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Article Title

Communication

The new (old) buzz word is "professionalism” We must learn to be a professional! We must be professional in our practice! "Professional behavior” is an integral part of our training! One may even be dismissed from medical school for exhibiting unacceptable professional behavior. This is a current "call to arms” in medical training. At the core of "professional behavior” is knowledge, competency, and skills. However elements that might be considered as contributing to the support of this core of "professional behavior” might include altruism, leadership, honor and integrity, accountability and responsibility, caring and compassion, excellence and scholarship, respect, and communication.

Most of these supportive elements seem to be essential in "behaving professionally”. Altruism referring to what the intent is, regarding the patient contact and well being. Leadership implies some creativity and courage in decision-making. Honor and integrity relating to one’s morality (or beliefs) complementing one’s ethics (or behavior). Accountability and responsibility infer predictability and open evaluation. Excellence and scholarship implies an eagerness to learn and progress. Respect relating to one’s desire to be fair and just in addition to recognizing individualism.

But just what do we feel constitutes communication. As an element of professional behavior, communication should probably entail two aspects. One is the ability to communicate to the patient is probably the one we are aware of and concerned about. The second being the ability to sincerely listen to what the patient is communicating to you. Both skills are equally important in order to be a good, professional communicator.

So just what does it take to be a good communicator? To begin with, having deep technical knowledge, plus an extensive vocabulary along with wonderful diction and good articulation may seem like the elements of good communication, although they may not guarantee that your message is being received.

A patient comes into your office complaining about a loss of energy Your patient may not understand when you tell him that, "what is causing his lethargy is that he is lacking an enzyme that catalyzes the third step in the electron transport sequence that is essential in the production of ATP for energy”. So, obviously choosing the right words for the particular patient is an important part of communicating properly.

Certainly in the realm of advertising being a good professional, or exhibiting good professional behavior, a hallmark is communicating. That is, getting the right message across, at the right time, to the right person. Writing an advertisement that is appealing to someone reading the Wall Street Journal may have to be different than writing an advertisement for the same product while appealing to someone reading the Podulla Gazette. Perhaps we, in the practitioner – patient relationship, can borrow some philosophy from advertising when we communicate with the patient. We can tell them what we are going to tell them, we can then tell them, and then we can tell them what we told them. This is reinforced communicating. In addition, we should consider who we are speaking with, someone with a PhD along with post doctoral education or someone who never graduated high school or someone who immigrated into this country?

However, other elements of good communicating have nothing to do with words. They include body language. This would include physical posture, physical positioning in relation to the patient, facial expressions including eye to eye contact. For example how would you feel when during an intimate moment your partner jockeys for position to turn away to be able to see the TV screen? How would you feel when you are delivering a wonderful lecture and the students’ heads are hidden behind the computer screens? How would you feel if the physician is eloquently asking you questions while never looking at you while punching the key board? How much more comfortable would you feel if your physician were standing near you or sitting close to you without being separated by that huge, imposing, solid Brazilian cherry wood desk? How about pouring your heart out while describing your symptoms to a bored facial expression, or an expression preoccupied with how the market is doing? How motivated to learn are you when the instructor is standing with his back to you and very carefully reading off the screen in monotone, that which you are capable of reading yourself? Wouldn’t you be more prone to listening if the communicator’s tone of voice was appealing and his display of enthusiasm was evident?

In the medical training of today we are justifiably quite concerned with such needs as learning: to read images; to determine what tests / labs to order; to interpret those tests / labs; appropriate surgical techniques / procedures; how to recognize symptoms; how to identify pathogens; how to select medications; the upgraded technologies, etc. These are our so called "tools of the trade.”

hese are some of the more traditional objectives in medical training. However today’s training also involves such frustrating, time consuming efforts as: learning new procedural paperwork and codes; adhering to new insurance protocols; how to potentially, legally defend diagnoses and/or treatments; placating legal demands; adapting new information / data technologies; understanding the business concerns of the practice; just to mention a few of the contemporary challenges in maintaining a practice.

The practitioner is trained to do all of this while at the same time he/she must balance the professional life with a personal life. The question is, "have we put enough emphasis on what it takes to be a good communicator?

It is unfortunate that in today’s practice of medicine, practitioners can become so distracted by these concerns that being a good communicator gets lost or winds up low on the priority list.

Why is being a good communicator so important? It is possible that by being more alert to the elements that make up good communications both the practitioner and the patient reap more benefits. These benefits would include greater trust and credibility in the practitioner. This in turn might foster greater compliance on the part of the patient, which in turn results in better health outcomes. In addition, if the patient is more comfortable with the communicating of the practitioner and feels the practitioner’s sincere interest, this might very well lead to fewer complaints with regard to the general care or even complaints of negligence. It is possible that with better communication, patient overall satisfaction will improve. This can become a self-feeding cycle. The chances are that as the patient experiences better communication from the practitioner, the patient in turn would become more "communicating” with the practitioner and this surely could improve the practitioner’s management of the patient’s health outcomes.

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