UNIVERSITY COLLEGE SHAHPUTRA

FACULTY OF ALLIED HEALTH SCIENCES

PATIENT COMMUNICATION

Subject Code: MKP 1121

Name of Student: MUHAMMAD AMIR FAIZ BIN ZAKARIA

Matric No: SP51213037

IC. No: 950405-01-6107

Name of Lecturer: MR AB. HADI H. ISMAIL

 Introduction to Doctor-Patient communication

Patient-physician communication is an integral part of clinical practice. When done

well, such communication produces a therapeutic effect for the patient, as has been
validated in controlled studies. Formal training programs have been created to
enhance and measure specific communication skills. Many of these efforts, however,
focus on medical schools and early postgraduate years and, therefore, remain
isolated in academic settings. Thus, the communication skills of the busy physician
often remain poorly developed, and the need for established physicians to become
better communicators continues. In this article, the authors briefly review the why
and how of effective patient-physician communication. They begin by reviewing
current data on the benefits of effective communication in the clinical context of
physicians caring for patients. The authors then offer specific guidance on how to
achieve effective communication in the patient-physician relationship.
The manner in which a physician communicates information to a patient is as
important as the information being communicated. Patients who understand their
doctors are more likely to acknowledge health problems, understand their treatment
options, modify their behavior accordingly, and follow their medication schedules. In
fact, research has shown that effective patient-physician communication can improve
a patient's health as quantifiably as many drugsperhaps providing a partial
explanation for the powerful placebo effect seen in clinical trials.

Decades ago, physicians were presumed to hone their soft communication skills at
patients' bedsides, in their rounds as residents, and as students at the elbows of
master clinicians. Today, the communication and interpersonal skills of the
physician-in-training are no longer viewed as immutable personal styles that emerge
during residency but, instead, as a set of measurable and modifiable behaviors that
can evolve. Based on emerging literature on the value of effective communication,
medical students and postgraduates are increasingly given instruction on techniques
for listening, explaining, questioning, counseling, and motivating. As such techniques
are central to delivering a full and tailored health prescription, 65% of medical
schools now teach communications skills. Training in patient-physician
communication is also now objectively evaluated as a core competency in various
accreditation settings, including the Comprehensive Osteopathic Medical Licensing
ExaminationUSAPerformance Evaluation, the United States Medical Licensing
Examination, and the American Board of Medical Specialties' certification.

These efforts to improve and measure communication skills are timely, as the
barriers to effective communication between patients and physicians are growing
.Despite evidence indicating that the average length of the patient-physician
encounter has not changed significantly in recent years, specific survey data
indicate a correlation between patient participation in capitated health plans and
shorter office visits.Further, hurdles arising from linguistic and cultural differences,
already abundant, will only increase in coming years. Medical information and
support groups found on the Internet, while potentially a great asset in educating and
motivating patients toward better health, have many physicians questioning their
traditional role as most trusted counsellors.However, even demands associated with
time, language, and technologyas Internet-available information, which potentially
limits face-to-face opportunitiesare not an excuse for neglecting one's
communication skills. During the typical 15- or 20-minute patient-physician
encounter, the physician makes nuanced choices regarding the words, questions,
silences, tones, and facial expressions he or she chooses. These choices either
enhance or detract from the overall level of excellence of the physician's delivery of
care.

Definition of communication

Communication is the activity of conveying meaning through a shared system

of signs and semiotic rules.
In the realm of biology in general, communication often occurs through visual,
auditory, or biochemical means. Human communication is unique for its extensive
use of language. Non-human communication is studied in the field of biosemiotics.

Purpose of communication

Purposes of communication is to:

1. Expression of needs and want to regulate the behaviour of another person

to get something.

