Are you a medical professional who uses a foreign language at work?

Have You Ever Been in This Situation?

Not knowing how to comfort a patient in distress.
Not remembering how to say or pronounce a word.
Knowing the medical term, but not being able to explain it to a patient.
Wanting to socialise with a colleague, but being scared that the words will not come naturally.

What Can MoM Do for You?

MoM is a tool that gives you the words and shows you how to say them in meaningful, professional contexts.
On the e-learning/mobile platform, you will learn how to better communicate in a cross-cultural medical context by means of sound files, conversation scenarios with patients and colleagues, everyday medical terminology with pronunciation, grammar tips, and a medical communication manual raising awareness about doctor-patient interactions.

On the Communication for Professionals Facebookpage and Google+, you can share your experiences with other learning professionals.

 

 

Boost your professional interactions by trying the following tips.

Let us answer your communication questions. Suggest topics for our next newsletter!

1) First Impressions

Communication Tips by Medics on the Move

When you walk in the room and greet your patients (or colleagues), they form first impressions of you.  First impressions are powerful, and can be difficult to change once they are established.  Although what you say matters, a large part of first impressions are based on nonverbal behaviour.

Try to make a positive impression by:

– Smiling;
– Making eye contact;
– Shaking hands (if customary in your hospital or medical practice);
– Showing enthusiasm and curiosity for the coming encounter in your body language;
– Avoiding signs of being in a hurry;
– Avoiding signs of disinterest;
– Avoiding signs of unease like shifting your eyes away from the patient;
– Avoiding signs of arrogance.

People tend to believe the nonverbal message more than the verbal message.  Contradictory communication may cause confusion and undermine others’ trust and belief in your sincerity and honesty.

2) Greet the Patient

Communication Tips by Medics on the Move

How you greet patients strongly influences their first impression of you.

To make this impression as positive as possible:

– Greet patients individually, by name, when you first meet them, either in the waiting room or in the consultation room
– Mind that in some cultures women keep their last name when married, e.g., in Belgium as opposed to the Netherlands.
– Address children directly and take them seriously.
– If applicable, stand up and walk toward a patient when they enter the room.
– Greet patients while they are fully dressed.
– Mind that in some cultures people will avert their eyes when speaking to you as a sign of respect.

3) Non-verbal Communication: Eye Contact

Communication Tips by Medics on the Move

In the Western world, eye contact usually communicates interest and attention, and is an important component of active listening. Eye contact generally gives patients or colleagues the impression that you are concentrating on them and what they are telling you.  Avoiding eye contact, looking away, or staring at the ground is often considered impolite, and can be interpreted as a sign of disinterest or dishonesty. However, it is important to be aware that in some cultures, direct eye contact may be seen as rude or threatening.

As with other types of nonverbal behaviour, it is generally best to monitor your patients’ level of comfort, and adapt your own behaviour to what makes them the most comfortable.

– For some, this will mean looking them in the eye; for others, it may mean directing your gaze elsewhere.

– If you cannot avoid doing something that makes your patient uncomfortable, explain the reason for your behaviour.

By all means, try to position yourself on eye-level height; you will indicate that you are interested, accessible, and not threatening.

4)  Be Aware of Your Verbal Behaviour

Communication Tips by Medics on the Move

Your verbal behaviour – that is, the language you use and the words you choose – also contributes to patients’ impressions of you.  To make a positive impression:

– Invite patients to sit down and/or make themselves comfortable:

Please sit down.

Please, take a chair.

– Start the consultation only when patients are comfortably seated.

– Apologise when you are late.  A patient wants to feel recognised and acknowledged. You cannot expect them to know what is going on behind the scenes.

– Name, explain, and apologise for any inconveniences or other circumstances that may interfere with the consultation.

  I hope you didn’t have to wait too long with the new registration system.

– Take some time – if appropriate – for some general or social questions or remarks to make patients feel at ease.  In case you know your patient reasonably well some reference to a shared topic of interest is possible.

So nice to see you again. Everything all right with the children/the dog …?

