Initially, there are three types of communication skills: content skills, process skills, and perceptual skills. Content skills refer to the knowledge a person or healthcare professional communicates and all the information discussed. How this information is communicated, the verbal and nonverbal skills involved, and the way it's constructed, arranged, and delivered to the receiver refers to the process skills. As for perceptual skills, they describe a person's initial thoughts and perceptions, their intrinsic reasoning, intentions, decision-making skills, and problem-solving skills. In medicine, it relates to clinical reasoning and the beliefs and thoughts about a patient and their illness. Most people's perception issues are due to stereotypes, distortions, or even their own biases leading to an error in judgment and reasoning.
Research domains such as linguistics, psychology, and philosophy of language attempt to understand the act of communication and its associated problems. Although humans use the same communication code, problems frequently occur since we tend to interpret information differently depending on our mental attitudes and abilities. A pivotal factor in establishing advantageous communication is choosing the language or terminology used appropriately in order to minimize misunderstandings. For instance, in medicine, it is preferable to avoid the use of medical terminology, like saying epistaxis instead of a nosebleed, when communicating with patients and their family members to prevent misunderstanding, confusion, or even anxiety in the patient. Moreover, the words communicated, signs and body language, visual elements presented, and formally written messages are also vital in communication. These aspects are termed verbal communication, non-verbal communication, visual communication, and written communication, respectively. Verbal communication is the incorporation of words to interact and share information with other people. It includes both spoken and written communication. It basically refers to the words chosen and how they're interpreted and analyzed by people. On the other hand, non-verbal communication describes the signs, facial expressions, tone of voice, eye contact, whether lacking or in excess and body language. In a nutshell, it is communication without the use of words or language. It is just as important as verbal communication and says a lot about how one feels about a conversation or interaction. Avoiding eye contact deems a person unconfident or relatively uninterested, while crossed arms suggest defensiveness. Therefore, when a doctor communicates with a patient, it is beneficial they remain alert, maintain proper posture and just the right amount of eye contact, enough to convey interest in the patient's concern and not mistake it for personal interest in the patient. Visual communication is the delivery of a message through the use of visual elements, such as graphs, charts, animation, and graphic design. This is particularly useful in medicine when a doctor attempts to explain a medical condition his/her patient is suffering from to allow them to comprehend their illness better and ultimately make better decisions regarding their care. Lastly, written communication is the act of dispatching messages through letters, internet websites, reports, etc. It is mainly used in formal situations, as when a junior resident writes to the chief of surgery. All of the following types of communication must be carried out favorably in order to minimize misunderstandings while communicating.
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Understanding and conducting the communication cycle appropriately is the first step in obtaining effective communication skills. The communication cycle expresses how the system of conveying and understanding messages operates. It includes seven main elements, which are the sender, message, encoding, channel, receiver, decoding, and feedback. The sender initiates the conversation with an idea of a message. It could be an urgent piece of information, suggestions for future plans, or expressing feelings and emotions. He/she then decides the content of the message, the channel of transportation, and who the receiver is. They will then encode this thought in words or symbols to be decoded by the receiver. Recalling the language barrier issue is vital in this step. The language the message is expressed in should match the recipient's knowledge. Additionally, body language also plays a role in the encoding process.
