Health communication is a relatively young discipline. It seeks to meet the needs of a patient and, at the same time, the goals of the care giver. Author R.C. Cantor ably reinforces the need for effective health communication with the following statement: "Illness induces uncertainty ... and with the uncertainty comes the loss of control, which in turn leads to feelings of fright, anger, helplessness, and incompetence." Only by the ability to communicate can people influence the events in their lives.
The success or failure of any practice can be traced to how the doctor and patient communicate. Put another way, the measure of how well doctors communicate with their patients can best be gleaned by noting their ability to recognize and accurately interpret a wide range of verbal and nonverbal cues. Experts agree that human communication is the singularly most important tool doctors have in providing health care to their patients. It has also been suggested that good doctor/patient communication lessens the number and cost of malpractice suits.
The moment a new patient calls your office for an appointment, communication begins. The tone of voice employed by your nurse or receptionist, the exact words she uses, and the manner in which she phrases her response could easily please or offend that new patient. In essence, along with a number of other forms of communication, those at the front desk are an extension of you. Before you ever get to see that new patient, impressions have been formed.
What makes up a practice? While physical entities such as your office, your shingle, your ad in the Yellow Pages, your appearance, your staff, equipment, and methods of treatment are all amenable to the senses -- your reputation and credibility are not. These phenomena are elusive to the senses. Hence, if a practice is failing, where does one look for answers? The contention here is that only a serious evaluation of your health care communication can provide information leading to solutions.
Psychologists suggest that it is difficult for people to contend with a clear-cut picture of themselves as they really are. Since the ego in a great many people is often fragile, one of the last things they do is hold themselves responsible for their failures. They invariably rationalize by blaming everything and everyone else but themselves.
For years, the doctor's persona has been dictated by film makers. Only recently have they allowed the doctor to be portrayed in more realistic and contemporary terms. In the 1940s, 50s, and 60s, the prototype of a doctor was Marcus Welby, M.D. -- typically a man in his 50s, graying at the temples, smoking a pipe, and wearing a sport jacket with patches on the sleeves. Many current soap operas still cling to that image. This stereotyping of the doctor has created a mental picture in the public mind. One must look like a doctor; your appearance most certainly communicates something about you to your patients. John Malloy, recognizing this, wrote a book titled, Dress for Success. Indeed, making the right first impression is crucial.
Communication is definitely more than just talk. It embraces not only people, but also their environment -- the many aspects that comprise their lives. When you treat Mrs. Jones for her sciatic neuritis, it is important to also realize that her cat, Oliver, plays an important role in her life. Therefore, if you wish to establish a positive rapport with her, your treatment must include an awareness and recognition of her cat. Bear in mind, mutual interests build bridges; differences build walls.
When illness strikes, people turn to doctors for help. Adults, many of whom are accomplished and distinguished in their field, are often treated like children when they are hospitalized. A hospital is one of the few places where an individual forfeits control over virtually every task customarily performed. Health care professionals who fail to recognize this infraction of ethical communication do their patients a profound disservice. A patient's dignity and self-esteem must, at all costs, be preserved; patients must, for example, be referred to by name, not by the condition for which they are being treated. This same policy should, naturally, carry over into the doctor's private practice.
Aside from the adjustment which makes the doctor of chiropractic unique in the health care field, there is still another area of distinction -- chiropractors intuitively communicate with their patients. They take the time to explain things, to listen to their patients. Many medical practitioners have earned just the opposite reputation; i.e., they say very little and communicate poorly. Perhaps the reason doctors of chiropractic are better communicators results from the laying on of hands -- a procedure that helps establish a bond facilitating a more meaningful exchange of concerns.
Meaningful communication, from the standpoint of both patient and doctor, must include five essential constituents: empathy, control, trust, self-disclosure, and confirmation. Empathy surpasses sympathy in that it prompts the doctor to figuratively put himself in the patient's shoes -- to genuinely feel for the patient. Control is where the doctor and patient share, equally, in any decision making related to the proposed treatment. Trusting the doctor helps patients cope with the fears and uncertainties of illness. Self-disclosure by the patient enables the doctor to reliably monitor psychological and physiological responses. Confirmation refers to the communication that allows others to value themselves more fully and, in turn, better cope with feelings of depersonalization, rejection, and alienation.
To my knowledge, none of the accredited chiropractic colleges on whose faculty I have served offered a separate and required course in communication. While it must have been touched upon in connection with various courses, it did not appear to warrant a separate and distinct place in the curriculum.
In the articles to follow, various aspects of health care communication will be discussed. Whenever possible, their relevance will be keyed to chiropractic and those who practice it. I trust they will provide the reader with a heightened sensitivity to the critical role communication plays in health care.
Abne M. Eisenberg, D.C., Ph.D.
Croton On Hudson, New York
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