Communication: The Key to Better Care

Health care is complicated. Eye and vision care is even more complicated. For most patients the whole damn thing is a mystery. Their understanding of what you do and why, and what decisions they might have to make is very limited.

When health professionals communicate badly, bad things happen as a consequence.

The Oxford Dictionary defines communication as “The imparting or exchanging of information by speaking, writing, or using some other medium”. It is important to consider that communication is not just verbal in form. Up to 93 per cent of communication is more affected by body language, your attitude, and tone of delivery.1 That leaves only 7 per cent of the meaning and intent based on the actual words said.

Time to Land the Fish

For most patients the essential reason they came to see you is the last five minutes of the consultation. All the value resides in that time. The equipment is very interesting and the optometrist’s questions can be tricky, but they want to know what you think about their vision, and what you suggest should be done about it. You can’t spend enough time at this stage, and the more you can arrange the better. Don’t be tempted to rush it because you are running late. Remember what depends on this time:

• Your future relationship with the patient
• Your patient’s understanding of their vision problem and care
• Their intention to complete or get the best outcome from the dispensing process
• How well your support staff can continue the care process when the patient leaves the room.

Prioritise Your Take Aways

The patient is not going to remember everything you said, in fact, you can expect him / her to remember and understand around 20 per cent of what you say – and that’s on a good day.

In part, this is because the human brain sometimes gets stuck at the first obstacle. The patient struggles to understand, but the message continues and more points keep coming.

What all this means is that it’s vital to ensure your patient remembers the most important 20 per cent of what you have to say.

Pick your first words carefully. Make this the most important point, then stop and make sure the patient understands. A useful protocol used by many emergency services is STICC:

For most patients the essential reason they came to see you is the last five minutes of the consultation

• Situation: Here’s what I think the problem is.
• Task: Here’s what I think we should do.
• Intent: Here’s why.
• Concern: Here’s what we should keep our eye on.
• Calibrate: Talk to me. Tell me if you don’t understand, or you are worried about anything, or see a problem I might have missed.

If you have covered a few points in your discussion, it is worth summarising and reiterating those important parts, with clear, concise and positive recommendations.

Make Sure We Are Consistent

In healthcare research, 20 per cent of patients reported receiving inconsistent or conflicting information from different professionals.

To overcome this, you have to make sure that everyone in the practice is using the same terms, language, and the messages are consistent for each patient. Talking to your staff about this and engaging them in your consultation process is vital. Most staff have experienced a consultation, but that’s not enough. You need to have them sit with you like a student, and hear what you say and why. They need to understand what decisions you make and why, and how you explain this to a patient.

Make sure they are clear about key terms and messages. Do we need to say again how important handover is for consistent communication?

Lessons from the Paratroops

The US Army 82nd Airborne Division suggests the following points for effective communication in critical briefings:

1. Put your main point up front
2. Use an active voice
3. Use short, conventional words
4. Keep sentences short (about 15 words average)
5. Be confident, be correct, be credible, be complete

Hard Copy the Important Bits

Psychologists have found that resting after hearing important messages improves retention. But what happens to our patients? We send them into the dispensing process.

• If you can, provide the patient with information in a take-home format.
• Use the health information brochures. Most practices never give them out.
• Have a simple check list to tell the patient what you did, and what you found.
• Make sure your website covers all the important information patients need and direct them to it.

Practice It

Changing what and how you do things in the consulting room is not easy. We develop pretty ingrained routines and behaviours. Think about what you are doing and saying today, and change one thing. Don’t throw the fish back, but do make a change and everyone will get better results.

Mark Overton is the CEO of Ideology Consulting and, on occasion, lectures at universities. He has science and business qualifications and, for over 30 years, has consulted to or worked with major public hospitals, federal government, small and medium private businesses, medical research institutions, professional associations and small businesses.

Reference

1. Allesandra T, O’Connor M. The platinum rule: discover the four basic business personalities and how they lead you to success. New York: Warner Books; 1966