Communication: THE Core Competency

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Communication THE Core Competency

• Nancy L. Harthun, MD

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Nothing we do is in isolation

• Patient/Physician relationship
• Interactions with hospital and ancillary
  personnel
• Physicians
• Nursing staff
• Administrators
• Community, regional, national, and world-wide
  educator

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Day-to-day examples

• Obtain history and physical
• Convey bad news to a family
• Organize resources and funds for a new clinical
  endeavor
• Dictate a note
• Present at a national meeting
• Run a medical staff meeting

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Recognize extremes of Communication Pro

• Successful/Inspirational physicians are all
  effective communicators
• Each of us knows someone like this
• At UVA, they win teaching awards!
• People we want to emulate but how?

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Extremes of Communication Con

• High association of communication breakdown
  with medical errors (43)
• High association with medical malpractice
• High association with burnout and job
  dissatisfaction
• People we dont like working with
• Frequently provide examples of how not to handle
  situations

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Communication what is it?

• Moving target
• Significant regional and cultural differences
• Context dependent
• Standards for physicians are very different than
  for movie stars (more applicable to airline
  pilot)
• Made up of components that can be analyzed and
  improved (batting swing)
• Components apply to many different situations
  where communication is important

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Communication components

• Front foot step
• Shifting weight from back leg to front
• Leaves hands and arms to adjust swing to the
  pitch
• Eyes on the ball!

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Components of Communication

• Non-verbal (55 of impact)
• Appearance
• Posture
• Distance (proxemic) and position
• Touch
• Gestures
• Eye contact
• Verbal Delivery (38 of impact)
• Intonation
• Volume
• Speed
• Pauses
• Verbal Content (7 of impact)

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Non-verbal Communication

• Appearance
• Professional (more on this later)
• Posture
• Distance (proxemic) and position
• 1.5-4 feet
• Right angles
• Touch (them, not yourself)
• Gestures
• Above the waist limited use
• Eye contact
• Yes!!!

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AppearanceRowland et al. Curr Surg 62214-92005

• Regional/Cultural differences
• Conservative (solid colors, short hair, collared
  white shirt, limited jewelry)
• Neat
• Avoid too much stuff in pockets
• Avoid wearing things around your neck
• Gender differences
• Men matching shoes (leather) and belt
• Dont loosen your tie
• Women no open-toed shoes
• Natural tones in hose and make-up
• Avoid earrings that move
• Skirts preferred over pants

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Appearance continued
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No one goes to a surgeon to establish a casual
relationship
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Communication

• Non-verbal communication is a mirror of
  competence, trust, expertise, and compassion
• Dont be afraid to show your intelligence
• Some components of selflessness also

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Communication

• Verbal communication continues to grow as
  knowledge expands
• Preparation is another key element for effective
  verbal communication (ask others for help)
• Remember that the written word is also verbal
  communication
• Knowledge of the rules of presentation is
  essential
• Always consider clarity as highest priority
• Listen very advanced verbal communication is a
  conversation!

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