AETCOM 1.

4 - The Foundations of Communication - I

Dr. Uttama Joshi

Professor, Anatomy
BV(DU) Medical College &
Hospital, Sangli
Competency – 1.4

 Demonstrate the ability to

communicate to patients in patient,
respectful, non- threatening, non-
judgmental empathetic manner
Short Answer Questions – Paper II
 1] Communication: Definition & Types

 2] Process of communication

 3] Barriers to communication

 4] Kalamazoo statement

 5] Importance of verbal & Non verbal communications

SLOs
➢ Define communication and its importance in healthcare system
 Identify the key components of effective communication
(verbal, non-verbal, written)
 Describe Kalamazoo’s consensus of communication
 Analyze barriers to effective communication in medical practice
 Demonstrate basic communication skills through role-play
activities
 Apply communication principles in simulated patient interactions
 Evaluate own communication strengths and areas for
improvement
 Think of a good/bad experience at a hospital
 what role did communication play?"

"How many of you have witnessed

miscommunication in a hospital?"
Why is Communication Important for Doctors?

 Builds doctor-patient trust

 Improves diagnosis and compliance
 Reduces errors and litigation
 Enhances professional satisfaction
Misconceptions
 Good speaking is good communication
 Talkative people communicate better than calm & silent
people
 To be a good speaker you don’t have to be good listener
 Only intelligent people can listen
 Speaking is more important than listening
 Listening is an unconscious process
 What is communication?
•Communication can be broadly defined as the meaningful
exchange of information, thoughts, or feelings between
individuals or groups. ( In health care system)
• It involves transmitting a message with the intent of creating a
shared understanding
•Requires …. ??
• Both the sender and receiver to be actively involved, whether
through verbal or non-verbal means
 Key Aspects – What is involved ? - Process
•Sender: The individual or group initiating the communication
•Receiver: The individual or group receiving the message
•Message: The information, idea, or feeling being conveyed
•Channel: The medium through which the message is
transmitted (e.g., speech, writing, email, body language)
•Feedback: The receiver's response to the message, indicating
understanding or lack
•Context: The circumstances or situation surrounding the
communication, which can influence its interpretation
Types of Communications

 Based on Number of persons involved

1] Intrapersonal
Self – Introspection
2] Interpersonal
3] Group communications
4] Mass communication – to society through …..
Communication based on feedback obtained

 Two-way communication
Best form in health care setup
Clear understanding
Overcomes conflicts & misunderstanding
May not be feasible in every circumstances
 One-way communication
Authoritative faculties – of working environment
after discussion carry out
Communications directed by the authorities

 Formal or Vertical

 Informal or Horizontal
Verbal & Non verbal

 Verbal - Spoken
Written
Written communication might be a letter, email, a report,
or a message on social media. Written communication should
aim to get your message across in a clear and concise
manner.
 Non verbal -
➢ Facial expressions can intensify, diminish, or can cover
up the emotions that you are feeling.
Verbal & Non verbal

 Non verbal -
➢ Posture
The way you stand or sit at work can often display your
attitude or attentiveness toward certain situations
➢ Body movements
includes nonverbal cues such as postures and gestures. For
example, slouched shoulders tend to communicate tiredness.
 Gesture
is a form of nonverbal communication or non-vocal communication in
which visible bodily actions communicate particular messages, either in
place of, or in conjunction with, speech. Gestures include movement of
the hands, face, or other parts of the body
 Paralinguistics
 It is vocal communication -
is the tone, loudness, pitch, tempo and accent of your voice when you
speak
➢ Appropriate Touch
Cultural diversity
 Proxemics
the perception and use of space to communicate meaning and
relational status
Importance of Verbal & Nonverbal communication
 Verbal Communication involves the use of words – spoken
or written – to convey messages. It helps in
Clearly explaining diagnoses and treatment plans
Building trust through empathetic conversations
Ensuring informed consent and patient understanding
 Non-Verbal Communication - It is vital because
It reinforces or contradicts verbal messages
Shows empathy, attentiveness, and respect
Helps decode patient emotions and concerns
Communication can be ---
 What you say with your words
 It Can also be what you share with your postures and
gestures (learned to express the right message).
 What you feel inside you impacts the subtle message you
feel compelled to share outside you.
 As you can see, (1) and (2) can be learned with practice.
But (3) has to be consciously built, so constantly align
yourself to what you want to express.
Barriers to communications
Barriers of communication are obstacles that hinder the
effective exchange of ideas, messages, or information
between individuals or groups.
 Language
 Cultural Barrier
 Stereotyping
 Physical
 Barriers due to perception of communicated information
 Emotional Barriers
 Interpersonal barriers
1] Physical barrier
 Noise, distance, faulty equipment, wrong choice of medium , poor
infrastructure
2] Physiological or Biological barriers
These are related to a person’s health and fitness
These may arise due to disabilities that may affect the physical capability
of the sender or the receiver
➢ Proper functioning of the vocal cords, hands, fingers, eyes is necessary
for effective communication
3] Semantic barriers/ Language Barriers
Misinterpretation of words
Use of technical language or jargons
Vocabulary deficiency of both the sender and the receiver may cause
Multiple meaning of the words in different context
4] Cultural Barriers
Differences in traditions, values, beliefs, or norms between
communicators
5] Psychological barriers
 Fear and Anxiety , Low Self-Esteem , Negative Thinking Perfectionism,
Stress and Overwhelm ,Prejudice and Stereotypes,Lack of Motivation,
Emotional Barriers
6] Organizational Barriers
 Hierarchical levels, rigid rules, or poor communication channels within
institutions
7] Technological Barriers
These barriers can range from simple issues like poor internet connectivity to
more complex problems such as digital literacy gaps or platform
incompatibility
Methods to overcome barriers
 Use of clear and simple language
 Be an active listener
 Reduction and elimination of noise levels
 Provide feedback and confirmation
 Be culturally sensitive and emotionally aware
 Improve the communication environment
 Eliminating differences in perception
 Maintain proper Emotional State
 Avoid Information Overload
 Proper Media Selection
Principles of communication
 Clarity
The message should be clear, simple, and understandable
Avoid jargon unless the audience is familiar with it
Use appropriate language and structure
 Conciseness
Be brief and to the point
Avoid unnecessary details or repetition
Keep the message focused on the objective
 Completeness
The communication should include all relevant information
needed for understanding or action
Answer all possible questions the receiver might have
 Consideration
Be empathetic and consider the receiver's perspective—their
background, level of understanding, emotions, and needs
Respect cultural and personal differences
 Courtesy
Communicate with politeness and respect
Avoid harsh or offensive language
Foster a positive relationship
 Correctness
Ensure the information is accurate, factual, and error-free
Use correct grammar, spelling, and pronunciation
In clinical communication, correctness includes medical accuracy
 Feedback
Communication should be two-way
Allow the receiver to ask questions, clarify, and respond
Listen actively to the feedback and adjust communication if needed
 Timeliness
Communicate at the right time and in the appropriate context
Timely communication prevents misunderstandings or errors,
especially in clinical settings
 Active Listening
Focus fully on the speaker, showing attentiveness through eye
contact, gestures, and appropriate responses
Avoid interrupting or judging prematurely
 Non-verbal Communication
Pay attention to body language, facial expressions, tone of voice,
and gestures
 Purposefulness
Every communication should have a clear goal or intention—to
inform, persuade, instruct, or build rapport
 Confidentiality (especially in healthcare)
Maintain the privacy of information, particularly in doctor-patient
communication, Respect ethical and legal boundaries
Kalamazoo’s Essential Elements of Communication

