Prescriptive Communication for the Healthcare Provider

By Abné M. Eisenberg Ph.D.

Professor Eisenberg's primary objective is to help patients and their healthcare providers communicate with one another more effectively. When they fail to communicate, it often negates or compromises the benefit they seek to derive from their treatment.

Aside from addressing the conventional issues that currently bog down healthcare communication, he exploits some less typical issues such as pseudoaffective communication, somatotyping, appellations, clinical musicology, genderlect, and territoriality. Healthcare providers reading this book should come away with an expanded and more inclusive perspective on how practitioners can enrich their interpersonal skills.

• Language: English
• Publisher: Trafford Publishing
• Release date: Feb 6, 2012
• ISBN: 9781466909694

Abné M. Eisenberg Ph.D.

Professor Eisenberg was born in New York City and served in the US Marine Corps in World War II. His career consisted of teaching interpersonal/intercultural communication, public speaking, organizational communication, nonverbal communication, group dynamics, and persuasion at four major universities. His publications include fifteen textbooks on various aspects of communication. He has a relentless reputation of asking his students, and often perfect strangers, thought-provoking questions. One of his earlier books was titled Questions That Challenge the Curious Mind. It consisted of seventy-nine choice questions. After each question, he would briefly describe how various people answered it. His favorite question is, “What one word best describes your entire life?” He presently resides with his beautiful and multitalented wife, Marianna, a former operatic star with the New York City Opera at Lincoln Center. His zodiac sign is Scorpio, and his favorite hobby is asking questions.

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Contents

DEDICATION

SPECIAL ACKNOWLEDGEMENT

OTHER BOOKS BY AUTHOR

FOREWORD

PART I

PROFILE OF A HEALTH CARE PROVIDER

BUILDING RAPPORT

CREDIBILITY

TRUST

EMPATHY

MEDICAL ETHICS

IS ANYONE LISTENING?

CRITICAL THINKING

PERCEPTION OF DIS-EASE

BURNOUT

ADMISSIBLE TO A MEDICAL SCHOOL

TRUTH-TELLING

HUMILITY

PART II

PRECONCEPTIONS & MISCONCEPTIONS

NON-ENGLISH SPEAKING PATIENTS

SELF-DIAGNOSIS

DESCRIPTION OF SYMPTOMS

WHY CAN’T PATIENTS FOLLOW

INSTRUCTIONS?

DEMANDING PATIENTS

THANKLESS PATIENTS

HELPLESS PATIENTS

GAY PATIENTS

GERIATRIC PATIENTS

HYPOCHONDRIACS

THE OPPOSITE SEX

MANAGING MEDICATION

LIFE: AN END OR A BEGINNING

PSEUDOAFFECTIVE COMMUNICATION

FEARFUL PATIENTS

YOUNG PATIENTS

INTRAPERSONAL COMMUNICATION

DEPERSONALIZATION

COMPASSION

INFORMED CHOICE

INFORMED CONSENT

ROLE OF FAMILY

IATROGENESIS

GRIEVING

IMPATIENT PATIENTS

CHOOSING A DOCTOR

DENIAL

PART III

COOPERATIVE HEALING

PATIENT-CENTERED INTERVIEW

WAITING ROOM ANXIETY

CROSS-CULTURAL COMMUNICATION

INDIVIDUAL OR GROUP PRACTICE

ALTERNATIVE or

COMPLEMENTARY MEDICINE

HEALING ARTS

MEANING OF MEANING IN HEALTHCARE

PROPHYLAXIS

OMBUDSMAN

SPEECHMAKING

SOCIAL WORKERS

FAITH HEALING

CLINICAL MUSICOLOGY

QUACKERY

TELEMEDICINE

MEDICAL ILLEGIBILITY

NURSING PROFESSION

CONFIDENTIALITY

MANAGED CARE

EUTHANASIA

TESTING FRENZY

COMMUNICATION IN THE E.R.

