Health Care Communication
A Different Question Leads to New Solutions
The ability to communicate effectively with patients from diverse backgrounds with different needs, abilities, values, and preferences is a critical skill for all health care providers. It is also a critical factor in ensuring patient safety, a good patient experience, and optimal patient health outcomes. Despite the importance of effective patient-provider communication, it can be very difficult to know if this has actually occurred. As William H. Whyte wrote: “The great enemy of communication … is the illusion of it.” That is, health care providers might think that they have had an effective health care conversation with a patient, in that they explained the diagnosis clearly, or provided clear instructions about the treatment, only to discover days, weeks, or perhaps months later, that effective communication had not taken place at all.
Effective patient-provider communication can be difficult in any situation; however, health care providers often find it particularly challenging when patients are communicatively vulnerable. People who are communicatively vulnerable in health care conversations are those with a different cultural, language, or ethnic background from their healthcare provider, who have low literacy, low health literacy, and/or communication disability. 1 Any one of these patient-related factors increases the risk of ineffective patient-provider communication and subsequent poor outcomes.
What Can Health Care Providers Do?
A common approach is to locate the source of the communication breakdown within the patient. That is, the health care provider thinks communication was unsuccessful because the patient could not [hear, attend, understand, remember, read]. Identifying the source of the problem within the patient leads to solutions to “fix” the patient. That is, we start to think “if the patient could [hear, attend, understand, remember, read] better, then I wouldn’t have a communication problem.” If no “fix” is possible, then we assume that there is nothing more that we can do.
However, if we think about effective patient-provider communication as the outcome of an interaction between two communication partners—that is, as the outcome of an interaction between the health care provider (and their knowledge, skills, attitudes, and resources) and the patient (and their knowledge, skills, attitudes, and resources), then the source of the communication breakdown is located within the interaction. Framing the issue in this way creates a different question and a different set of possible solutions.
The question shifts from “how can I fix the patient?” to “how can I support the interaction with this patient?” Health care providers need to be knowledgeable, skilled, and resourced to support health care conversations with patients who are communicatively vulnerable. They need to know that a patient is communicatively vulnerable, they need to know how to tailor their communication to match the patient’s communication needs, to recognize when communication has broken down, and they need the skills and resources to repair it. Despite this, most education and health care systems do not equip health care providers with the requisite knowledge, skills, and resources to enable them to communicate effectively with communicatively vulnerable patients.
The Inpatient Functional Communication Interview: Screening, Assessment and Intervention (IFCI:SAI) 1 is a set of clinical tools that has been developed for speech-language pathologists and other health care providers working in the hospital setting, to help them support communicatively vulnerable patients in health care conversations. These tools guide clinicians to ask: “How can I support the interaction with this patient?” That is, if:
· the patient has difficulty hearing, then the clinician might consider supporting the interaction by offering an assistive listening device, reducing background noise, or working to change the acoustic environment of the ward.
· the patient has difficulty attending, then the health care provider might be able to support the interaction by closing the curtains, turning off the TV, or reducing other visual or auditory distractions.
· the patient has difficulty understanding, the health care provider could reduce the complexity of his or her language, or add gestures and/or picture supports to aid the patient’s comprehension.
· the patient has difficulty remembering, the clinician might use the teach-back or show-me methods,2 provide the patient with a written summary of what was discussed, or encourage the patient to have a support person with them during important health care conversations.
· and if the patient has difficulty reading, the health care provider might ask the health service to create written health care information that is easier to read, 3 and might decide to work through the written information with the patient. 4
Viewed as an interaction, there is so much more that health care services and health care providers could do to support patients who are communicatively vulnerable in health care conversations. Given the right support, communicatively vulnerable patients and their health care providers would know when effective communication had taken place and would not be left with an illusion.
1 O’Halloran, R., Worrall, L., Toffolo, D., & Code, C. (2020). Inpatient functional communication interview: Screening, assessment, and intervention. San Diego, CA: Plural Publishing Inc.