2. Information transfer to convey information from person A to person B

3. Social closeness to establish and maintain relationships with others

4. Social etiquette to conform to the social conventions of politeness.

 Types of communication

Nonverbal communication

Nonverbal communication describes the process of conveying meaning in the form

of non-word messages. Examples of nonverbal communication include haptic
communication, chronemic communication, gestures, body language, facial
expression, eye contact, and how one dresses. Speech also contains nonverbal
elements known as paralanguage, e.g.rhythm, intonation, tempo, and stress.
Research has shown that up to 55% of human communication may occur through
non verbal facial expressions, and a further 38% through paralanguage.[2] Likewise,
written texts include nonverbal elements such as handwriting style, spatial
arrangement of words and the use of emoticons to convey emotional expressions in
pictorial form.

Verbal communication

Effective verbal or spoken communication is dependent on a number of factors and

cannot be fully isolated from other important interpersonal skills such as non-verbal
communication, listening skills and clarification. Human language can be defined as
a system of symbols (sometimes known as lexemes) and the grammars (rules) by
which the symbols are manipulated. The word "language" also refers to common
properties of languages. Language learning normally occurs most intensively during
human childhood. Most of the thousands of human languages use patterns
of sound or gesture for symbols which enable communication with others around
them. Languages tend to share certain properties, although there are exceptions.
There is no defined line between a language and a dialect. Constructed
languages such as Esperanto, programming languages, and various mathematical
formalisms are not necessarily restricted to the properties shared by human
languages. The communication is two way process instead of one way.
CHANNEL OF COMMUNICATION

The channel, or medium, used to communicate a message affects how accurately

the message will be received. Channels vary in their information-richness.

Information-rich channels convey more nonverbal information. Research shows that

effective managers tend to use more information-rich communication channels than

less effective managers. The figure illustrates the information richness of different

channels.

Information channels differ in their richness.

 Barrier of communication

Barriers to effective human communication

Barriers to effective communication can retard or distort the message and intention
of the message being conveyed which may result in failure of the communication
process or an effect that is undesirable. These include filtering, selective perception,
information overload, emotions, language, silence, communication apprehension,
gender differences and political correctness
This also includes a lack of expressing "knowledge-appropriate" communication,
which occurs when a person uses ambiguous or complex legal words, medical
jargon, or descriptions of a situation or environment that is not understood by the
recipient.

Physical barriers. Physical barriers are often due to the nature of the
environment. An example of this is the natural barrier which exists if staff are
located in different buildings or on different sites. Likewise, poor or outdated
equipment, particularly the failure of management to introduce new technology,
may also cause problems. Staff shortages are another factor which frequently
causes communication difficulties for an organization.

System design. System design faults refer to problems with the structures or
systems in place in an organization. Examples might include an organizational
structure which is unclear and therefore makes it confusing to know whom to
communicate with. Other examples could be inefficient or inappropriate
information systems, a lack of supervision or training, and a lack of clarity in roles
and responsibilities which can lead to staff being uncertain about what is
expected of them.

Attitudinal barriers. Attitudinal barriers come about as a result of problems with

staff in an organization. These may be brought about, for example, by such
factors as poor management, lack of consultation with employees, personality
conflicts which can result in people delaying or refusing to communicate, the
personal attitudes of individual employees which may be due to lack of
 motivation or dissatisfaction at work, brought about by insufficient training to
enable them to carry out particular tasks, or simply resistance to change due to
entrenched attitudes and ideas.

Ambiguity of words/phrases. Words sounding the same but having different

meaning can convey a different meaning altogether. Hence the communicator
must ensure that the receiver receives the same meaning. It is better if such
words are avoided by using alternatives whenever possible.

Individual linguistic ability. The use of jargon, difficult or inappropriate words in

communication can prevent the recipients from understanding the message.
Poorly explained or misunderstood messages can also result in confusion.
However, research in communication has shown that confusion can lend
legitimacy to research when persuasion fails.

Physiological barriers. These may result from individuals' personal discomfort,

causedfor exampleby ill health, poor eyesight or hearing difficulties.

Cultural differences. Cultural differences affects communication between

people from different departments in the organisation. It occurs frequently
between people who have experienced different social and religious
environments. For example: words, colours and symbols have different meanings
in different cultures. In most parts of the world, nodding your head means
agreement, shaking your head means no, except in some parts of the world.