PIONEERS IN HEALTHCARE

HOSPITAL TEAM PLAYER

MEDIA AND HEALTHCARE

FACIAL DIAGNOSIS

THE RECEPTIONIST

MALPRACTICE

INTERDISCIPLINARY MEDICINE

MEDSPEAK: A Secret Language

TREATING THE DISABLED

SPIRITUALITY IN MEDICINE

PATIENT SATISFACTION

HEALING POWER OF HUMOR

ACCENT-REDUCTION

FORMS, FORMS, FORMS

PHARMACIST-PHYSICIAN RELATIONSHIP

BIOETHICS

MEDICAL INTERPRETERS

MEDICAL ERRORS

PARADIGM SHIFT

APPELLATIONS

MORALE

PART IV

READING BODY LANGUAGE

EYE CONTACT

ANATOMY OF A SMILE

HEALING TOUCH

SOMATOTYPING

OLFACTION

COLOR

TERRITORIALITY

PARALANGUAGE

SILENCE

PAIN

HOPE

POSTURE

INTELLIGENCE

INSTINCT

BEDSIDE MANNER

TIME

INNER VOICES

AFTERWORD

GLOSSARY

DEDICATION

Thanks to my wife, Marianna, for a life of consummate joy. I want more.

Encore!

SPECIAL ACKNOWLEDGEMENT

My special gratitude goes to my colleague, Professor Christopher P. D’Amico, for his moral support and to the thousands of students from whom I learned more in my sixty years of teaching than what I taught them.

OTHER BOOKS BY AUTHOR

Nonverbal Communication

Argument: An Alternative to Violence

Living Communication

Understanding Communication in Business & the Professions

Job-Talk

Argument: A Guide to Formal and Informal Debate

Painless Public Speaking

Questions That Challenge the Curious Mind

Call of the Restless Mind

Speechmaking: An Ancient Art in a Modern World

Anatomy of Communication

Command the Argument

Correlative Rhetoric: The Art of Speechmaking

Mind-Walk: Journey of an Holistic Essayist

FOREWORD

THE INFORMATION PRESENTED in this book has been explicitly designed for members of the healthcare community. While experienced practitioners may find some of the tenets expressed familiar and consistent with their existing philosophy, many of the headings will convey a slightly different and, perhaps, new and exciting viewpoint.

The philosophical perspective subscribed to by the author is, salus aegroti suprema lex—the welfare of the sick is the supreme law. Each topic addresses a specific aspect of healthcare designed to provide readers with a better understanding of how to effectively communicate with their patients and, thereby, avoid unnecessary breakdowns in communication.

Another central theme in this book is that patient and practitioner constitute a partnership. A recent shift to holistic medicine reflects this approach to healing. Contemporary HCPs have been urged to engage their patients in a broader therapeutic context, one that includes such variables as family, occupation, personal and public relationships, attitudes, values, and beliefs. To help achieve this patient-practitioner relationship, integrative medicine is now part of the curriculum at twenty-eight major medical schools in the United States.

Patients should be made to feel that they are playing an indispensable role in the healing process. In PART III, the unit entitled Cooperative Healing illustrates this patient-provider relationship.

NOTE:

Rather than referring to a professionally trained individual as a physician, nurse, psychologist, social worker, medical technician, or therapist, the acronym HCP will be used throughout the book.

PART I

THE PROFESSIONAL

PROFILE OF A HEALTH CARE PROVIDER

A HEALTHY SELF-ESTEEM is based upon whether you perceive yourself as a success or a failure. If you have a flourishing practice and your patients are forever complimenting you on your dedication and compassion, your self-esteem will invariably be higher. If your practice is failing, your self-esteem will usually suffer.

Your professional persona derives from how you see yourself, how you think others see you, and how you would like them to see you. Of one thing you may be certain, how you see yourself in a mirror is often wishful thinking. People rarely see themselves as they really are. What you say to a patient, how you say it, and how you look when you say it all serve to modify your professional persona.