– Gap-filling: if necessary (in case you have to wait for some information or a procedure to start), prepare a few remarks of general interest (e.g. on current events). Make sure to keep up to date.

The weather isn’t very nice today.

Did you get here easily with all the roadworks going on?

– Some consider it unprofessional to spend a lot of time on small talk at the beginning of the consultation (Maynard and Hudak 2009). Announce that you will make time for some social chat at a later stage of the consultation.

Let’s first see what I can do for you and have a chat afterwards.

5) Understandable Language

Communication Tips by Medics on the Move

How you say things can be as important as what you say.  You are more likely to have effective and satisfying consultations with your patients (and colleagues) if you use appropriate language, i.e. language that is understandable, respectful, and honest.

Try the following tips for understandable language:

 – Simplify (e.g. break long explanations down in smaller parts);
– Make your speech recognisable (e.g. adjust your speed to your patient’s speed, use the same kind of vocabulary, …)
 – Explain why what you say is true or important.

6) Respectful Language

Communication Tips by Medics on the Move

How you say things can be as important as what you say.  You are more likely to have effective and satisfying consultations with your patients (and colleagues) if you use appropriate language, i.e. language that is understandable, respectful, and honest.

Try the following tips for respectful language to reassure patients that you see them as people who have not only medical, but also personal and social needs:

– Show attention,
– Use descriptive rather than judgemental words. E.g. Why-questions may sound accusatory or disapproving. They make patients think you are suspicious of them or their reasons for doing things. This could lead them to feel uncomfortable and/or to invent reasons for their actions

7) Honest Language

Communication Tips by Medics on the Move

How you say things can be as important as what you say.  You are more likely to have effective and satisfying consultations with your patients (and colleagues) if you use appropriate language, i.e. language that is understandable, respectful, and honest.

Try the following tips for honest language: even when this is difficult, speak the truth about the seriousness of patients’ diagnosis, their options for treatment and their prognosis

– Try to find out what kind of emotional support each individual patient needs and wants by observing them carefully and listening attentively. It is possible to be both honest and emotionally supportive.
– Ask your patients: What can I do for you now? How can I help you?  Is there anyone you would like to call?  Their answers can tell you whether they are seeking information, or emotional support.

8) Address Potential Problems

Communication Tips by Medics on the Move

Late for work? Has the hospital turned into a construction site? Bad luck? To maintain the professional character of encounters with patients, it is important to address potential problems:

– Inform patients if you will be late. Most patients will be much less bothered by waiting if they know that you are late. You can ask the secretary or nurse to inform them.  When you arrive, apologise for being late.
– Apologise for any other external circumstance that may interfere with the professional character of the consultation, such as construction in the hospital, a new administrative or records system, a lack of privacy due to the design or configuration of examination rooms.

 9) Verbal Encouragement
– Use of Silence

Communication Tips by Medics on the Move

Sometimes, silence can be used to facilitate conversation. Often, you can guess the patient’s reason for silence using clues from the context.  Short questions may help you determine the reason for the silence. Different responses are appropriate for different reasons for silence:

– For patients that are trying to organize their thoughts, a short question inviting them to continue can be helpful:

Can you tell me more about this?
What are you thinking about?

– For patients that are working through emotions associated with what was been said, it can be helpful to provide a sympathetic comment with a friendly, understanding and inviting tone, such as:

I have the impression that you find it difficult to tell more about this.

– For patients who have nothing more to say, the best answer can be to change the subject of discussion
– If you are not sure of the reason for silence, it can be best to ask an open question such as:

May I ask you, as this may be difficult: what makes it difficult for you?
Is there anything else you would like to tell me?

Silence can be powerful in verbal communication, but it can also become uncomfortable.

If you need to be silent for a period of time, let the patient know. You can make a comment explaining the silence, such as:

I just want to think over all you have been telling.

I first want to make some notes.

There can be a fine line between comfortable and uncomfortable silence.  To make sure everyone has time to process and think about what is being said, a good general rule is to wait at least three to five seconds before intervening or responding if there is a pause in conversation.

