait her turn while suffering through her pain quietly. When she finally enters the doctor’s office, he examines her at a rushed pace, explaining each of the steps he is taking during the examination process. Then he asks her questions about the pain and as Vivian provides the responses, he notes them all down in his medical file. Without slowing down the pace, he prescribes medication; and informs her that it is quite possible she has an ulcer. He suggests that she should make another appointment before she leaves, for an ultrasound. Finally, when he is on his way out, he stops at the door and almost as an afterthought, asks her whether she has any questions, to which Vivian responds that she does not, because she is feeling rather overwhelmed. Communicational perspectives as revealed by this scenario: Examining the communication methods in the above mentioned scenario reveals a great deal about many of the drawbacks of the current patterns of communication among health care professionals. From a purely clinical perspective, it may be argued that Vivian went to the doctor’s office for a resolution of her abdominal pains and received some medication as well as guidance on further steps that could be helpful in achieving a medical resolution to the problem. But from the perspective of providing therapeutic health care that can achieve a truly successfully resolution of Vivian’s problem, there is a lot that is lacking. Vivian’s perspective: At the outset, it must be noted that Vivian arrived at the doctor’s office with a great deal of eagerness to discuss her anxieties about her health and the abdominal pain that she is experiencing. Since she has been without health insurance and has not been able to afford to pay for health care, the abdominal pain has persisted for a while and it appears quite likely that her anxiety about her condition and the underlying stress may well have worsened the condition. Sears (2004) has pointed out one very important aspect, which also needs to be taken into consideration, namely, that the issue under which the patient has been admitted to the hospital or arrives for therapeutic consultation, may not necessarily be the only issue with which the patient wants to deal. Therefore, it appears very likely that Vivian has come to the clinic, not only anxious to talk about her abdominal pains but also experiencing underlying tensions and anxieties which need to also be resolved if a successful clinical outcome is to be achieved. An assessment of Vivian’s needs in coming to the clinic is therefore the need for therapeutic communication. O’Gara and Fairhurst (2004) have defined therapeutic communication is essentially patient centered communication, and the application of therapeutic communication techniques such as active listening, clarifying and focusing could be of great value in health care and enhance the therapeutic nature of the clinician-patient interaction. Through this process of active interaction between the health professional and the patient, it becomes possible to not only make amore accurate diagnosis of the medical problems of the patient, but also to tap underlying anxieties and issues which may also be contributing to the problem, and which, if addressed, can achieve more successful clinical outcomes. On this basis, Vivian’s most pressing need in coming to the clinic would have been to be able to talk to knowledgeable medical personnel about her health problems in order to receive not only a therapeutic solution but also reassurance and an assuaging of her worries. But as may be noted from the scenario as stated above, Vivian has barely been allowed to communicate at all. It may be noted that the doctor’s office is completely bare of any medical information – there are no posters or informational pamphlets around that the patients can read while they are waiting. There are not even any recreational magazines with which patients can read, to take their minds off their anxieties until it is their turn to see the doctor. Moreover, when Vivian arrives at the clinic she is bursting to share her health problems with someone, but the assistant does not even allow her to speak, she is too busy sending in patients who have been waiting before Vivian, so that she does not even have time to hand out a few reassuring words for Vivian. As a result, Vivian is forced to suffer her pain in silence, without recourse to any reassurance or anything to distract her from the pain during the agonizing waiting period. Then when her turn comes and she finally gets to se the doctor, the scenario above demonstrates how impersonal the doctor is in his attitude to her. While he takes care to inform her at every step of the examination process what exactly he is doing, he does this at a very fast pace, as if it is something he has to get through with as soon as possible. He does not allow Vivian to get a word in edgewise, does not ask her how she feels about any of the elements in the examination, and whether she is comfortable or not. He does ask her about her specific medical symptoms, but does not provide any encouragement or space for Vivian to express any of her other concerns. Neither does he take the time or effort to patiently discover any of the underlying anxieties Vivian might be suffering from, which are contributing to her medical condition. While it could be argued that this might well be the most important part of the communication the doctor needs to have with his patient, in the above scenario, it has become peripheral. It is only as the doctor is leaving the room that he stops to ask Vivian whether she has any questions; at a time when it is unlikely that Vivian would voice them even if they existed, because he appears to be such a busy man who has so many other patients to see, that he could hardly spare time to listen to her irrational fears and worries about her health. The Assistant’s perspective: From the assistant’s perspective, Vivian would have been one more patient in a long line of patients who have arrived to see the doctor. It appears quite likely that since her job is to man the front desk, she may not view her job as health related at all in the sense that her focus may be on her administrative duties. The significance of the anxiety and pain Vivian is feeling may be lost on her because all the patients who come to the clinic have some problem or the other. Therefore, while from Vivian’s perspective, her abdominal pains are very important, from the assistant’s perspective, she is just one more person to be seated in the waiting area and then herded into the doctor’s office when her turn comes. She may feel little or no empathy for Vivian’s plight or the plight of the other patients and appears more likely to communicate with the patients only if they do not follow the instructions to shut off the cell phones. She is concerned only with the