Certain behaviors, such as getting too close or keeping direct eye contact, may affect how the receiver perceives a message due to cultural differences. The channel is the means by which the message is sent, and it can also affect the end result. Different channels include face-to-face contact, telephone, e-mail, formally written letter, broadcasts, etc. Some messages are better received when delivered in person, like the passing away of a close family member or friend. Furthermore, the sender must take into consideration their skill when choosing a channel as well as the receiver's skill in using the channel. Another aspect is the environment the communication takes place. A noisy environment or inaccurate reception may hinder understanding and cause inattention and distractions. The decoding process begins when the receiver receives the message and attempts to understand it and interpret it according to his/her own knowledge and beliefs. The message is broken down into two parts, the content, and context of the message. Content refers to the material contained within the message, such as the words or symbols used. Different terms may be interpreted differently by other people, which could possibly arise in misunderstandings. Context relates to the positioning of the communication. It can be formal or informal. A message is never fully communicated unless it's fully understood by the receiver. However, some people may lack the effort to ask for clarification or are simply too timid to ask. Therefore, it is required to request feedback from the receiver. This helps the sender know whether or not the message is communicated effectively. The feedback stage is fundamental and includes five categories: evaluation, interpretation, support, probing, and understanding. Evaluation is judging the appropriateness and worthiness of a message. Interpretation is the rewording and phrasing of the message in an attempt to explain the message. Support is aiding and backing up of the sender. Additional inquiries about the topic and elongation of the communication process are termed 'probing.' Lastly, understanding is the uncovering of the true purpose and meaning of the message. The communication cycle must be followed thoroughly, and every step should be thought out meticulously to achieve a smooth and effective communication process.
It is important to reiterate that while all professions and fields of education require effective communication skills, its highest significance comes in the field of medicine. All healthcare professionals are required to attain efficacious communication skills, not just social workers and psychologists. The twenty-first century brought a shift in patient care from paternalism to autonomy, the latter stating that patients have full autonomy over their healthcare decision and treatment plan, even if it's contrary to his/her best interest in a healthcare professional's perspective. This resulted in hospitals encouraging history taking at the patients' bedside rather than at the nurses' station, as it helps ensure patients that they're being involved in their care and encouraged to participate in the decision-making process regarding their treatment plan.
The patient must choose the course of treatment they know suits them best, and doctors must help them do so by addressing their concerns with empathy, compassion, understanding, and a non-judgmental approach. However, before the twenty-first century, medicine was ruled by a paternalistic attitude, suggesting that the doctor knows best what's required for the patient, and the patient has no say in his/her care. Patients were not seen as people with ailments, but as symptoms that needed fixing. This was obviously a major flaw in the art of medicine, as communication is its heart. Focusing on a patient's physical symptoms may not uncover the underlying issues they may be facing. They could have social or psychological problems that they may refrain from addressing unless they're questioned about it. Disregarding these factors may result in the doctor prescribing treatment that isn't appropriate to this specific patient. This leads to the patient neglecting the prescribed medication or treatment and lack of compliance with the doctor's recommendation due to a lack of trust. Hence, it's important to be able to connect with the patient and communicate effectively with them to gain their trust, as they will only open up if they are comfortable enough, enhancing the chances of diagnosing their ailments correctly and ensuring they comply with their medications. On top of that, when communicating with patients, it is necessary to follow up with their pace of information absorption from the doctor, as delivering a large chunk of information without being able to give feedback may result in confusion, anger, anxiety, and even depression in some patients. The patient must be given a chance to comprehend the new information and ask about any uncertainties they may have. In addition, a physician's lack of attention towards his/her patient causes them to feel reluctant to disclose their personal information, which could be the key to discovering their illness.
Therefore, the physician must direct his/her attention solely towards the patient, encouraging them to discuss concerns they may otherwise feel uneasy discussing due to self-conscious emotions such as shame, guilt, or embarrassment. Communicating with patients allows them to predict the outcome of their care. For instance, informing them about the recovery period and level of pain following the surgery has proven to result in faster recovery time and less post-operation pain. This, in turn, improves physician-patient satisfaction, recall, understanding, and overall health outcome of the patient.
