July 2022 President’s Message

Physicians don’t always master the art of communication

by E. Jeanne Kroeker, MD —

If one were to do a Google search “Communication is…,” the following results could be found:

• Communication is the process of sending and receiving messages.
• Communication is simply the act of transferring information from one place, person or group to another.
• Communication is fundamental to the existence and survival of humans as well as to an organization.
• Communication is the fundamental principle that influences how we relate to the people around us.
• Communication is defined as the process of understanding and sharing meaning.

That last statement is simple and yet layered in complexity. “Communication is defined as the process of understanding and sharing meaning.”

The process of communication involves reading the audience, identifying the best way to transfer information, recognizing the appropriate time and setting for that information transfer, and anticipating how the audience will be most able to receive and absorb the information. This process needs to be fluid and flexible, adapting to the response of the audience.

Understanding depends on both the communicator’s and the receiver’s perception and interpretation of the communicated concept. How I see, experience, perceive or learn something will influence how I share concepts, and it will also influence how I accept and assimilate things shared with me. My point of view affects how I communicate and how I receive communication.

Sharing occurs when we convey thoughts, feelings, ideas or insights to others. Our method of sharing or the directness of our conveyance can hinder or augment that transfer. Perceived or real interference inhibits sharing of a message, preventing the communication from fully reaching the audience or hindering direct communication.

Meaning is what we share through our communication. It is the message or content, and it depends on context, language, perspective, history and many other factors. Meaning includes ideas, information, views and facts.

Every physician is required, on a daily basis, to communicate with a wide variety of patients. As I open each clinic exam room door, I have to immediately adjust my communication style and method to best fi t the setting within that room. Sometimes I do pretty well and the patient clearly understands my message. Sometimes I do poorly, and the blank faces, confused expressions or (worse) boredom make it obvious that I did not effectively make my point or educate them. Sometimes I think I have effectively communicated, and then I realize that my perception of the patient’s understanding is terribly wrong. I try to learn from the less successful communication episodes, looking for new ways to share and transfer information and meaning.

In medical school and residency, physicians attend classes and seminars to learn and practice effective patient communication. Standardized patient exams are useful for testing and refining methods of transferring our knowledge and conclusions to patients. Patient responses provide feedback about our communication methods and success.

I would argue that most of the time we are taught how to communicate with patients, and we are not taught how to enable their communication with us. Nor are we taught how to effectively communicate with peers or other members of the health care team. Medical students and residents are evaluated on their ability to effectively communicate with other members of the health care team, but are rarely taught techniques or styles of inter-team communication.

In my column last month, I shared the plight of medical students who are not able to match with residencies after completing medical school. I thought I was communicating the unfortunate reality of an antiquated method of funding residency positions and a shortage of positions for graduating MD/DO students desiring a U.S. residency position (including qualified domestic and international medical students). I shared the mismatch of medical students and residencies from the perspective that there is an inadequate number of residency slots each year.

Unfortunately, I did not recognize that one could interpret this mismatch as a consequence of an excess of medical students. My communication of the data points was not shared as effectively as I had planned.

Multiple studies have demonstrated a projected shortage of physicians throughout the United States now and in the future. Educating more physicians is essential. Educating physicians requires medical school and residency. As medical school classes gradually increase, residency positions must also increase.