10) Verbal Encouragement– Repetition

Communication Tips by Medics on the Move

We show others we are paying attention through our use of verbal encouragement. These phrases are usually short and neutral, like, I see, uh huh and go on. Their function is to acknowledge patients, their story and their feelings, and let patients know that you are listening, without interrupting the flow of their speech.

– Repeating or echoing (one of) the last few words of patients’ sentences when they pause can encourage them to keep talking. Echoing the patient’s own words not only shows that you are listening and understanding them, but also enables them to hear what they have just said. This can help them refocus and make sure they are communicating what they intend.

The patient says:
– … Then I suddenly felt something strange in my stomach …

You echo:

– In your stomach?

– Repetition can also be a useful technique to reinforce information when explaining a diagnosis to a patient, and planning next steps in treatment or management. In this case, you may repeat your own words to emphasize important points, or may echo the patient’s words to confirm understanding.
– This strategy should be used in moderation. Frequent echoing may be irritating, as patients may think you are parroting or mocking them. One way to avoid the impression that you are parroting is to repeat the key ideas or essence of what you heard in your own words.

11) Verbal Encouragement: Paraphrasing

Communication Tips by Medics on the Move

Paraphrasing is a type of verbal encouragement and it means restating what you have heard and understood in your own words.  Paraphrasing can be a good way to check whether your own interpretation of what a patient has said is accurate.  By playing back the message in your own words, you show the patient what you have understood.  Following your paraphrasing with a short phrase like, Is this correct?gives the patient the opportunity to correct any misunderstandings, and to embellish the story further if they would like to.

The process of paraphrasing involves eliciting, organising and reflecting on the information a patient provides. This process is something both you and your patients can learn from.

12) Verbal Encouragement: Reflecting Feelings

Communication Tips by Medics on the Move

While paraphrasing generally refers to the content of what the other was saying, reflecting feelings involves summarising and playing back your impression of the feelings or emotions that others are experiencing. This is often done through short questions or phrases such as:
– ‘It seems that you’re upset by this’
– ‘It seems that the situation troubles you’

As with paraphrasing content, you may follow such a statement with a short question like:
– ‘Is that correct?’

This question enables you to check whether you have understood the patient properly. Reflecting feelings can also help you empathise with patients and see the situation from their perspective.

13) Picking up Cues during Consultation

Communication Tips by Medics on the Move

Cues are signals by one person that are picked up by another. During a medical consultation,

they generally point to patient’s emotions, ideas, concerns and expectations. Cues can be both verbal and nonverbal:

Examples of verbal cues:
– ‘I feel worse’ (incomplete message)
– ‘It doesn’t improve’ (vague message)
– ‘I have problems’ (emotional message)
– ‘It is always like that’ (generalisation)

Nonverbal cues can be found in the patient’s:
– Tone of voice (signalling, e.g. distress)
– Facial expression (signalling, e.g. depression)
– Eye movement (signalling, e.g. boredom)
– Posture (signalling, e.g. dislike)

Picking up verbal and nonverbal cues requires care and attention. A doctor cannot ignore patients’ cues: these cues are requests for help or for a response. How to respond to patient’s cues will be included in the communication tip for next month.

14) Responding to Cues during Consultation

Communication Tips by Medics on the Move

A doctor cannot ignore patients’ cues: these cues are requests for help or for a response. Rather,a doctor must decide whether to act on the cue immediately or wait and respond later. Regardless of whether the issue which a cue signal can be addressed immediately, it is important to acknowledge the cue, either verbally or nonverbally.

Examples of Verbal Cues:
– ‘I feel worse’
– ‘It doesn’t improve’
– ‘I have problems’
– ‘It is always like that’

Acknowledgement:
– ‘Worse than what? In what sense? About what?’
– ‘What doesn’t improve?’
– ‘Do you care to tell me about them?’
– ‘Does that mean every month?’

Acknowledging a cue shows the patient that you have seen or heard what they are trying to communicate, and in doing so acknowledges patients’ right to have their own views and feelings, even if you disagree. This can facilitate present and future communication, as well as help build rapport.