While effective communication is required by all healthcare members, its most critical role applies in medical emergency management, as it is complex and fragile. These situations require rapid and coordinated responses by medical experts. Therefore, effective communication is the key to the efficient functioning of resuscitation teams and the trauma department. According to a study, 43% of medical errors and miscalculations are caused by miscommunication or lack of communication. Resuscitation teams must follow a specific algorithm when performing cardiopulmonary resuscitation (CPR). CPR is a lifesaving technique used in emergencies, such as myocardial infarction (MI) or when rescuing a near-drowning person. Paramedics provide onsite basic life support for CPR. They perform chest compressions, artificial respiration, and, if available, use a portable defibrillator machine to restore the heart rhythm. They must work in coordination, and assigning roles for the team members help speed up and improve the process. During CPR, medicines are usually administered intravenously, adrenaline after the third shock, and amiodarone after the fourth if the pulse is still unavailable. Any miscommunication that results in inappropriate administration of these drugs could have dire consequences.
Consequently, perfect communication is crucial in these situations. When it comes to trauma cases, there are three main communication obstacles in the emergency department: the experimental parameter (process), the interpersonal parameter (physician's engagement with patients and other physicians), and the contextual factors (time pressures). The experimental parameter discusses the issues that develop due to the rapid exchange of information of admitted patients to the emergency department regarding their condition, diagnosis, and treatment, resulting in inconsistencies in medical records. A common mistake observed in these situations is forgetting to give a prescribed medication to the patient. For instance, if a member of the medical team in the trauma room was instructed to hand pre-medication prescribed by a doctor to the staff in the operation theatre but forgot to do so due to the rush, it could result in an unnecessary delay of administration or unfortunate death. Therefore, lack of communication and the unavailability of medical records reduces the quality of healthcare. As for the interpersonal parameter, it involves the relations of physicians with patients and other physicians in the emergency department. The main objective of these interpersonal connections is to upgrade the calibre and safety of the patient's healthcare. Physicians must be able to establish rapport and empathy when engaging with patients. These skills help build trust and develop a mutual understanding of both the physician and patient's perspectives. Issues arise in this field when physicians fail to establish rapport and empathy with patients. While these concepts are fundamental to patient care, the emergency department's central priority is the patient's safety. The instinctive move is to administer treatment instead of thinking about how to empathize with the patient due to time limitations. It is challenging for emergency physicians to build relationships in a brief period of time since the workload is high, and the patient load is boundless. On top of that, they simply see no point in establishing a positive relationship, as they won't see the patients again.
Hierarchy issues within hospitals have also proven to be a major setback in patient care. Junior doctors and nurses look up to senior doctors for diagnosis and treatment plans. However, some senior doctors may be unapproachable, leading to reluctance in junior doctors and nurses in requesting clarification about concepts they're unsure of. Hence, to avoid a clash with their senior doctor or avoid appearing weak in front of them, they choose to neglect their uncertainties. Sometimes, some senior doctors are overconfident with their prognosis that they may miss minor details, which could be life-threatening. To illustrate, a doctor may miss a fracture or provide the same medication, regardless of whether or not it alleviates the patient's symptoms, simply because they're too confident with their decision and refuse to be told otherwise. This is why it's always necessary for juniors to be able to consult their seniors with any doubts. Last but not least, contextual factors bring up the issues of time pressures and patient-doctor ratios. Patients arriving in the emergency department tend to have high expectations about their care and can be demanding. Unfortunately, in some areas like Hong Kong, there is a significantly high patient attendance rate compared to the insignificant doctor attendance. This load on doctors causes them to work long hours with little to no sleep at night, making them less capable of handling patients and more susceptible to errors. Furthermore, because of the lack of time, each patient gets minimal attention and is only provided with the most basic information about their healthcare.
This brief explanation leads to agitation in patients and causes them to behave impulsively and inappropriately within the emergency department, thus inflicting damage on other patients and jeopardizing them. Lowering the patient-doctor ratio could make a great impact on communication in medical emergencies. Hospitals could ensure enough doctors and nurses are available, especially at peak times, easing the load on the doctors and allowing them to communicate with their patients efficiently. Overall, it is compulsory to consider these three areas of communication and work on mastering them while working in the emergency department.
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