HOW TO OVERCOME THE BARRIER OF COMMUNICATION

In order to remove hindrances in the way of communication the following steps are
worth consideration:

(1) Clarify Ideas before Communication:

The person sending the communication should be very clear in his mind about what
he wants to say. He should know the objective of his message and, therefore, he
should arrange his thoughts in a proper order.
(2) Communicate According to the Need of the Receiver:
The sender of the communication should prepare the structure of the message not
according to his own level or ability but he should keep in mind the level,
understanding or the environment of the receiver.

(3) Consult Others before Communication:

At the time of planning the communication, suggestions should be invited from all the
persons concerned. Its main advantage will be that all those people who are
consulted at the time of preparing the communication plan will contribute to the
success of the communication system.

(4) Be Aware of Language, Tone and Content of Message:

The sender should take care of the fact that the message should be framed in clear
and beautiful language. The tone of the message should not injure the feelings of the
receiver. As far as possible the contents of the message should be brief and
excessive use of technical words should be avoided.

(5) Convey Things of Help and Value to the Listener:

The subject matter of the message should be helpful to the receiver. The need and
interest of the receiver should specially be kept in mind. Communication is more
effective in such a situation.

(6) Ensure Proper Feedback:

The purpose of feedback is to find out whether the receiver has properly understood
the meaning of the information received. In the face-to- face communication, the
reaction on the face of the receiver can be understood.

But in case of written communication or some other sort of communications some

proper method of feedback should be adopted by the sender.

(7) Consistency of Message:

The information sent to the receiver should not be self- contradictory. It should be in
accordance with the objectives, policies, programmes and techniques of the
organisation. When a new message has to be sent in place of the old one, it should
always make a mention of the change otherwise it can create some doubts.

(8) Follow up Communication:

In order to make communication effective the management should regularly try to
know the weaknesses of the communication system. In this context effort can be
made to know whether to lay more stress upon the formal or the informal
communication would be appropriate.

Similarly, suggestions can be invited in respect of the medium of communication

(oral, written and gestural) to know as to which medium would be more effective and
appropriate.

(9) Be a Good Listener:

It is the essence of communication that both the sender and the receiver should be
good listeners. Both should listen to the each others point of view with attention,
patience and positive attitude. A sender can receive much relevant information by
being a good listener.
 How to improve communication

There are many ways to improve our communication skills.. such as:

1. Watch Your Body Language

You tell your partner you're open to discussion but your arms are crossed; say you're
listening but haven't looked up from your phone yet. Our non-verbal and non-written
cues often reveal more than we think they do. Whether it's how you make eye
contact or how you hold yourself during a video interview, don't forget that you're
constantly communicating even when you're not saying a word. One strange way to
tap into your body for better communication? Think about your toes. Or adopt a
power pose if you need to boost your confidence before a big talk. Or learn how to
read other people's body language so you can respond appropriately.

2. Get Rid of Unnecessary Conversation Fillers

Um's and ah's do little to improve your speech or everyday conversations. Cut them
out to be more persuasive and feel or appear more confident. One way is to
start keeping track of when you say words like "um" or "like." You could also
try taking your hands out of your pockets or simply relaxing and pausing before you
speak. Those silences seem more awkward to you than they do to others, trust us.

3. Have a Script for Small Talk and Other Occasions

Small talk is an art that not many people have mastered. For the inevitable, awkward
silences with people you hardly know, it helps to have a plan. The FORD (family,
occupation, recreation dreams) method might help you come up with topics to
discuss, and you can also turn small talk into conversation by sharing information
that could help you and the other person find common ground. Hey, all that small
talk could make you happier in the long run.
4. Tell a Story

Stories are powerful. They activate our brains, make presentations suck less, make
us more persuasive, and can even help us ace interviews. Learn the secrets of
becoming a phenomenal storyteller with these rules from Pixar or by simply using the
word "but" more to structure your narrative. Everyone's got at least one great story in
them.