Reflecting feelings is one way of acknowledging and responding to cues. As mentioned above, it can also help you empathise with your patient and see the situation from that patient’s perspective:

Instead of …
– ‘Yes but …’ (a response which is easily perceived as a negation of the acceptance and may provoke defensiveness)

Say …
→ ‘Yes, I understand …’ (an accepting response followed by an attentive silence inviting the patient to continue

15) Directive Skills

 Part 1: Asking Questions

Communication Tips by Medics on the Move

Directive skills are powerful tools in medical interaction. They include asking questions, asking for clarifications, providing a rationale and signposting.

Asking good questions provides evidence that you are a good listener. As with all types of communication, it is important to consider both content and language when formulating a question. In other words, it is not only important what you say, but also how you say it.

Find more information, tips and examples, here.

16) Directive Skills

Part 2: Asking for Clarification

Communication Tips by Medics on the Move

The communication may require some directive skills.

Directive skills are powerful tools in medical interaction. They include asking questions, asking for clarifications, providing a rationale and signposting.

Although you often ask questions to gain new information, sometimes questions are needed to clarify information that a patient has already provided. This is usually necessary when a patient’s statements are too vague or require further elaboration before you can use the information they are trying to provide:

The patient says …

– ‘I feel bad.’

– ‘This uncertainty is driving me crazy.’

You respond …

→ ‘What feels bad?’

→ ‘What makes you feel uncertain?’

Echoing or paraphrasing what was unclear, or reflecting feelings, may precede the clarifying questions as an introduction:

– ‘You said that … Could you give an example?’

– ‘That must have been difficult for you. Could you tell me more about it?’

Asking questions related to time frame may be useful to clarify the sequence of events, when this is important:

The patient says …

– ‘Since I left hospital …’

You respond …

→ ‘When exactly did you leave the hospital?

17) Directive Skills: Types of Questions and When to Use Them

Part 1: Open Questions

Communication Tips by Medics on the Move

Consultations commonly involve asking questions and gaining information. Using different question types may facilitate the consultation and affect the type and amount of information the patient will provide when replying. There are three main question types: open questions, directed questions and closed questions.

Asking the right question at the right time will simplify the process of consulting with patients. A good consultation follows a particular technique called the open-to-close cone of questioning. A good general strategy for gathering information from patients is to start with open-ended questions and move towards more focused and closed-ended questions.

Open questions are general questions, giving the patient a lot of freedom to choose how to respond. It is important to use open questions when exploring a new problem. They give patients the opportunity to reflect and think, and to tell a story about the problem they are experiencing.

An example how to formulate an open question is:

– ‘Tell me …’

• ‘Tell me about …

18) Directive Skills: Types of Questions and When to Use Them

Part 2: Directed Questions

Communication Tips by Medics on the Move

Consultations commonly involve asking questions and gaining information. Medical professionals should always be aware that patients with a different language or cultural background may find it difficult to identify or explain their problem. Using different question types may facilitate the consultation and affect the type and amount of information the patient will provide. There are three main question types: open questions, directed questions and closed questions.

A good consultation follows a particular technique called the open-to-close cone of questioning. A good general strategy for gathering information from patients is to start with open-ended questions and move towards more focused and closed-ended questions.

Focused or directed questions generally follow open-ended questions. Directed questions allow you to ask for clarification or additional information about points the patient has raised in response to earlier questions. Responses to directed questions mainly will give you more information about the cause or nature of a problem:

Example of a good directed question:

– ‘Does something make your headaches change, for better or worse?’

19) Directive Skills: Types of Questions and When to Use Them

Part 3: Closed Questions

Communication Tips by Medics on the Move

Asking the right questions and gaining accurate information from a patient are powerful tools during consultations. Using different question types may facilitate the consultation and affect the type and amount of information the patient will provide. There are three main question types: open, directed and closed questions.

