Mastering Communication in Clinical Practice: The 10 Presuppositions

For clinicians, effective communication can make or break treatment success.?

In many of my workshops I introduce the concept of ‘presuppositions’ in healthcare communication.

Understanding and applying the 10 presuppositions of communication can significantly enhance patient interactions, leading to better outcomes and more satisfying therapeutic relationships.

These presuppositions guide clinicians to adopt a patient-centred approach, foster empathy, and continuously improve their skills. Research has shown that effective communication between patients and healthcare providers is essential for the provision of patient care and positive health outcomes.

Let's explore each presupposition and discover how you can apply them in your daily practice:

1. You Cannot Not Communicate

Every action, gesture, and even silence communicates something. Clinicians must be aware of their non-verbal cues and their impact on patients, especially before meeting them for the first time.

Non-verbal communication, such as nodding and smiling, can help convey engagement. These behaviours can help patients feel more at ease and more trusting of a caregiver's input. If you look flustered, annoyed snappy in the reception room this also converts a message to the patient.

Exercise: In the next patient interaction, pay attention to your body language, facial expressions, and tone of voice. Reflect on how these might have influenced the communication.

2. The Meaning of Communication is the Response It Gets

Effective communication is measured by how it's received, not how it's intended. This encourages clinicians to focus on patient understanding rather than their own intentions.

Research has shown that communication processes are essential to more accurate patient reporting and disclosure.

Exercise: After explaining a treatment plan, ask your patient to explain it back in their own words. I like to say to the patient, “Imagine they are telling a friend or family member what I said today. What would you say to them?” Note any discrepancies and adjust your communication accordingly.

3. People Make the Best Choice Available to Them at the Time

This principle promotes empathy and non-judgmental attitudes towards patients' decisions. It encourages clinicians to explore the reasons behind patient choices rather than dismissing them as non-compliance.

Patients may withhold medical information for various reasons, including feeling intimidated by their providers or believing their providers will not listen to them?.

Exercise: Think of a patient who hasn't been adhering to their treatment plan. List possible factors influencing the decision and consider how you might provide additional support or information.

4. Behind Every Behaviour is a Positive Intention

Understanding this can help in addressing non-adherence to treatment plans more effectively. It encourages clinicians to approach patient behaviours with curiosity rather than frustration.

Effective clinical communication is two-way, structured, and continuous, resulting in timely, accurate, and appropriate transfer of information?.

Exercise: Identify a patient behaviour you find challenging. List three possible positive intentions behind this behaviour and approach your next interaction with this perspective.

5. The Person with the Most Flexibility in a System Will Have the Most Influence

This emphasises the importance of adaptability in communication. Being flexible allows clinicians to tailor their communication to each patient's unique needs and preferences.

Improving communication skills benefits other healthcare professionals on a patient's care team, as a clearly written medical history helps inform future care?.

Exercise: In the next three patient interactions try using a different communication style for each. Reflect on which style seems most effective for each patient.

6. A Person Cannot Not Respond

Even silence or lack of action is a form of response. This presupposition encourages clinicians to be attentive to all forms of patient feedback, verbal and non-verbal.

Active listening is the practice of listening to understand. It requires paying attention to the speaker, noticing nonverbal cues, and engaging with them as they speak without interrupting?.

Exercise: In the next patient session pay close attention to all forms of response, including body language, facial expressions, and silence. Note how these responses guide you communication.

7. Resistance is a Comment on the Communicator

When clinicians encounter resistance from patients, this principle encourages them to reflect on their own communication style rather than labelling the patient as 'difficult'.

Respectful communication between clinicians and patients can reduce uncertainty, enhance greater patient engagement in decision making, and improve patient adherence to medication and treatment plans?.

Exercise: Recall a recent instance of patient resistance. Reflect on your communication approach in that situation and brainstorm three alternative ways you could have communicated.

8. The Map is Not the Territory

Each patient has their own 'map' or perception of reality, which may differ from the clinician's. Understanding this can help in tailoring the approach to each individual patient.

Healthcare teams often deal with populations from diverse backgrounds, and understanding how to tailor their communication to each individual is key to providing effective care?.

Exercise: In the next patient interaction, ask them to describe their understanding of their condition. Note any differences between the patient's 'map' and your clinical understanding.

9. There is No Failure, Only Feedback

This mindset encourages both clinicians and patients to maintain a growth-oriented approach to treatment. It helps view challenges as learning opportunities rather than setbacks.

Patient-centred communication is crucial in promoting patient-centred care and requires that patients and their caregivers engage in the care process?.

Exercise: Identify a recent communication challenge with a patient. List three lessons or insights from this experience and plan how to apply these in future interactions.

10. The Mind and Body are Interconnected Systems

This presupposition emphasises the importance of a holistic approach in clinical practice. It reminds clinicians to consider psychological factors in physical treatment and vice versa.

Through open communication and collaboration, where information and care plans are shared among care providers, patients, and their families, care provision becomes patient-centred?.

Exercise: In the next patient assessment include questions about stress levels, sleep quality, and emotional well-being. Reflect on how this information enhances your understanding of the patient's physical condition.

Summary

Understanding and applying these presuppositions can transform communication skills, leading to more effective treatments and stronger therapeutic relationships. By consistently practicing these principles, you can create a more empathetic, patient-centred approach to healthcare.

Remember, mastering communication is an ongoing journey. Each patient interaction provides an opportunity to refine skills and deepen understanding of these presuppositions.

Are you ready to take your communication skills to the next level?

DM me today see how we can help you or your team develop lasting therapeutic relationships with patients.

References:

?Boykins, D. (2014). Core Communication Competencies in Patient-Centered Care. ABNF Journal, 25(2), 40-45.

Tulane University. (n.d.). Effective Communication in Health Care. Retrieved from?https://publichealth.tulane.edu/blog/communication-in-healthcare/

?Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC Nursing, 20(1), 158.

Australian Commission on Safety and Quality in Health Care. (n.d.). Communicating with patients and colleagues. Retrieved from?https://c4sportal.safetyandquality.gov.au/communicating-with-patients-and-colleagues

Ali, M. (2017). Communication skills 1: benefits of effective communication for patients. Nursing Times, 113(12), 18-19.

CONTACT ME to see how I can support you or your team in achieving communication excellence