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Communication Skills: From practice, self-knowledge, reflection, and common sense.

Communication skills are strenuous to teach or describe. We may encounter so many possible situations that make it arduous to draw rules or guidelines. Actions also instinctively depend on the personalities present – both yours and the patient.

We’ve garnered a few advice from several communication texts. We present them to you. These rules don’t set the bar – they help you uncover the various ways you may tackle the same situation. Ultimately, skill at communication comes from practice, self-knowledge & reflection and a large amount of common sense.

Over the years, experts have discussed various communication models of practitioner-patient encounter in detail. Even though the models target the hardened student of communication, we’ve mentioned some here so you can know they exist.

For the biomedical model, the health care provider accounts for the consultation and examination, and the focus is on managing the disease. The patient-centred model addresses the whole patient. Both the health care provider and the patient share power and decision making.

In recent years, we’ve acknowledged that the patient has a unique experience of the illness. It entails the social, psychological and behavioural effects of the disease. It is the patient-centred model (bio-psychosocial model).

Let’s note the salient points in the patient-centred model.

Explore the disease and its patient’s experience: This involves understanding the patient’s ideas and feelings about the illness, the quality of life and psychosocial well-being affected, and the expectations of the encounter.

Understand the whole person: his or her family, social and work environment, and beliefs. Find common ground on disease management and establish the clinician-patient relationship. Be realistic in treatment priorities and resources.

For confidentiality, as a doctor, health-care provider, or a student, you are party to personal and confidential information. While we must follow local or regional regulation on confidentiality, we can break it in a few exceptional situations. We should understand this.

The essence of everyday practice has been – never telling anyone about a patient unless it concerns his or her care with permission. It includes relatives, which can be very difficult at times, particularly if a relative asks you directly about confidential information. You can reinforce the importance of confidentiality to relatives and visitors. If the relative requests that you to speak about a patient, approach the patient first and ask their permission, within full view of the relative.

This rule also applies to friends outside of medicine. As care providers, we come across bizarre, amusing, or uplifting stories daily, but like any other kind of information, don’t share them with anyone. If you intend to use an anecdote in public, as a bare minimum, you should ensure that your story identifies no one involved. If you are in a small community, don’t share anything, lest you undermine your reputation as a professional.

Essential Considerations about communication include attitude, timing, setting, and personal appearance.

Attitude: patients are entrusting their health and personal information to you, they want a confident, approachable, competent, and, above all, trustworthy person.

Timing: if in a hospital setting, ensure that your encounter with a patient is not during an allocated quiet time or disturbing to the patient’s roommate. You should also avoid mealtimes or when the patient’s missing relative has just come to visit.
If you plan to move the patient from the bed to an exam room, ask the supervising doctor (if not you) and the nursing staff, and inform all the concerned your whereabouts in case they need the patient.

Setting: students, doctors, and other medical providers tend to see patients on hospital floors filled with distractions that can break up the interaction. Often, such meetings are necessary during the day. However, if you need to discuss a vital matter that requires concentration from both of you, consider the following conditions:
 The room should be quiet, private, and free from disturbances.
 There should be enough seating for everyone.
 Have comfortable chairs for an extended conversation.
 Arrange the seats close to yours, with no intervening tables or other furniture.

Personal appearance: first impressions count and studies have consistently shown that your mien (clothes, hair, makeup) considerably affects patients’ opinion of you and their willingness to interact with you. Part of that intangible professionalism comes from your image. The white coat is still part of the medical culture for students and most providers. Fashions in clothing change rapidly, but some basic rules still apply:

 Neutralize any extreme tastes in a fashion that you may have.
 Men and women should wear appropriate professional attire.
 Women may wear skirts or slacks, but the skirts’ length should not raise any eyebrows.
 Necklines should reveal nothing—no decolletage!
 Cover the belly—no bare midriffs!
 Cover the shoulders.
 Polish the shoes – clean them always.
 Wear clean surgical scrubs, if appropriate.
 Conservatively style up the hair. Wear long hair tied up.
 Have your name badge visible, even if you don’t like your picture.
 We best hold the stethoscopes in a coat pocket—worn at the neck is acceptable, but somewhat less pretentious, according to some views.
 Try not to tuck items in your belt—use pockets or belt-holders for cell phones, keys, and wallets.

Psychiatry, paediatrics, and a handful of other specialities require a different dress code, as they deal with patients who require differing techniques for bonding with the health-care professional.

As in all aspects of medicine, learning is a lifelong process. One part of this process, particularly in acquiring communication skills and at the beginning of your career, is watching others. Take every opportunity to observe provider-patient interactions.

Request to be present during difficult conversations. Instead of glazing over during clinic visits or on rounds, you should watch the interaction and consider if the behaviours you see are worth emulating or avoiding. Consider how you might adjust your future etiquette. Select the actions and words you like and use them as your own, building up your repertoire of communication techniques.

Related article: Violence against women: What can you do!

When you watch an eloquent communicator, you will see them making friendly conversation and spontaneous jokes, and using words and phrases that put people at ease. The conversation seems natural, relaxed, and spontaneous. Watching that same person interact with someone else can shatter the illusion as you see them using the same “spontaneous” jokes and other gambits from their repertoire.

It is one of the keys to stellar communication—an ability to judge the situation and pull the appropriate phrase, word, or action from your internal catalogue. If done well, it leads to smooth interaction with no hesitations or misunderstandings. The additional advantage is that your mental processes are free to consider the next move, mull over what you have said, or assess the findings, while externally you are partially on autopilot, following a familiar pattern of interaction.

During a physical examination, this ability is particularly relevant. Coax the necessary actions from the patient and put them at ease while considering the findings and your next step. It is not the same as lacking concentration— quite the opposite.

All that said, skill at communication comes from practice, self-knowledge & reflection and a large amount of common sense. No book explains communication skills better than Hutchison’s clinical methods.


MBChB (MUK), Graduate Fellow, Department of Physiology, Makerere University Founder and Content Creator Peer reviewer, Associate Editor

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