Your persona is dynamic, not static. At a wedding reception or at a relative’s anniversary party, the image you present usually differs from the one you present in your office. This dichotomy is normal. Problems may arise when these roles become distorted; i.e., you behave toward members of your family the way you behave toward your patients.

Sartorial communication is another important dimension of your professional persona—the way you dress. While situations usually dictate a way of dressing, your persona is invisible. The manner in which the HCP is dressed on an ocean beach will not elicit the same response it would elicit when dressed in a white coat in a hospital setting. However, once the HCP is engaged in conversation, the professional persona may then become more apparent.

Psychologist, Carl Rogers, maintained that the only way to develop a fully functioning self (persona) is to be open to new ideas and experiences. Open mindedness builds bridges, closed mindedness builds walls.

A paradigm called the Johari Window is an excellent way of analyzing your persona. It consists of four windows: Pane number one is called the Open Area. It denotes things you know about yourself and what others also know; e.g., your name, address, and telephone number. Pane number two is called the Blind Area. It denotes things others know about you, but you don’t know. Pane number three, the Hidden Area, denotes things you know about yourself, but others do not know. Finally, pane number four, the Unknown Area contains things that neither you nor others know about you.

Your reputation is the best clue to your professional persona. Do people in your neighborhood describe you as being kind, gentle, friendly, caring, trustworthy, competent, intelligent and available? If so, that positive persona will become self-evident in whatever career you pursue.

If you asked a layperson, What makes a good doctor? you would probably get a different answer than you would get if you asked a doctor. An informal survey conducted by the author revealed the following differences:

A patient’s connotation of a good doctor

1.   Respect for a patient’s time, thus, minimize waiting-room time.

2.   Listen, not just hear.

3.   Charge reasonable fees.

4.   Be available when needed.

5.   Be thorough.

6.   Allow enough time for a description of symptoms with minimal interruptions.

7.   Explain technical terms.

8.   Restrict non-emergency incoming calls during a conversation or an examination.

9.   Have a good reputation.

10.   Have a professional appearance.

11.   Defer to a patient’s gender and sexual orientation.

12.   Respect for a patient’s religious or cultural affiliation.

A doctor’s connotation of a good doctor

1.   Hospital privileges.

2.   Published peer-reviewed articles in leading field- related journals.

3.   Reputation among peers.

4.   Organizational affiliations.

5.   Apprised of current advances in the field.

6.   Credentials in a specialized area.

7.   Recipient of distinguished awards or commendations.

8.   Graduated from an highly respected medical school.

9.   Years in practice.

Despite these diverse perceptions of a good doctor, each doctor-patient experience must be judged on an individual basis. It also should be borne in mind that each of these laudable characteristics and expectations ultimately are confirmed or denied by how physicians actually conduct themselves in practice. There are certain HCPs who may suffer a deficiency in a number of the aforementioned qualities, but should be excused because of their unique abilities. That could apply to surgeons possessing an outstanding reputation for performing a highly specialized surgical procedure also.

To repeat: What makes a good doctor or any other type of healthcare professional? This perfectly legitimate question traditionally confronts potential patients seeking medical attention. They usually have several options. They can ask a neighbor to recommend someone, check with a respected referral agency, search the Internet, or simply take their chances with a nearby practitioner.

BUILDING RAPPORT

WHAT MAKES CERTAIN patients have unconditional confidence and trust in their HCP? Having such a relationship with a healthcare provider has been known to last for many years—occasionally a lifetime. Such long lasting relationships are built on a sound rapport. Rapport is defined to be an emotional and/or intellectual bond established between people who impute to others qualities that they, themselves, either possess or admire. Put simply, it is a relationship based upon similarities, rather than differences.

