Download Chapter 5

How Healthcare providers
communicate with themselves, Their
Patients, and Others: Clinical
Communication and its Vehicles
Chapter 5
Communication
• Essential to succeed in medical care.
• Deficient communication, poor understandings, and breakdowns are
responsible for medical error and harm.
• Interpersonal communication –glue of health information usage and
evaluation of its contribution to improve the practice.
• Internal and External dialectic
Newcomers must thoroughly understand the essentials to effective
communication: What is it all about?
Know the vehicles and tools of effective communication: Encounters with
patients, charts, referrals, consults, and studies/reports. How do we get our
messages across to others?
Be aware of common potential failures of communication and how to avoid
them and prevent or correct them. How do we overcome our weakness?
Realize the communication not only have its own identity, methods and
techniques, but purpose.
Broadest Sense
• Communications—
• A process whereby information is enclosed in a package and is
channeled and imparted by a sender to a receiver via some
medium.
• Communication takes place when ones mind acts upon its
environment and another mind is influenced.
• Imparting or interchanging of thoughts, opinions, or information
by speech, writing, or signs,,,
Communicology
• Defined by Lanigan as the study of human discourse in all of
its semiotic and phenomenological manifestations or simply as
the science of human communication.
Communication
• Table 5.1 Medical and Nonmedical Meanings
Multiple Ways of Communication
Some less and some more
interrogative
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Barking orders
Just watch me
Do it after me
Pimping
Uttering Wisdom
Argumentation and Critical Thinking-Based Evidence-Grounded Exchange of
Data and Information: A “what do you think?” Type of Medicine I
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-Questions
-Independent and dependent variables
-Hypothesis
-Quality
-Setting
-Who are the stakeholders
Socratic Dissent—Refined
Pimping; Medicine II
• Negative method of hypotheses elimination, in that better
hypotheses are found by steadily identifying and eliminating
those that lead to contradictions.
• 5-part form:
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1.) Question is stated
2.) An answer is proposed to the question
3.) Objectives and objections to the answer are explored
4.) The answer is revised in light of the objections.
5.) If it evades those objections, objections to the revised answer
stands up to all known objections.
Socrates method
• Shared exploration and examination by all dialoging parties
• Steering student thinking and responses in a direction that is
usually unknown ahead of time by the instructor who works
backward to clarify with students the process of reaching a
solution.
• Learning reasoning skills by talking out loud
Socrates method
• Maintaining a variable degree of dependency on authority
figures or experts in problem solving
• Guiding answering learners to a self-awareness of their
deficits and a recognition and correction of their errors
• Engaging learners by effective questioning in order to hone
critical-thinking skills, diagnose learning needs, offer
immediate “teaching pearls of wisdom” seek knowledge, and
the ability to self-direct.
Communication via Medicine II
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In nature, it means:
Clarifications
Assumptions
Reasons and evidence
Instrumental Vehicles
• Environments and opportunities for communication between peers
to provide written and oral communication.
• Sharing on request
• Bedside consult
• Grand Rounds
• Specialty and interspeciality grand rounds
• Morbidity and Mortality reports in clinical practice
• Administrative communication
• Clinical guidelines investigations
• Formal Lectures
• Emergency meetings for discussions of needs
• Consultations and exchange of ideas, data, or information by
electronic means
• Scut work for inexperienced—place to learn.
Illustrative Fallacies in
Communication
• May not result only from erroneous reasoning and decision
making, but deliberate manipulations of messages.
• Rhetorical Ploys
• Wishful thinking
• Self-Evidence fallacy
• Appeals to anything
• Alternative choice fallacy
• Complementary treatment fallacy
• Blinding the science fallacy
Patient Interviews
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Verbal, oral and written
Nonverbal ways
Hard and Soft data
Soap Notes
Narratives and Clinical Case Reports
Clinical Vignettes and Clinical Case Reports