Submitted by: Deborah Nicholson MSN RN CCM CHPN
Communication is one of the most essential aspects of human life. Communication is how human beings interact to convey messages, information, or express emotions. Language is the medium through which the process of communication takes place. Language in communication can be verbal, for example using words to read, write and speak or non-verbal by using signs, facial expressions, or body language. Despite the variety of the means of communication, messages are sometimes not comprehended or simply misunderstood.
Each of us has our own style or ways they are comfortable, to communicate such as sit-down conversations versus cryptic short phrases, or while driving so you don’t have to look at the other person or joking about serious matters or not discussing anything of significance at all. We can use gifts, cards, letters, hugs, angry faces, doing favors or things the person likes or doesn’t like…..you get it. We each control how we communicate.
In normal everyday conversations there can be miscommunications. These can be simple or complex and can positively or negatively impact a relationship. Things that can affect communication can be stress, lack of sleep, incomplete sentences, difficulty expressing self-due to language, impairment of thinking or speech, or incomplete idea formation or many other things you can insert here.
Personally, I sometimes speak as if the person already knows what I am thinking about or in the middle of the story. Sometimes I realize this, other times a family member might say “start over please”, at times a friend might say “Hold on, I speak Nicholson, this is what she meant!!” We laugh about this, and I will try to improve for next time. It’s an ongoing process that I have taken responsibility for.
Each of us has a different level of understanding in separate situations which a variety of factors could impact. For example, I could tell you many things and help you interpret or navigate many healthcare related situations but would have no idea how to navigate the world of construction, plumbing, or financial planning and many other things that require a certain level of expertise. With that said, a person’s understanding of what is being said can be affected by medications, time of day, willingness, or ability to receive information and many more.
Scenario
Imagine that I must make a major decision and a plan about where and how to install new plumbing in an old house. I will need the construction and plumbing experts to break it down to me in very simple terms and educate me about building codes, prices etc. The basics of the whys and why nots. I ask for this and hopefully get my questions answered. I may seek out another plumber for a second opinion. I will plan for the process; they told me not to wait too long. The expert shared information with me and gave me the tools I needed to make an informed decision to develop a plan.
Let’s escalate this into a plumbing emergency that requires fast decisions due to leaking or bursting pipes and oh boy this is news to me to replace all of this! Last year, I was informed, it was old and on its last legs but WOW! Now it’s going to cost more. I did not take full responsibility for the plan. I still need a simple breakdown but am under more stress. Maybe the plumber is also stressed and has not been sleeping well due to a personal matter, and I am not the only customer the company has! They may not have time or think to break it down simply, they may revert to technical “plumber speak.” Or they could tell me I need or require something and not make it clear that I still have either or type decisions to make. The plumber may be slightly frustrated because I was warned about the work that needed to be done. They may assume I remember the conversation with the technical aspects. A different plumber from the company has no idea what was discussed, or I have called a new plumber who doesn’t know the history either. Along with the emergency stress, I am left confused and may make decisions that are not beneficial to me. Do I need the expensive pipe? Am I required to do it all at once? Can we try something else to see if it works? Should I do that? The type of language used as well as its delivery can affect the decisions made either positively or negatively.
As this is the Circle of Life Coalition Blog that discusses and educates about advanced care planning and end of life concerns you may be able to tell where this is going. In the interest of clear communication: This is not about plumbing or a plumbing emergency. The scenario is being used as an example of what can happen in communications with humans, communication nuances, and ultimately how it can impact a decision. Substitute healthcare diagnosis and emergency healthcare situations into the written scenario.
Shared Decision Making and Communication in healthcare:
Shared decision making is not a new concept for humans or businesses or healthcare. In healthcare the concept was introduced in 1972 or so, was studied and developed with variations of implementation and adoption by clinicians, formalized guidelines were published in 2015. The link above is to the Agency of Health Care Research and Quality’s’ fact sheet regarding Shared Decision Making. There are links within that can help Professionals and Consumers learn what this is and how to use it.
Professional Actions:
The clinician presents the facts in plain language, including all the information you need about treatment options, possible outcomes as well as the likelihood of the treatment being successful or not. They should discuss side effects of the treatment as well as explore what is important to you (your values). They could involve, with your permission, family, friends, social workers, and/or case managers who could be another source of information and support. Armed with this information the person/patient/you can make the correct decisions for you and your circumstances. The clinician shares the plan with other involved healthcare professionals such as Primary Care Clinicians and other specialists as well as who you identify as important to your personal life.
Customer/Patient/Your Actions:
You should get all the information you need to understand what is happening. Do not be afraid to ask for rewording or repeat explanations. Explore reputable websites, articles, or magazines. Ask the healthcare experts you are meeting with for resources. Consult with trusted people, but know they also need the background and the information you were given to help you. This is improving your and your supports systems healthcare literacy. You are learning the most you can about what is happening with your health. Share your plan with any other healthcare providers you are in contact with and the people you identify as important to your personal life.
Both Parties Responsibilities and take aways:
Communication is one of the most essential aspects of human life.
Despite the variety of the means of communication, messages are sometimes not comprehended or simply misunderstood.
We can each control how we communicate.
In normal everyday conversations there can be miscommunications.
Each of us has a different level of understanding in separate situations which a variety of factors could impact such as stress, medications, etc.
Both parties have a responsibility to learn how to communicate clearly.
In times of emergency or stress understand that words or phrases such as “need” “require” and “these are the next steps” are not necessarily accurate. Both parties have the responsibility to remind or tell others of the previously made plan and ask for clarification of what is currently being presented.
Remember, we are all only human.
[Keywords: Communication, Healthcare, Health Literacy, Shared Decision Making, Quality]