administrative aspects of her job, including the completion of the paperwork on each patient. The Doctor’s perspective: From the doctor’s perspective, his job is to attend to the medical problem that the patient is facing. He is a busy man and has to see a lot of patients in one day, added to which he has to maintain the medical records of all the patients and fill up insurance forms for each and every one of them. He is well versed with the human body and all the illnesses that can afflict it and due to the experience he may have had, is likely to spot a problem immediately and arrive at a diagnosis based on the answers to the questions he asks the patients. Unlike Vivian who is almost clueless from the perspective of medical knowledge, the doctor is able to approach her from his superior vantage point in this area. He is legally required to gain the informed consent of the patient, therefore he fulfils his legal obligations by explaining every procedure he is carrying out to her, but does not at all realize the significance of the underlying psychological issues in achieving a truly successful clinical outcome to Vivian’s problem.. Communication implications: Using communication, which supports patients through the use of empathy, helps them to deal with their repressed feelings of anxiety and can be very helpful in providing excellent health care outcomes. But from the above scenario, neither the doctor nor assistant has met Vivian’s need for communication, because they have not provided her much opportunity to talk about her problems. At the same time, they have not bothered to explain the implications and ramifications of her problem to her, nor provide any kind of communication that will provide reassurance. There is a notable lack of empathy in the communication between the health care professionals and the patient in this scenario. According to Antai-Otong (2007, p 58), health professionals must practice active listening, which “requires the use of all the senses and involves attention, comprehension and mindfulness to assess verbal and non verbal communication”, requiring an active interest in others’ points of view. It allows a health patient to establish a dialogue with the patient, so that said patient is encouraged to set the tone and become more direct about underlying concerns so that the reassurance sought for can be provided. According to Daniels (2004), active listening involves hearing and interpreting of language, while at the same time, noticing nonverbal movements and para-verbal enhancements and identifying the underlying feelings. In this scenario, Vivian has been provided with non-verbal communication that restricts her expression of her inner concerns and questions. One of these is the entirely impersonal nature of the entire visit, while other aspects are the lack of medical information, lack of attention from the assistant and the doctor’s rushed up style in carrying out the examination. Moreover, no attempt has been made to identify her underlying feelings, although it appears that her underlying anxieties and tensions about her hitherto jobless state could have conceivably contributed to her stress levels and brought on the ulcer. Daniels defines empathy as “an emotional linkage between two or more people through which feelings are communicated; involves trying to imagine what it must be like to be in another person’s situation. (Daniels, 2004). But in this scenario, there is a lack of empathy for the patient, because the health care professionals are not interested in communicating with her but merely in rushing thorough their individual jobs as quickly as possible. The overall process of the visit to the clinic has been a rushed up procedure, where the patient spends more time waiting while worrying, and not enough time with the doctor himself. The impersonal nature of the environment and the attitude of the assistant and doctor dampen the communication process, which could be highly beneficial in the health care process and instead reduce the patient to a state where she is hesitant to voice any of her underlying problems for fear of taking up too much of the time of the health care professionals. Over and over again, the impersonal nature of the health care communication process has been emphasized in this scenario. There is too much concern about financial issues and not enough about health care issues. The message about the co-pay further communicates the message that the health care service is to be paid for and is a business arrangement where the patient is grudgingly being accommodated along with a long line of other patients. The reluctance of the assistant to discuss the patient’s problems or even to listen with empathy to a patient recital of her problems limits the degree of comfort and reassurance that the patient receives. The doctor’s verbal cues, i.e, talking very fast and going through the procedures mechanically without really paying close attention to the patient or providing a quiet reassuring atmosphere where they can discuss their concerns, signify a lack of concern for the patient. The scant importance the doctor pays to the views of the patient is revealed when he asks if she has any questions almost a san after-thought, when he is on his way out the door. It must also be mentioned however, that from the perspective of the health care professionals, stress and tension may not be completely absent. The necessities of maintaining insurance paperwork and medical records is an onerous chore that consumes a great deal of the time that these health care professionals should instead be devoting to communicating with the patients and providing them reassurance. It is quite likely that the need to complete the formalities may be a source of tension and stress for health care professionals, since most health care facilities are severely understaffed and over crowded with patients. Due to the sheer volume of patients that health care professionals in public health facilities may have to face, it may be logistically impossible for them to spare the time to communicate effectively with the patients Resolution: In the above scenario, no attempt that has been made to provide a more friendly, relaxing setting for the patients in the waiting room, or to adopt a les impersonal attitude. There is a noticeable lack of information being communicated to the patients in the doctor’s office, which further distances them, from the health care process. Researchers have highlighted the importance of providing health care information to patients. When health messages are posted up in the doctor’s office, for example about the need for regular mammograms in a gynecologist’s office or the need for and the schedule of immunizations in a pediatrician’s office, it serves the purpose of a public education campaign, which can change social climate and can promote awareness about diseases so that healthy behavior can be promoted through a change in attitude of members of the public.