The Greatest Skill We Have: Communication in Clinical Settings

It is known that if clinicians communicate well they are more accurate, they drive greater satisfaction, patients are more likely to follow advice, and patients’ anxiety and stresses are lessened.

So, in this week’s Clinical Insight we consider some of the findings from studies that identified behaviours and actions in clinicians that do the opposite, plus what we might do to change.

The Power of Listening and Offering Empathy 

It is tough to help explore with patients when there is an emotional component that the individual is finding a challenge, and opening up to the clinician is not an easy task. Clinicians also may become nervous in moving to the spaces in conversation that are emotional and therefore can sometimes block that themselves, as a form of protection.

Switching a topic back to a medical model and focusing on physical elements, explaining away distress as “normal” and offering advice and reassurance when the main problem is yet to be understood, whilst “jollying” along through a tough consultation: these are errors that we can avoid.

When patients report long term low back pain as opposed to short term symptoms, clinicians can be seen to not offer appropriate empathy, offer poorly constructed information, and not be able to understand the patient perspective (Gulbrandsen et al 2010). If we know this, it’s important to focus on the good stuff as it will support a better outcome. Seems obvious, but it is easy to fall into patterns of behaviour when we are tired, overworked and stressed, to protect ourselves; which will limit how we help others.

When asked for their perspectives on a consultation regarding low back pain, patients will report that listening and showing empathy are key skills. Clinicians understanding how the patient’s experience is unique to them, and therefore ensuring the approach is tailored, are further key elements of improved outcome. Some patients report a value in a clinician offering a shared experience and really wanting their pain experience to be validated. Patients also want a thorough examination and if they do not receive it, a good explanation as to why (Evers et al 2017).

The Impact of Interrupting and Negative Language 

As we communicate with patients, physiotherapists are seven times more likely to interrupt than patients (Roberts et al 2018), whilst negative language can directly lead to higher anxiety and illness beliefs and communication faults such as “your muscles are weak” can lead to the anticipation that something negative will happen, along with a subsequent loss of confidence (Linskens et al 2023).

So, if we know these things how do we as clinicians improve them? This is an enormous question and one we cannot expect to answer simply, however let’s consider some macro, meso and micro elements that could be considered.

Communication on a Macro Scale 

Why might on a macro scale communication be challenged in clinicians?

Hierarchy, role ambiguity, conflicts within a service and with external partners, concern over competency, work stresses, lack of feeling in control, the list could go on will all be impactful. As individuals we might look at our body language (inflections, information delivery) but of course with clinicians’ own personal and professional lives having an enormous effect on outward personality and expression, these factors (many cannot be changed) will come into effect.

To allow the clinician to feel “comfortable” and ready to be a great communicator, we need to understand ourselves and these factors. It surely just doesn’t switch on and off irrespective of what’s going on and so preparing a mindset for the task ahead, such as communicating with distressed individuals, will be a key self-management tool (for clinicians).

So, clinicians have to apply some sort of acceptance model towards these factors to allow them the space to communicate.

Meso and Micro Factors Affecting Communication 

Meso factors such as training, feedback, and having time to reflect and grow will generate a better communicator. Then micro, the real “skills” of the task, although described as micro they are perhaps the most important elements.

The style, the natural empathy and validation, the non-verbal cues to encourage an open conversation, the ability to open up rather than close down, the skill of creating narratives of explanation that both can agree upon, are all essential characteristics.

The ability to offer kindness and do that time and time again, irrespective of the emotional situation being addressed, is probably the easiest way to describe the great communicators.

“They were really kind”- how often do you hear that?

So perhaps starting with “Be kind” if you don’t know what communication style or approach to take, will be the safe option when wondering “how do I improve my patient communication?” Add this to understanding the clinicians’ own “yellow flags” and contextual effects on how we act, could be vital when trying to improve and celebrate the greatest “skill” we have.

References 

Evers, S., Hsu, C., Sherman, K.J., Balderson, B., Hawkes, R., Brewer, G., La Porte, A.M., Yeoman, J. and Cherkin, D., 2017. Patient perspectives on communication with primary care physicians about chronic low back pain. The Permanente Journal, 21.

Gulbrandsen, P., Madsen, H.B., Benth, J.S. and Lærum, E., 2010. Health care providers communicate less well with patients with chronic low back pain–a study of encounters at a back pain clinic in Denmark. Pain, 150(3), pp.458-461.

Linskens, F.F., van der Scheer, E.S., Stortenbeker, I., Das, E., Staal, J.B. and van Lankveld, W., 2023. Negative language use of the physiotherapist in low back pain education impacts anxiety and illness beliefs: A randomised controlled trial in healthy respondents. Patient Education and Counseling, 110, p.107649.

Roberts, L.C. and Burrow, F.A., 2018. Interruption and rapport disruption: measuring the prevalence and nature of verbal interruptions during back pain consultations. Journal of Communication in Healthcare, 11(2), pp.95-105.