 It includes 7 core elements, - identifies 7 evidence based

essential elements or tasks of effective doctor- patient
communication , Skill competencies are identified for each
statement.
 These statements are sub- categorized & assessed on Likert
scale
 Assessment of communication skill is done with the help of
check list based on these 7 elements
 Scale – Done well, Needs improvement, Not done
7 elements are
❖ Building a relationship
❖ Opening the discussion
❖ Gathering information
❖ Understanding patient’s perspective
❖ Sharing information
❖ Reaching on agreement
❖ Providing a closure of the meeting
Building a relationship with patient

 Initiate the Session & Establish rapport with the patient

 Greet and introduce yourself
 Confirm patient identity
 Explain the purpose and structure of the encounter
 Use words that express concern about the patient
throughout the interview
 Effective use of body language
Opening the discussion

 Allow patient to complete opening statement without

interruption
 Ask-” Is there anything else?:”
 Explain & / Negotiate an agenda for the meeting
 Be non-judgmental
 Use verbal and non-verbal communication to foster trust
 Display respect, empathy, and attentiveness throughout.
Gathering information

 Begin with patient’ s story using open ended question

like – Tell me about…
 Clarify details as & when required with more specific
Yes/ No
 Give patient opportunity to add or correct the
information
 Transit effectively to additional question
 Summarize the gathered information
Understanding patient’s perspective

 Ask about life event circumstances and other people

that might affect health

 Elicite patients’ beliefs, Ideas, concerns and

expectations (ICE) about illness and treatment

 Respond explicitly to patient statements about ideas

feelings and values –show empathy
Sharing information
 Assessing the patients understanding of problem and
desire for more information
 Use simple words to explain- that are easy for patient
to understand
 Checking for mutual understanding of diagnostic and
or treatment plans
 Asking whether the patient has any queries
 Provide accurate, relevant, and complete
information
 Use visuals or written materials if needed
Reaching on agreement

 Include patient in choices and decisions what he or she

desire
 Involve the patient in shared decision making
 Asking about patients ability to follow diagnostic and or
treatment plans
 Discuss options, benefits, and risks
 Respect the patient’s values and choices
Providing the closure of the meeting

 Asking whether the patient has questions

concerns or other issues
 Summarize the key points
 Clarifying follow up or contractor arrangement
& next step
 Acknowledge the patient and close the
interview with positive, respectful note
5 A’s of Behaviour Change Model

 This model of communication is based on providing a

patient action plan at each level
 1] Assessing the patient
 2] Advising the patient
 3] Agreeing with the patient
 4] Assisting the patient
 5] Arranging the patient
References
 National Medical Commission (NMC), India.
Attitude, Ethics and Communication (AETCOM) Competencies for the Indian
Medical Graduate, Module 1.4: Foundations of Communication – 2019.
Available at: https://www.nmc.org.in
 Makoul G. Essential elements of communication in medical encounters: the
Kalamazoo consensus statement. Acad Med. 2001;76(4):390–393. according to the
National Institutes of Health (NIH)
 Silverman, J., Kurtz, S., & Draper, J. (2013). Skills for Communicating with
Patients (3rd ed.). Radcliffe Publishing.
 Rao, K.G. (2011). Doctor-Patient Communication. Jaypee Brothers Medical
Publishers.
 K rajgopal Shenoy, Krishna Garg, Sanjay Andrew Rajaratnam, Maria Pauline (2020)
AETCOM Manual – Learning Module for Professional Year I – CBS Publishers