On that first visit to an HCP, a tentative positive or negative rapport is established. Colloquially, it is called a first impression. An initially positive rapport provides both parties with an excellent foundation for a harmonious and lasting relationship.

Having a diploma, hanging out a shingle, and having business cards printed is no guarantee that you will have a good rapport with your patients. Every rapport needs to be fueled by ingredients such as trust, confidence, understanding, needs, openness, flexibility, empathy, honesty, sharing, and kindness. While there are innately gifted individuals who are instantly liked by everyone they meet, most people treat new relationships as a matter of fate or random speculation.

By themselves, legitimately earned professional credentials play only a marginal role in the establishment of health-related relationships. Equally marginal are the professional’s actual skills. There have been cases of extremely well-qualified HCPs who repeatedly fail in private practice. Then, there are HCPs who are less qualified who are markedly successful. The difference can usually be traced to the rapport they have with their patients.

In the business world, a salesperson’s impeccable reputation often generates more revenue than the quality and price of the product they sell. Business involves people interacting with people; i.e., interpersonal communication skills.

Future anthropologists may well refer to this generation as, The age of group-mongers. In search of meaningful relationships, people form or join groups of every conceivable description. Name anything and you can find a group that consists of people who dedicate themselves to a cause; e.g., political, religious, educational, motivational, hedonistic, and a host of health and disease-centered groups.

While taking a case history, express a respect for or a casual interest in a patient’s hobby or avocation. Bear in mind that people like people who like what they like. While doing this might seem a little ingenuous, it seldom generates any untoward consequences. What it does do is facilitate a stable rapport.

Every HCP should take a serious interest in learning what makes a rapport succeed. An exceedingly effective technique is called mirroring. On meeting a new patient, take notice if whether direct eye contact is made. If it is, mirror that nonverbal trait by returning it in kind. If their body language is relaxed, relax yours. If their speech-speed is rapid, match it. If they are soft spoken, be soft spoken; if they speak loudly, increase your volume slightly. Overall, discretely mirror their behavior.

While a busy practice tends to make rapport building somewhat inconvenient, a modest effort should be made. The benefits will justify the effort. The world in which we are now living is becoming more and more depersonalized. Face to-face conversations are being replaced by various forms of mediation; cell phones, computers, YouTube, Facebook, and Twitter. They allow millions of people around the world to communicate with one another without ever meeting them in person. Although efforts are being made to keep dialogic interaction alive, technology has created some formidable obstacles for interpersonal communication to overcome.

The pen is the tongue of the mind.

Miguel de Cervantes

CREDIBILITY

THE WORD CREDIBILITY is derived from the Latin credere meaning, to believe. Credibility is not an anatomical entity such as the brain, heart or liver. It is an attribute assigned to you by others. It can also be assigned to inanimate things such as works of art, a diploma, an historical document, sculpture, literature, film, or a musical score. No matter how the term is applied, the bottom line is always predicated upon its believability. If it is not credible, a credibility gap is said to have occurred.

For HCPs to be considered credible, they must be competent, have a laudable reputation, be trustworthy, and possess bonafide credentials. Paradoxically, since the administration of health care is an art, not a science, simply being credible is not always enough. It is how that credibility is pragmatically implemented in clinical practice.

There is more than one kind of credibility. There is prior-credibility and demonstrated credibility. Prior credibility comes with an individual’s status or rank. Examples might include a judge, a college professor, or a law enforcement official. Demonstrated credibility must be earned.

HCPs routinely display their credentials on the walls of their office. Diplomas, awards, licenses, and specialty degrees all denote prior credibility. Practitioners must then earn credibility from their patients. That credibility, however, is not inherent or immutable. An inappropriate act or behavior inconsistent with standard healthcare conduct could easily erase pre-existent credibility.

The physical appearance of an office can contribute to or detract from a practitioner’s credibility. Does it generate a professional atmosphere? Do the paintings and other items on the walls instill patient confidence? Do other adjunctive members of the staff look and act professionally? All of these factors could indirectly affect your credibility.

