Communication - The Key to Better Care
“The single biggest problem with communication is the illusion that it has taken place.” ― George Bernard Shaw
Health care is very complicated. For most patients the whole damn thing is a mystery. Their understanding of what you do and why, and what decisions they might have to make is very limited.
When health professionals communicate badly, bad things happen as a consequence. The Oxford Dictionary defines communication as “ The imparting or exchanging of information by speaking, writing, or using some other medium.” It is important to consider that communication is not just verbal in form. Up to 93 percent of communication is more affected by body language, your attitude, and
tone of delivery (1). That leaves only 7 percent of the meaning and intent based on the actual words said.
Time to Land the Fish
For most patients the essential reason they came to see you is the last five minutes of the consultation. All the value resides in that time. The equipment is very interesting and the questions can be tricky, but they want to know what you think about their vision, and what do you suggest should be done about it? You can’t spend enough time at this stage, and the more you can arrange the better. Don’t be tempted to rush it because you are running late. Remember what depends on this time:
Your future relationship with the patient
Their understanding of their vision problem and care
Their intention to complete or get the best outcome from the dispensing process
How well your support staff can continue the care process when the patient leaves the room
Prioritize Your Take Aways
The patient is not going to remember everything you said. You can expect a patient to remember and understand around 20% of what you said to them on a good day. It’s vital that they remember the most important 20%.
The human brain sometimes gets stuck at the first obstacle. The patient struggles to understand, but the message continues and more points keep coming.
Pick what you want to say first carefully. Make it the most important point, then stop and make sure the patient understands. A useful protocol used by many emergency services is STICC:
Situation: Here's what I think the problem is
Task: Here's what I think we should do.
Intent: Here's why.
Concern: Here's what we should keep our eye on.
Calibrate: Talk to me. Tell me if you don't understand, or you are worried about anything, or see a problem I might have missed.
If you have covered a few points in your discussion it is worth summarising and reiterating those important parts, and make clear, concise and positive recommendations.
Make Sure We Are Consistent
In healthcare research, twenty percent of patients reported inconsistent or conflicting information from different professionals.
You have to make sure that everyone in the practice is using the same terms, language, and the messages are consistent for each patient. Taking to your staff about this and engaging them in your consultation process is vital. Most staff have experienced a consultation, but that’s not enough. You need to have them sit with you like a student, and hear what you say and why. They need to understand what decisions you make and why, and how you explain this to a patient.
Make sure they are clear about key terms and messages. Do we need to say again how important handover is for consistent communication?
Lessons From the Paratroops
The US Army 82nd Airborne Division suggests the following points for effective communication in critical briefings:
1. Put your main point up front
2. Use active voice
3. Use short, conventional words
4. Keep sentences short (about 15 words average)
5. Be confident, be correct, be credible, be complete
These people need to be consummate communicators. Second best will get someone killed.
Active Voice
In a sentence delivered in the active voice, the subject of sentence performs the action.
Active: Carelessness caused the accident
Passive: The accident was caused by carelessness
Hard Copy the Important Bits
Psychologists have found that resting after hearing important messages improves retention. But what happens to our patients? We send them into the dispensing process.
If you can, provide the patient with information in a take-home format.
Use the health information brochures. Most practices never give them out.
Have a simple check list to tell the patient what you did, and what you found.
Make sure your web site covers all the important information patients need and direct them to it.
Practice It
Changing what and how you do things in the consulting room is not easy. We develop pretty ingrained routines and behavior’s. Think about what you are doing and saying today, and change one thing. Don’t throw the baby out, but do make a change and everyone will get better results.
1. Allesandra T, O’Connor M. The platinum rule: discover the four basic business personalities and how they lead you to success. New York: Warner Books; 1966
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