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Communication – it doesn’t have to be so clinical

clincial comm

Only secondary to patient injury, the legal consequences of ineffective communication in healthcare settings can be calamitous. Medical claims and complaints can also be attributed to non-technical skills such as communication, leading to misunderstandings, negligent care and inappropriate interventions. In 2019, Walton et al1 reported a profile of the most common complaints received for a group of healthcare professions in Australia. The study revealed that communication was the second most common source of patient dissatisfaction in medicine, third in dentistry and fourth across all health professions included in the research.

In the same study the authors identified disrespectful manner, failure to communicate openly, honestly and effectively, as well as insensitive or inappropriate comments as the main types of miscommunication issues reported by patients. On another study, Kee et al2 examined patients’ feedback emerging from negative interactions with junior practitioners that led to patient dissatisfaction and eventual lodgment of complaints. The nature of communication errors was broadly classified into four main categories:

Nature of communication errors
Non-verbal Eye contact
Facial expression
Verbal Failure to listen actively
Unsuitable choice of words
Content of Information Inadequate/poor quantity of information
Poor quality of information
Poor attitudes Lack of empathy
Lack of respect
Table 1: Summary of observable communication errors in healthcare

The patient-practitioner relationship is complex, and the understanding of the other party's emotional state is a requisite. As a healthcare practitioner, it is important to develop awareness of your own emotions and how they may impact the verbal and non-verbal aspects of your communication with your patients which ultimately determines their perception of you.

Good communication and your wellbeing

The effect of stress and burnout on healthcare practitioners has demonstrated that ineffective communication significantly contributes to clinicians’ lack of job satisfaction and emotional burnout. In this regard, the medical literature provides reassuring evidence that actively engaging in self-care practices, seeking support from others and developing effective communication skills fosters emotional wellbeing and resilience3-5

Active listening 

Good listening skills involve more than simply comprehending what is being said through words. It requires an appreciation of what is being said verbally and non-verbally through listening intently in an arbitrary and empathic manner, in order to fully appreciate the other person’s point of view and state of being. To listen actively, you are encouraged to refrain from interrupting, pose open ended questions and answer questions without judgement.

Understanding, respect and empathy 

Building supportive relationships with your patients shouldn’t require an extraordinary investment of time but it may ask you to foster a ‘patient-centred’ approach to care. Research suggests that healthcare practitioners who demonstrate empathy can improve patient health outcomes and minimise clinico-legal risk exposure6. Empathetic communication and relating to someone else’s feelings and emotions, involves a high level of self-awareness and control of one’s own emotions. To develop your ability to empathise with colleagues and patients, it is recommended to develop self-awareness and self-reflection of one’s identity, personal values and boundaries.

More than words - Improving your communication

While there is no ‘one size fits all’ approach for successful communication, there are effective frameworks that you can implement in your everyday practice

The emphasis on good communication skills by the Australian boards is a major priority that it is part of the required code of conduct for all healthcare practitioners. The Australian Health Practitioner Regulation Agency (AHPRA) Annual report 18/19 states that: “improving communication skills, obtaining written consent, maintaining boundaries, and safe prescribing are recommended ways a practitioner can mitigate the risk of having a notification made about them”.

Furthermore, Medical and Dental Boards Codes of Conduct detail what is expected of you by the community, your peers and AHPRA regarding effective communication in healthcare settings. 

Section 3.3 of the Medical and Dental Board Code of conduct:
  • Listen Ask for and respect patients’ opinions
  • Encourage them to explain their condition and how they are managing
  • Inform patients of the nature/need for their clinical management
  • Discuss with patients their condition and available management options
  • Confirm patients understand what you have said
  • Ensure patients are informed of the material risks
  • Respond to questions. Keep patients informed on clinical progress and provide timely updates.
  • Meet patients’ specific language, cultural and communication needs

Culturally appropriate communication and care 

Australia is a culturally diverse nation. Consequently, healthcare providers are advised to approach healthcare in a holistic manner and consider the linguistic, ethno-cultural and religious characteristics of patients as essential components of high-quality healthcare. 

Minnican and O’Toole7 (2019) identified three essential domains of culturally appropriate communication between Australian health practitioners and their patients as shown in Table 2. In the research, the authors recommend practitioners develop the ability to self-reflect, be flexible, have awareness of self and others and to be willing to learn, among other traits. 

Domain Sub-domain
Required competency of healthcare practitioner Reflexibility
Flexibility
Self−/other awareness
Respectfulness
Trustworthiness
Honesty and transparency
Non-judgmental
Willingness to learn
Required foundational communication skill Ability to listen
Check comprehension
Include and/or acknowledge family
Use simplified, inclusive language
Required contextual factors Access to culturally appropriate resources and literature
Availability, quality and use of interpreter services
Table 2: Skills required for effective culturally responsive communication 

Foster good working relationships with colleagues
In MIPS’ experience, complaints and claims can arise when a healthcare practitioner reports the conduct, treatment or diagnosis of a colleague. Often this occurs in circumstances where:

  • there has been no adverse outcome 
  • damage to the patient, or 
  • the patient had no initial issue

  • Exercise caution
    You may not know all the details and you may be wrong in hindsight. If you instigate the patient to complain or claim against a colleague, you may in turn be implicated in the complaint.  Effective communication among colleagues and staff is an essential risk management tool and you should avoid commenting adversely about another practitioners’ care. The Australian Commission on Safety and Quality in Health Care recommends implementing the ISBAR standardized approach to communication in healthcare settings. The elements of the ISBAR framework are:

    I – Introduction: Who you are, your role, where you are and why you are communicating
    S – Situation: What is happening at the moment?
    B – Background: What are the issues that led up to this situation?
    A – Assessment: What do you believe the problem is?
    R – Recommendation: What should be done to correct this situation.

    Good communication is an essential aspect of clinical care. MIPS encourages all members to pursue ongoing reflective practice, evaluate your communication skills and your own cultural responsiveness to improve the overall quality of healthcare as well as your wellbeing. 

    References

    1. Walton M, Kelly PJ, Chiarella EM, Carney T, Bennett B, Nagy M, Pierce S. Profile of the most common complaints for five health professions in Australia. Australian Health Review. 2019 Oct 29.
    2. Kee JW, Khoo HS, Lim I, Koh MY. Communication skills in patient-doctor interactions: learning from patient complaints. Health Professions Education. 2018 Jun 1;4(2):97-106.
    3. Kuhn CM, Flanagan EM. Self-care as a professional imperative: physician burnout, depression, and suicide. Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 2017 Feb 1;64(2):158-68.
    4. Krasner MS, Epstein RM, Beckman H, Suchman AL, Chapman B, Mooney CJ, Quill TE. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. Jama. 2009 Sep 23;302(12):1284-93.
    5. Murray M, Murray L, Donnelly M. Systematic review of interventions to improve the psychological well-being of general practitioners. BMC family practice. 2016 Dec;17(1):36.
    6. Howick J, Steinkopf L, Ulyte A, Roberts N, Meissner K. How empathic is your healthcare practitioner? A systematic review and meta-analysis of patient surveys. BMC medical education. 2017 Dec 1;17(1):136.
    7. Minnican C, O’Toole G. Exploring the incidence of culturally responsive communication in Australian healthcare: the first rapid review on this concept. BMC Health

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    The materials provided are for educational purposes only. Whilst all reasonable care has been taken in preparing these materials, including the accuracy of the information supplied, MIPS does not accept any liability whatsoever arising out of the use or reliance of the information provided. Contact MIPS 24/7 Clinico-Legal Support 1800 061 113 or education@mips.com.au for specific advice.