Credibility often extends beyond a single individual; i.e., a group practice. In recent years, the solitary practice has been replaced by the group practice. This is when credibility is shared and how one member of the group behaves could easily reflect upon the entire group. Like-minded practitioners definitely insure positive group credibility.

When circumstances necessitate having another practitioner cover for you during a vacation or some other unavoidable personal contingency, your credibility is on the line. It is essential that your replacement understands the nature of your method of practice and makes every effort to deal with your patients in a similar manner. If the replacement’s approach elicits too much of a departure from your own, your credibility could be seriously damaged.

The success or failure of any practice can often be traced back to a breakdown in a practitioner’s credibility. Too often, this breakdown will be rationalized and a completely erroneous cause may be blamed. It is essential that credibility not be viewed as a magic bullet. It is a very complex phenomenon with a number of psychodynamic and psychosocial variables. As mentioned earlier, both prior and demonstrated credibility are extremely fragile. One accidental or unintentional incident could destroy a person’s credibility permanently.

Lastly, damage to one’s credibility may also be caused by an external source. On occasion, a disgruntled patient will deliberately blemish a practitioner’s reputation and, by so doing, threaten that practitioner’s credibility. Scandals have the reputation of doing just that. At all costs, every effort should be made to insure and protect one’s credibility.

TRUST

THE ELEMENT OF trust plays an indispensable role in healing. HCPs have the responsibility of taking good care of their patients by being hopeful, honest, conscientious, and give them the benefit of their best therapeutic effort. A lack of trust between them can reduce the amount and accuracy of any shared information. It can also reduce any suspicion that may be associated with that information. Without mutual trust, healing can be seriously jeopardized. Meaningful cooperation markedly increases the chances of reaching mutual goals. There is considerable evidence that the expression of warmth, accurate understanding, compassion, and cooperative intentions increase the level of trust. When the trust level is high, all concerned are more optimistic.

Aside from a strong recommendation from a friend or family member, patients have difficulty knowing whether a particular HCP is trustworthy or competent. Too often, there is the element of risk and disappointment. If, however, a patient is fortunate enough to find an HCP who immediately is able to instill a feeling of trust, the office visit is off to an encouraging start. Several things contribute to that feeling of trust; i.e., a professional looking office and an affable receptionist displaying a warm and reassuring smile. There is also an intuitive ingredient which cannot be verbally explained.

Mutual trust between practitioner and patient does not occur automatically. It must be earned! On that initial visit, concerns are aired, fears are disclosed, and professional recommendations are made. Throughout this verbal and nonverbal exchange, attitudes and opinions are formed that will act as the foundation for any future treatment.

In a busy practice, the amount of time spent with each patient inclines to be somewhat curtailed. The result is that patients often feel under treated or under attended. This may attenuate their trust in the practitioner’s genuine concern regarding the treatment of their problem.

Expectations of the HCP and the patient are not the same. While the goal may be the same, the means by which that goal is reached is often different. For patients, their expectation is that the HCP will behave in a way that is conducive to a successful outcome of their treatment and will do nothing that will be harmful. For HCPs, their expectation is that their patients will follow their instructions faithfully. keep scheduled appointments, and report a lessening of their unpleasant symptoms.

If any ingredient for trusting or trustworthy behavior is lacking or compromised by either the patient or the practitioner, both will suffer some degree of disillusionment. Trust requires that each party be willing to risk something, be it time, money, reputation, or psychological angst.

The opposite of trust is deception; the deliberate falsification or omission of information to a HCP with the intent to mislead. A patient might deliberately lie in order to avoid certain untoward consequences. It might be during an eye examination where withholding certain information might lead to the revocation of a driver’s license. Another instance of deception might occur when patients dread learning that they have a terminal illness; they intentionally deny having certain telltale symptoms that could have dire diagnostic implications.

