Why is Communicating with Patients Such a Challenge?

It makes some people’s skin crawl just to think of it.

What is it?  It’s the unforgiving blank stare you get after spending valuable time explaining your diagnosis to “Patient X”. Sitting in your office chair, your mind races, trying to think about how to explain things for what face-535769_960_720seems the 100th time.

Enter Osmo A. Wiio….

Wiio was a Finnish academic, journalist, author and member of the Finnish Parliament who wrote some humorous observations on communication, that have become known as Wiio’s Laws.[1][2]

The first and fundamental law states that: “Communication usually fails, except by accident”. [1]

He went on to say:
Communication usually fails, except by accident.
If communication can fail, it will.
If communication cannot fail, it still most usually fails.
If communication seems to succeed in the intended way, there’s a misunderstanding.
If you are content with your message, communication certainly fails.
If a message can be interpreted in several ways, it will be interpreted in a manner that maximizes the damage.
There is always someone who knows better than you what you meant with your message.
The more we communicate, the worse communication succeeds.
The more we communicate, the faster misunderstandings propagate.
In mass communication, the important thing is not how things are but how they seem to be.
The importance of a news item is inversely proportional to the square of the distance.
The more important the situation is, the more probably you forget an essential thing that you remembered a moment ago.

Let’s return to your office. Any number of these laws could be happening in your context, not to mention a host of other cultural and personal factors.  So what is a healthcare provider to do?

Here are 5 tips for improving  communication with patients:

1. Engage as many learning styles as possible. Gardner (2011)  found that people experience the world differently, and have different types of intelligence. In fact, most people have a combination of intelligences. People tend to learn using their strong intelligence suits, so it’s important for you to discover their learning styles quickly. Gardener’s intelligences are as follows: naturalist, musical, logical-mathematical, existential, interpersonal, bodily-kinesthetic, linguistic, intra-personal, and spatial. [3]

Bonus Pro tip: You can guess at some of these combinations based on the individual’s profession. You can even ask the person what their preferred learning style is when you begin your consultation.

2. Read your patient’s body… We’re not talking about just anatomy here. Non-verbal communication is key to understanding what’s going on in your interaction. Example: Crossed arms can often indicate that “Patient X” has built an invisible wall and is closed off to the conversation. Facial expressions are also very crucial to read properly.

3. Do a check for understanding. Have “Patient X” summarize what you just said in their own words.

4. Don’t be long winded. Watch your time! Leave enough time in the consultation so that the patient find answers to key questions such as: 1. What is my main
problem? 2. What do I need to do? 3. Why is it important for me to do this?

5. Don’t judge the patient by their outside appearance. Each person has a story. Don’t assume you know it before they open their mouths.

EXTRA BONUS: Remember that culture plays a key factor in understanding patients’ backgrounds. See Ruth Van Reken’s website for some interesting twists in culture in our globalized world.

What questions do you have regarding patient communication?  Feel free to comment below.

1.Osmo A. Wiio (1978). Wiion lait – ja vähän muidenkin (Wiio’s laws – and some others). Weilin and Göös. ISBN 951-35-1657-1.
2. Korpela, Jukka (2010). “A commentary of Wiio’s laws”. IT and communication. Retrieved 2017-2-16.
3. Gardner, Howard & Seana Moran. “The science of multiple intelligences theory: A response to Lynn Waterhouse.” Educational Psychologist, 41(4), 227-232. 2006. doi:10.1207/s15326985ep4104_2.

©Allison J. Weaver Consulting, LLC 2017


2 thoughts on “Why is Communicating with Patients Such a Challenge?

  1. That “unforgiving blank stare” you find so uncomfortable may simply be your patient desperately trying to assimilate the implications of what he or she has just been told. Doctors communicating life-changing news rarely give patients enough time to absorb the news and integrate it into their world view.
    As a cancer patient in remission, I have found a distinct lack of patience and willingness by doctors to repeat polysyllabic diagnoses I wanted to note down, simply so that I could use my own ‘valuable time’ to go and research the meaning and implications I should have received from my doctors and surgeons. My time is as valuable as yours, ma’am, even if I’m not paid quite as much for it – especially if my diagnosis is not optimistic.
    Communication is a two way process, and has not been achieved by the communicator unless meaning is received. A blank stare would sure indicate that meaning has NOT been received, or not fully. Speak slowly, avoid technical terms and tell them what the news means for them. Encourage them to take notes; writing things down helps to embed understanding.
    Sorry to have dished up a serving of irritation, but an attitude of “why are patients so difficult?” isn’t going to make you an effective communicator.

    Liked by 1 person

  2. Thanks for your comments and thoughtful reply. We don’t find it uncomfortable, but some of our clients, especially those who are attendings do struggle with this regularly. Compassion, putting others first, and an excellent listening are of paramount importance.

    Also, from what you are writing, we observe that you have had several unpleasant interactions with physicians and surgeons. We are saddened to hear that and believe that you deserve the best care and interactions with all healthcare providers. It seems that those in charge of your care were unable to meet your needs in that regard. You are right. There need to be more ways to help patients in life changing situations, especially those such as yours as a cancer survivor.

    Those we are addressing here often experience situations where they are overworked and ‘burned out’ by the system, in addition to a host of other factors. We wish we could have mentioned all of the factors that both patients and professionals are experiencing, especially since this is a challenging topic for everyone. Communication is indeed a ‘two-way street’. We could write pages and pages about it, and apologize that we were unable to address every angle of it in our article.

    Our motive for writing was to open up the dialogue for patients and caregivers to talk about their experiences, especially those who have been a bit ‘burned out’ by the system. The 5 suggestions that we provided above are the minimum that our clients can do to improve communication with their patients, and are a first step in the process. Again, we thank you for your comments and taking your time to write.


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