5. Ask Questions and Repeat the Other Person

Let's face it, we've all drifted off when someone else was talking or misheard the
other person. Asking questions and repeating the other person's last few
words shows you're interested in what they say, keeps you on your toes, and helps
clarify points that could be misunderstood (e.g., "So to recap, you're going to buy the
tickets for Saturday?").

It also helps for small talk and to fill in awkward silences. Instead of trying to stir up
conversation on mundane topics like the weather, ask the other person
questions (e.g., "Got any plans for the summer?" or "What are you reading lately?")
and engage in their answers. It's more important to be interested than to be
interesting.

6. Put Away the Distractions

It's pretty rude to use your phone while someone's talking to you or you're supposed
to be hanging out with them. Maybe we can't get rid of all our distractions or put
away technology completely, but just taking the time to look up could vastly improve
our communication with each other.
7. Tailor Your Message to Your Audience

The best communicators adjust how they talk based on whom they're speaking to;
you'd probably use a different style of communication with co-workers or your
boss compared to when you're speaking with your significant other, kids, or elders.
Always try to keep the other person's perspective in mind when you try to get your
message across.

8. Be Brief Yet Specific

There's actually a BRIEF acronymBackground, Reason, Information, End, Follow-

upto help you keep your emails short without leaving anything out. It's a good
policy for both writtena nd verbal communication (I've always felt that my job as a
writer was to clearly get the point across and then get off the page as soon as
possible. Just two more items on this list!) Clear and concise are two of the 7 Cs of
communication, along with concrete, correct, coherent, complete, and courteous.

9. Up Your Empathy

Communication is a two-way street. If you practice taking the opposing viewpoint,

you can reduce the difficulty and anxiety that sometimes arises when trying to truly
communicate with others. (For example, knowing what your significant
other really means when she says she's too tired to talk.) Developing empathy helps
you better understand even the unspoken parts of your communication with others,
and helps you respond more effectively.

10. Listen, Really Listen

Finally, going hand-in-hand with most of the points above, the best thing you can do
to improve your communication skills is to learn to really listento pay attention and
let the other person talk without interrupting. It's hard work, we know, but "A good
conversation is a bunch of words elegantly connected with listening." Then, even
if your communication styles don't match, at least you're both working off the same
page. And hopefully the other person will be
 HOW COMMUNICATION CAN BE USED AS THERAPEUTIC

THERAPEUTIC COMMUNICATION

Practicing therapeutic communication is in many ways simply developing a

good bedside manner. When your patient asks you a question or discusses
something with you, be careful to respond in a helpful and caring manner. By
encouraging the patient to speak up, you are probably helping him/her to
decrease his level of stress and thereby his recovery time.

When your patient communicates with you, you must be able to correctly
observe, evaluate, and respond. Your knowledge, understanding, and skill in
human relations will enable you to do so.

CRITICAL ELEMENTS OF EFFECTIVE THERAPEUTIC COMMUNICATION

Be able to decipher the patient's message. Get to know the patient well enough to
discover the underlying meaning (intent) of his/her communication. Be alert and
perceptive enough to pick up the correct message. Many people feel uncomfortable
talking about their feelings, especially if they are trying to be "good patients." Learn
to "read between the lines."

Be realistic in your relationships with people; avoid making assumptions or

judgments about your patients' behavior. If you have negative thoughts about
something a patient says or does, try to keep in mind that he is an adult, responsible
for making his own decisions. You do not want him to feel he must conceal anything
from you. You want him to see that you will accept him for what he is; you will allow
him his own identity.

Be emotionally mature enough to postpone the satisfaction of your own needs in

deference to the patient's. Find sources other than the therapeutic relationship to
meet your own needs.
 Conclusion

In conclusion, from the findings about the communication skills in this assignment,

communication skills is a really important elements in our live especially in order to

get a good feedback from the person who interact with us. Its important also at our

workplace for example when we communicate with our patient, our ways to

communicate can affects their emotion and behaviour. When communicating with

patients, each Practical Nurse has to find the ways that are the most effective for the

people and circumstances concerned. If the Practical Nurse tries to express care

and concern for the patient and can communicate well verbally and nonverbally, the

nurse-patient relationship will thrive.

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