In the study of interpersonal communication, the matter of deception finds patients in situations where they speak in a dishonest manner to prevent harm or cause offense to someone else. Some enter the therapeutic situation with a pre-existing level of trust or distrust. If they have had a number of negative past experiences with HCPs, it could develop into a self-fulfilling prophecy. If their past experiences were all positive, they will incline to be very trusting. Past experiences can powerfully color one’s perceptions of the present and, by so doing, contaminate future experiences.

When patients no longer trust their practitioner, they simply discontinue treatment. When practitioners no longer trust a patient, they either politely discharge them, or continue to treat them with less enthusiasm. Once the trusting bond is broken, it can seldom be rebuilt.

When a patient is in great pain, the ability to forgive or rationalize another person’s unacceptable or hurtful behavior is extremely difficult. Fred Luskin, in an article titled, Four Steps Toward Forgiveness, states, The act of forgiveness involves a multistage problem-solving process. Initially, the person feels anger and hurt, but then finds a way to forgive the offending party by taking less personal offense and blaming the offender less. While adopting this approach may provide a modicum of psychological comfort, it seldom erases the hurt.

The word trust is an abstraction, something that cannot be materially seen, touched, or heard. Since it is an intrapsychic phenomenon that can dramatically influence behavior, it behooves the HCP to become more respectful of the integral role it plays in the healing arts.

If I had my way, I’d make health catching instead of disease.

Robert Ingersoll

EMPATHY

A DISTINCTION SHOULD be made between apathy, sympathy, and empathy. Apathy applies to someone who is completely devoid of any caring, compassion, or concern. Sympathy involves feeling sorry for another person’s misfortune. Empathy is the ability to identify with and understand another person’s feelings, difficulties, or adversity. The highest form of caring is putting yourself in another person’s moccasins. Perhaps, an HCP who lacks empathy should consider another life career path.

Unlike the clinical determination of a patient’s blood pressure, sugar level, or cardiac status, there is no laboratory test that can objectively measure the exact degree of an individual’s empathy. There appears to be a consensus among most patients that a good HCP is one who emanates empathy. Characteristics indigenous to such practitioners are good eye contact, attentive listening, patience, and one who takes a serious interest in the patient as a whole.

Being empathic has two distinct advantages: Firstly, it makes the HCP feel good about being able to help patients with their health problem. Secondly, it reinforces the practitioner’s sense of effectiveness by having patients acknowledge that their diagnosis was correct.

While empathy is usually an inherent trait, it can be developed by someone who is highly motivated, observant, and willing to persevere. The HCP must be willing to temporarily set aside personal attitudes, values, and beliefs and focus entirely upon the patient’s concerns. Empathy is also reinforced by a descriptive atmosphere, rather than an evaluative one. When a patient perceives communication as a request for information or a description of a symptom, that it is not viewed as threatening. Conversely, communication that is judgmental, Have you always been this heavy? often leads to a defensive state of mind and works against the establishment of empathy—a wall or barrier between practitioner and patient.

According to psychologist, Carl Rogers, equality requires that patients are given unconditional positive regard. Patients often complain that they were treated like a child or of limited intellectual ability. Therapeutically, to be effective, both parties must recognize and respect the equality of the other. Statements such as, Don’t you realize that talking on the phone for two hours can cause neck pain? or Yes, not wearing a seat belt was very foolish. Thus, an HCP who makes these statements is exercising no sense of equality. The patient is being treated as someone who should know better or who lacks common sense.

Developing empathy is not easy. This is especially true when treating patients who are unlike you with regard to such things as language, race, gender, age, culture, socioeconomic status, or intelligence, To overcome these differences, it requires a concentrated effort and focused deliberation.

The most advantageous characteristic of the empathic HCP is open-mindedness—the ability to temporarily set aside one’s own attitudes, values, and beliefs and assign a patient’s concerns the highest therapeutic priority. The HCP need not feel the same