It is important to know what kind of question to ask first, and what to ask last. A good consultation follows a particular technique called the open-to-close cone of questioning. A sound general strategy for gathering information from patients is to start with open-ended questions and move towards more focused and closed-ended questions.

Closed questions generally follow directed questions. They are focused and are used to elicit specific pieces of information which are considered important for the consultation. They often arise from information the patient has already given and zoom in on specific details or a particular problem. Responses to closed questions mainly will give you the information needed to determine the cause or nature of a problem.

20) Directive Skills: Types of Questions and When to Use Them

Part 4: The Language of a Good Question

Communication Tips by Medics on the Move

Directive skills are powerful tools in medical interaction. During a consultation with a patient practitioners need to be aware of what language to use when asking questions. While the type of question affects the type and amount of information the patient will provide when replying, formulating your question in the right way will avoid confusion.

When asking a question during a consultation, you have to be clear and concise. The patient has to be able to follow your train of thought.

The language of a good question:

− is language that a patient can understand, which generally means using understandable, respectful and clear language and avoiding specific medical jargon.

− is structured in a way that makes it clear how to provide an answer.

It is not advisable to ask multiple questions in a row. Instead, introduce the patient to the series of questions and politely give them instructions on how to answer.

Instead of …

– ‘Do you feel the pain? When do you feel the pain? How long does it last?’ (many sequential closed questions)

Say …

→ ‘Sorry, to be complete, I now have to ask a series of short questions. A ‘yes’ or ‘no’ is OK.’ (apologise and announce what is going to happen, explain why)

21) Directive Skills: The Importance of Descriptive Language

Communications Tips by Medics on the Move

During consultations, practitioners need to consider what language to use when asking questions. While the type of question affects the type and amount of information the patient will provide when replying, formulating your question in the right way will avoid confusion.

When asking a question during a consultation, you have to use appropriate language that does not make a patient feel uneasy. Avoid asking questions which contain suggestive language, or which may sound disapproving. The patient will feel more at ease when you ask questions using:

– descriptive language, which is used to describe the problem at hand clearly and unambiguously, and which leaves as little room for interpretation as possible.

– non-judgemental language, which generally means using words and terms in a neutral way rather than in a way that suggests an opinion or evaluation.

Example

Instead of …

– You probably also suffer from …?
(inherent judgment and disapproval)

Say …

→ What you just mentioned may cause other problems … Are you experiencing any other problems?
(descriptive, non–judgmental question)

One way of structuring your talk is by chunking. ‘Chunking’ means breaking down longer and more complex explanations into digestible pieces, or ‘chunks’. This can help patient understanding and recall because smaller pieces of information are easier to process.

After you give a piece of information, check that patients have understood what you want to say. You may do this by asking explicitly whether patients have understood or by observing patients’ nonverbal responses.  Only move on to the next ‘chunk’ when you are confident a patient has understood the previous chunk.

It is not only important to provide patients with small pieces of information and check their understanding by studying their verbal and non-verbal responses, you can improve the quality of your communication by timing your information well.

Sometimes, when you provide a piece of information it can be as important as what you say. Research shows that we are better at remembering what we are told first (the primacy effect) and what we have been told last (the recency effect), than what has come in between. So, if you have something important to tell a patient, consider saying it either at the beginning or at the end of your discussion with them.

27) Explicit Highlighting

It is not only important to provide patients with small pieces of information (see Structuring Skills in May) and check their understanding by studying their verbal and non-verbal responses (Chunking and Checking, see June), you can improve the quality of your communication by timing your information well (see July’s Communication Tip) and explicitly highlighting certain components of your message.

Explicit highlighting means verbally drawing attention to a particular point. This can be similar to signposting, but makes explicit that what follows is something that requires attention. This is a form of meta-communication (which we will discuss more in November). Two examples:

28) Summarising

Summarising is closely related to paraphrasing, but it is often more extensive. Summarising generally restates all of the important points in a discussion up to that point, rather than just reformulating the most recent statement.

