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Barriers to communication

Let us look at a few examples to see how easily communication can fail. Many professionals use the term ‘blood thinners’ to describe medicines that slow the blood’s clotting process. Hearing a blood specialist (Haematologist) use the term at a conference, I raised the point that the emotive description might scare patients out of taking their medicine. He agreed with me, and pledged not to use the term again.


Now imagine a pharmacist dispenses a prescription for an antibiotic for you. The label says ‘Take one tablet four times a day, on an empty stomach.’ How would you interpret this? Would you take all doses by lunchtime or spread them throughout a 24-hour period? What do you understand by the term empty stomach? The stomach is empty just before a meal, but the intention here is that the medicine is swallowed one hour before, or two hours after food, as some medicines are better absorbed this way.

A doctor asks a patient if his pain is chronic. Thinking it means ‘really bad,’ he answers ‘no.’ The point is health professionals use the term chronic to describe ongoing conditions, so the doctor got wrong information, as the patient’s pain was actually chronic – there all the time. Type 2 diabetes was previously called ‘mature-onset diabetes’ because it mainly occurred in adults, over 50 years of age. Today, we see teenagers with the condition. Had we retained the original descriptive terminology, I believe more people would have asked why the condition was affecting younger people, which would have attracted attention to issues like insulin resistance, much sooner.

 At a conference, a skin specialist (newly arrived from overseas), said she tells patients to ignore the way authorities in NZ tell pharmacists to label anti-inflammatory steroid creams, because it contradicts what she wants them to do. I suggested she talk to authorities and explain her point of view. In my experience, most people will not deal with issues like this, probably because they see the process as being too hard or fear repercussions.

Body language is an important part of communication as it gives clues to what a person is thinking.[i] For some patients, even a desk between them and their professional may affect their ability to feel comfortable enough to discuss key aspects of their health.

 I trust the above examples give you a feel for the consequences of communication breakdown in health like when doctors talk about their ‘practice’, which does not inspire confidence, as it infers they are ‘practising’ on patients. People come from different backgrounds and education levels so, it is important for health professionals to avoid medical jargon (terminology unique to a profession, group or event) that is unintelligible to patients. Health professionals should heed what George Bernard Shaw once said i.e. ‘The single biggest problem in communication, is the illusion that it has taken place.’ Reflective listening, where a patient repeats what they have been told is one way to follow his advice. The acronym, assume highlights what happens otherwise, i.e. it makes an ass out of you and me. Have you ever notice someone say they agree with you, then negate it by saying ‘but’ and putting forward their idea? In this situation, Anthony Robbins a motivation speaker and author suggests we listen to peoples’ points of view, respectfully and then respond with ‘That’s interesting’ and comment, if necessary.[ii] Positive listening like this means focussing on what people are saying rather than detracting from it by thinking about a response and interrupting.  

[i] Pease A., Questions are the Answer.

[ii] Robbins A., Awaken the Giant Within. Fireside Simon and Schuster, New York 1991