The Go-To Clinical Skill—Communications

Of All the Clinical Skills, Which Serve Patients Best?

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It’s a tough question, given the range of patient needs and conditions. Yet one skill can have a huge impact time and time again: Communications.

Talking and listening to patients “is the most common procedure a clinician will employ,” says the non-profit Institute for Healthcare Communication (IHC). “Evidence continues to mount that a structured approach to communication measurably improves care delivery.” Effective clinician-patient communications can:

support better history-taking, diagnoses and clinical decisions
increase a patient’s adherence to recommendations and follow-ups
help patients to self-manage a chronic condition
influence patients to adopt preventive health behaviors
improve patient satisfaction and experience of care

That’s true across health care fields, and certainly in physiotherapy. A study in the May 2015 Archives of Physical Medicine and Rehabilitation looked at 24 physiotherapists from four hospital clinics who were working with patients with back pain. The physiotherapists were split randomly into two groups. One received eight hours of communication skills training.

Compared to the other group, the trained group subsequently paid greater attention to needs during clinical practice*. “When patients’ psychological needs are supported,” the study stated, “willingness to participate and long-term compliance to treatment is more likely.”

Another study published in 2012 in the Journal of Physiotherapy (Australia) showed a clear link between communications abilities and what they called the “therapeutic alliance”. The study authors noted that “communication is an essential skill”, one that physiotherapists and other clinicians “need to master to improve quality and efficiency of care.”

Glossary

Clinical Practice:
Any component of assessment, analysis of findings or treatments to patients for whom you are directly responsible. This includes the assignment of any portion of care to physiotherapist assistants.

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Communication: Six Keys

Show Basic Courtesy

Without trust, patients might not provide needed information or follow directions. How can you start building trust in minutes? Acknowledge the patient—greet them professionally, introduce yourself, look them in the eye, and tell them what to expect. It helps patients to be more comfortable.
Be Clear

Avoid jargon. Use plain language to explain what’s happening and why. Give patients multiple chances to ask questions. Don’t mistake silence for understanding or agreement. Ask patients to recap what you’ve done or discussed in their own words, to confirm their comprehension.
Listen

That’s half of communications. Ask about the patient’s concerns and feelings. Probe their emotions and beliefs. Paraphrase what they tell you. It shows they’re heard.
Consider Culture

Think of culture beyond race, ethnicity or language. It’s also gender, age, religion, socio-economic status, abilities and disabilities, and more. Everybody has a unique mix of experiences and circumstances. These cultural influences can shape health and perspective on health. By learning more about your patients’ hopes, fears and requirements, you can better tailor your care and your communications. That’s being culturally sensitive in the broadest way.
Confirm Understanding

What are patients anticipating? Discuss goals and ensure a mutual understanding regarding next steps, possible outcomes, timelines, etc. Part of communications is aligning expectations.
Watch Your Body Language

According to studies our words make up just 7% of what others perceive. How we say it (tone, volume, pace) accounts for 38%. The other 55% comes down to non-verbal communications, like expressions, gestures and posture. Folded or open arms, raised eyebrows, smiles, frowns, slumped shoulders, glances, nods, tilted head, clenched or open hands—these all send signals. Notice your cues and your patients’ too. Remember, body language speaks.

Preventing Complaints

The central role of communications in effective care is evident in the complaints the College receives. On the surface, a complaint might be about informed consent, fees or the quality of treatment, but the root problem is really communications. Often, the issue could have been avoided with little effort—risks and benefits clearly explained, simple language used or empathy shown.

One College case involved a woman who sought physiotherapy after rotator cuff surgery. She complained that the transcutaneous electrical nerve stimulation machine wasn’t working during the 20 minutes it was applied. What gnawed at her beyond the malfunctioning equipment was the feeling, in her words, that “no one seemed concerned”.

When this patient had another appointment, she was kept waiting and was put off by what she perceived to be a “casual and uncaring” attitude.

Like any clinical skill, communications can be learned and honed. With the connections between communications and patient outcomes, this is a skill that requires dedication. As a physiotherapist, you’re not just providing care—you’re showing care. Ultimately, both have an effect on a patient’s well-being.

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