Good communication is key to good medicine (Proceedings)

Nov 01, 2009

Study after study in all walks of life demonstrate the importance of good communication. This is as true in scientific fields as in more obvious professions such as teaching or the law. Some of the studies documenting the need for good communications in veterinary medicine include:

     • PEW National Veterinary Education Program
     • AVMA Market Study (1999)—"Veterinarians are strong in scientific, technical and medical skills and lacking in communication and management skills necessary for success in practice."
     • Brakke Management and Behavior Study (2000)—Identified three business practices to increase practice income (employee longevity, employee satisfaction, and client satisfaction)
     • Personnel Decision Study (2003)—Identified non-technical competencies for career success (business acumen, work life balance, effective communication, and leadership skills)
     • AAHA Compliance Study (2004)—Lack of communication in making recommendations
     • AVMA-Pfizer Business Practices Study (2005) —Identified client relationships as a pillar of financial success

Strong scientific evidence in the human medical field demonstrates the relationship between communication and more positive medical outcomes. A recent study by Jody Hoffer Gittel and colleagues looked at the outcomes of joint replacement surgery in nine urban hospitals. Some of the hospitals invested heavily in hiring and training for relational competence (an ability to interact with others to accomplish goals; others focused on hiring the most technically qualified individuals with less emphasis on relational competence. The hospitals that considered relational competence important showed significantly improved patient outcomes:

     • 31% reduction in length of stay
     • 22% increase in quality of service patients perceived
     • 7% increase in postoperative freedom from pain
     • 5% increase in postoperative mobility

A very recent study by Morris and Latham in the veterinary field demonstrated:

     • Significant improvement in veterinary students' communication skills with increasing levels of training
     • No significant difference between no training and intermediate training
     • Client's recall highest in student group with highest level of communication training

A number of myths abound regarding communication skills. The first is that communication is a personality trait and you either have it or you don't. In reality communication is a series of learned skills and anyone who wants to can learn them. Another myth is that experience is a good teacher of communication skills. In reality, experience alone tends to be a poor teacher of communication skills—experience just tends to reinforce habits whether those are good or bad habits!

One of the next myths is that focusing on communication takes too long to be practical. This is obviously of great concern to any busy professional. In reality, relationship centered communication takes no longer than traditional approaches and is more efficient in the long run and results in greater client satisfaction and better medical outcomes.

One study demonstrated that the average consultation for doctors who don't use patient centered skills takes about 7.8 minutes. The average for doctors who have mastered patient centered skills is 8.5 minutes. It's a little longer for those in the learning stages—about 10.9 min for doctors who are learning relationship centered skills. But once mastered, it's clearly no more time-consuming.

The four key elements of good communication are:

     • Non-verbal communication
     • Open ended inquiry
     • Reflective listening
     • Empathy

Non-verbal communication is about building the relationship and fleshing out the verbal communication. Nonverbal communication includes all the behavioral signals that go on between interacting individuals, exclusive of verbal content. Roughly 80% of all communication is nonverbal; these non-verbal signals are generally involuntary. 20% of communication is verbal and intentional. Voluntary verbal communication reflects a person's thinking. Involuntary nonverbal communication more accurately reflects a person's feelings. When mixed messages are sent, the nonverbal message more truly reflects the person's actual feelings and will predict his behavior.