Communication is a means of exchange of information, as also a method of sharing ideas. Fundamentally it has three components – Speaking, Listening, and Non-verbal communication (use of posture, hands, eyes & gestures). We use words, vocabulary, emotion, enunciation, dialect, and our knowledge of the subject to speak and our ears and brain to listen. We tend to ignore the role of the non-verbal part of communication, despite research that emphasizes its role and value. Whilst the University of Pennsylvania’s research gives 70% of weightage to body language, the more commonly followed 7-38-55 rule gives it 55% weightage.
Communication follows a 7C formula – Complete, Correct, Concrete, Clear, Concise, Considerate, and Courteous.
However, in health care, poor communication is a bane as 65% of all sentinel events (JCACO 1995-2004) were related to poor or no communication and most complaints about doctors are related to communication errors. Research also indicates that as we progress from being medical students to senior consultants, our technical proficiencies certainly get enhanced but, in many cases, our ability to communicate well with our patients declines. 75% of wrong site, surgeries (Haynes etal, 2009), 60% of medication errors (Reader etal, 2006), 72% of neonatal deaths in obstetric cases (Leonard et al, 2004) & 30% of all malpractice suits in the United States (US) (2009-13) were a result of communication errors/deficiencies.
Health care is a complex field wherein communicating well is as great a necessity as learning the technicalities of the practice of medicine and surgery. Poor communication between colleagues, peers, and juniors, amongst doctors, doctor-nurse, and doctor-patient, and lack of communication and documentation during patient handovers are quite common and potentially harmful.
The quality of information recorded and conveyed, time is given to listening to the patient; (77% time doctors interrupt the patient’s initial statement and interrupt the patient once every 18 seconds (Beckerman & Frankel), improper communication using medical jargon like COPD, AMI, CHF, and TNM– words which the layman can’t understand, create a gap that causes distress and mishaps.
Whilst communication is (wrongly) attributed purely as an art, there is a science to it. Art is the most important part of “how” in communication but science is key in the “when, where & whom” part of communication. Tools like SBAR for structured communication in healthcare can help. SBAR stands for Situation, Background, Assessment & Recommendation. Even the United Airlines CUUS – Concerned, Uncomfortable, Unsafe, Scared – mode can be used in health care settings to good effect.