Sometimes, it can be helpful to signpost a summary by using time indicators: first, now, …

Example: Let’s see whether we’ve discussed everything. First, …

Now that we have summarised our talk so far, we can …

Like paraphrasing, summarising may be used to check your understanding of what the patient has said. It can also give patients an explicit opportunity to elaborate on or extend their story. This can enhance accuracy and help patients provide the most complete information possible.

Asking short questions such as ‘Is that correct?’ or ‘Would you still like to add something?’ can facilitate this. Be aware that although summarising is helpful, doing it too frequently can disrupt the flow of communication.

29) Structuring

Structuring your talk means sequencing actions in an ordered way. Having a plan for the structure of an interaction can help make your conversations smoother, and can help you make sure you have not missed anything important.

For medical consultations, it can be helpful to have a mental map – that is, a plan of how something will go – for not only the entire consultation, but also for different sub-parts of this process. Mental maps help provide a clear structure of the content to be kept in mind during each part of the interaction. The basic outline of the consultation with its five tasks: opening the session, information gathering, examination, explaining and planning and closing the session, is one example of a mental map. Ticking the boxes of that mental map will keep you focused on the conversation.

30) Meta-communication

Meta-communication literally means communication about communication. In doctor-patient communication, it usually refers to communication about how the consultation is going to proceed, and what is going to be discussed or done next.  Both signposting and explicit highlighting (discussed in April and August) are forms of meta-communication.

Meta-communication may be verbal or nonverbal. You can explicitly state what you will do or talk about next (as in signposting), or you may communicate these intentions with nonverbal signals like eye contact, facial expression, or tone of voice (which we will discuss later).

In cases where communication has stalled or otherwise become difficult, you can use meta-communication to try to understand how the problem has come about, and how best to solve it or proceed in a new direction. Thus, meta-communication can also be used to prevent or solve conflicts with patients in the consultation.

31) Appropriate Verbal Communication

Active listening is an important skill in a medical context and it lays the foundation for your professional interactions and relation-building with your patient (see the tips from May 2016 until November 2016).

When we start communicating using words, how we say things can be as important as what we say. This may seem odd, but approximately 30% of our understanding relies on voice quality, tone of voice, intonation patterns and the like. So, the same basic message can be interpreted very differently, if it is said in different ways. However, using appropriate language (words) will help both you and the patient have an effective and satisfying consultation (see Pendleton 2007; Silverman et al 2006; Tate 2007). Generally, appropriate language is understandable (January 2017), respectful (February 2017) and honest (March 2017).

32) Understandable Language

Understandable language uses simple, recognisable and clear words and phrases to ask questions, to explain, for example, symptoms and examinations and plan, for instance further tests and treatment. It avoids jargon, abbreviations and other difficult or complex words and phrases.

Instead of saying: Do you feel better or do you still feel the pain? (a double question)
You should say: Do you feel better? (single question)

Sometimes jargon, abbreviations and in general more complex words and phrases cannot be avoided. In this case, it is best to apologise and then do what you can to help make this complex language easier for the patient to understand.  Some strategies for doing this are:

• Breaking long explanations down into smaller, more digestible ‘chunks’ (see June 2016). Check that the patient has understood each chunk before moving on to the next.

• Using logical structuring to make these chunks easier to understand, and to connect to each other.

• Using explicit categorisation to make these chunks easier to understand, and to connect to each other.

33) Respectful Language

Respectful language makes communication more effective in many ways, since it prevents misunderstandings and conflicts. It also reassures patients that you see them as people who have personal and social needs as well as medical needs.

Respectful language shows attention, uses descriptive words and is problem-oriented.

• Showing attention: you are interested and engaged in what is being said, which is also a sign of respect. Showing attention is an important part of active listening (discussed May 2014 and May 2016).
• Using descriptive words, and not judgmental words, allows you to ask questions and collect information in a way that makes a patient feel respected and comfortable, rather than judged.
• Problem-oriented language focuses on the patient’s medical issue, in a way that is clear and understandable to them. Here, a stepwise approach is often helpful.  A stepwise approach involves approaching a problem in steps or phases, and providing optional statements with a rationale.