(Maibach and Parroet, 1995; Backer et al, 1992). The doctor’s attitude in particular demonstrates a lack of empathy, because a firm yet kindly manner where the doctor’s inner eagerness to complete the examination as soon is not so apparent, would have been much more helpful to Vivian. One important aspect of the health care communication process is reflection, which requires not only astute listening skills but also the ability to interpret non verbal cues in order to arrive at a correct interpretation of what the patient means (Antai Otong, 2003). The health professional makes certain assumptions about the real sources of conflict and anxiety in the patient’s life based upon the verbal and non verbal responses. Reflection then involves making statements based on the client’s comments in order to confirm those assumptions. Therefore in this scenario, the doctor would have been able to gain considerable insight into the source of Vivian’s health problems if he had taken the time to encourage her to discuss her problems, listened carefully to her comments and reflected upon her comments, so that he could have confirmed his medical diagnosis that an ulcer could have been at the root of Vivian’s problems. This would have been a much more positive experience for Vivian and could have alleviated much of her anxiety and stress, so that the doctor could likely speeded up the process of a cure. It would made her feel that the entire process was a little less impersonal and that the health professionals felt some empathy for her, instead of merely being concerned about the financial details such as co-pay and filling up the insurance papers and medical records. Secondly, the process of communication could have been improved right at the outset, by providing a friendly, relaxed atmosphere in the waiting room rather than a cold, clinical one. The color scheme in the room is a dull gray with black chairs, which in itself communicates a depressing atmosphere. Patients who arrive at the clinic are already depressed and anxious about their health, such a depressing environment is only likely to increase such feelings. Using a brighter color scheme would be more helpful. For instance if the walls are white, they can form an effective background to display posters and banners about health conditions and thereby the process of communication can start in the waiting room itself. The time that the patients spend in waiting can be used to educate them and make them more aware about basic health precautions, as well as dangers posed by certain diseases and preventive measures that can be taken. If this is also supplemented with free brochures on various health conditions, the patients are likely to gain useful information, instead of biting their nails and waiting anxiously to see the doctor. The lack of knowledge and unfamiliarity with the health care environment may itself be a cause of nervousness and tension in the patients and this could be relieved if their attentions are otherwise engaged and they are educated on health issues during the time that they are waiting. At the reception desk, as patients check in, the attitude of the assistant could be considerably improved through communication. Her non-verbal cues are daunting; but if she is trained to provide a friendly, reassuring smile and a word of comfort to the patients, it could considerably enhance the patient experience. The patient should not be made to feel that he or she is an unwanted intrusion into the clinic and is being accommodated grudgingly. While the assistant undoubtedly has to deal with a large number of patients, taking a moment to explain that she will soon see the doctor who will be able to assist with her problems, would go a long way towards reassuring the patients. The most important change that needs to occur is of course, in the attitude of the doctor. Rather than treating the patient as an impersonal case, a change in attitude on the part of the doctor with more empathy and patience is likely to be more effective. Conclusions: Communication is very important from the perspective of clinical outcomes because it involves a curative nurse-client interaction, reducing stress in both the nurse and the client and helping them to collaborate together effectively. It is an effective and critical tool that affects clinical outcomes. It is not merely the process of relaying and interpreting messages verbally; it also takes into account non verbal cues. It is a collaborative process between the caregiver and the patient in determining the source of patient anxieties and working together effectively to arrive at solutions to the problems. Communication also requires the active participation of the caregiver, who must possess the ability to deal with patient anxieties and accord them the level of importance that they deserve. Communication requires more than mere listening skills, it also requires the caregiver to interpret underlying messages being conveyed by the client in the form of non-verbal cues. The care giver must then clarify and reflect on what the client is really saying and then restate it to affirm whether the assumptions made on the basis of verbal and non verbal cues are indeed correct. Effective communication is critical because it can achieve successful clinical outcomes, while the lack of communication may negatively impact upon clinical outcomes. On the basis of the above, I conclude that in the scenario described above, there is a lot of scope for improvement of the communication process. Efforts must be made to enhance the communication skills of both the doctor and assistant, while the environment also needs to be made more pleasant and informational. There must be an effective process of patient-health care professional interaction, so that together they can arrive at the best clinical outcome for the patient. References: * Antai-Otong, Deborah, 2003. “Psychiatric Nursing: Biological and Behavioral Concepts”, Thomson Delmar Learning * Backer, T.E.; Rogers, E.M.; and Sopory, P, 1992. “Designing Health Communication Campaigns: What Works?”, Sage Publications. * Daniels, Rick, 2004. “Caring Fundamentals: caring and clinical decision making”, Thomson Delmar Learning * Maibach, E., and Parrott, R.L, 1995. “Designing Health Messages”, Sage Publications * National Cancer Institute, 1989. “Making Health Communications work”, Publication no: NIH-189-1493, Washington D.C: Department of Health and Human Services * O’Gara, Paula E and Fairhurst, Wendy E, 2004. “Therapeutic Communication: general approaches that enhance the quality of consultation”, Accident and Emergency Nursing, 12(3): 166-172 * Sears, Melanie, 2004. “Using Therapeutic Communication to Connect with Patients”, Home Healthcare Nurse, 14(8) :614-617 Read More