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Communication is essential for optimum treatment of patient.
Discuss why and elaborate how you can maintain it.

Prepared by: TAN RUI ERN
Guidance Lecturer: MANIKANDAN RENGASAMYCONTENTS
TOPICS PAGES
INTRODUCTION 2
MODEL OF COMMUNICATION PROCESS 3
SHANNON-WEAVER MODEL 4
TYPES OF COMMUNICATION 5-6
THE REASONS OF COMMUNICATION IS ESSENTIAL FOR OPTIMUM TREATMENT OF PATIENT 7
THE WAYS TO MAINTAIN THE ESSENTIAL OF COMMUNICATION FOR OPTIMUM TREATMENT OF PATIENT 8
CONCLUSION 9
REFERENCES 10
INTRODUCTION
Communication is the process of exchanging information, usually via a common protocol. Protocol which means that the system of rules and acceptable behaviour used at official ceremonies and occasions.
According to research, “Medicine is an art whose magic and creative ability have long been recognized as residing in the inter personal aspects of patient-physician relationship.” A physiotherapist’s communication and interpersonal skills encompass the ability to gather information in order to facilitate accurate diagnosis, counsel appropriately, give therapeutic instructions, and establish caring relationships with patients. These are the core philosophies in the ultimate goal of achieving the best outcome and patient satisfaction, which are essential for the effective delivery of health care. Basic communication skills in isolation are insufficient to create and sustain a successful therapeutic physiotherapist-patient relationship, which consists of shared perceptions and feelings regarding the problems, goals of treatment, and psychosocial support. Interpersonal skills build on this basic communication skill. Examples of Physiotherapist communication are sharing of knowledge and experiences, the giving or receiving of orders and cooperation.

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People in organizations typically spend over 75% of their time in an interpersonal situation. Physiotherapists interact even more with patients, spending up to 90% of their time and effort. So, it is no surprise to find that at the root of a large number of organizational problems is poor communications. Thus, effective communication is an essential component of organizational success whether it is at the interpersonal, intergroup, intra group, organizational, or external levels, not only that, the effective communication is also an essential for the optimum treatment of the patients.

MODEL OF COMMUNICATION PROCESS
According to some theories, there are five steps for physiotherapist to communicate with their patients:
18143368890COMMUNICATION
00COMMUNICATION

2777067190218
373394116446519078221643945101731170815598311175189587022164394
right15875RESPONSE
RESPONSE
00CREATIONS
CREATIONS

294583593698INTERPRETATION
0INTERPRETATION
130951171966TRANSMISSION
0TRANSMISSION

2246630198614RECEPTION
RECEPTION

This model of the communication process is based on a model of signal transmission known as the Shannon-Weaver model.

SHANNON-WEAVER MODEL
3701415866281TRANSMISSION:
To overcome barriers shyness, tap on shoulder if not looking at you noise.

00TRANSMISSION:
To overcome barriers shyness, tap on shoulder if not looking at you noise.

According to Shannon-Weaver model, the process of communication divided into seven components which are ideal initiation, encoding, transmission, receiving, decoding, action and feedback. The explanation will be shown clearly in below figure:
48655112482921486551111610623364089414232138853341599637115751520966RECEIVING:
Make sure message has been received by others.

00RECEIVING:
Make sure message has been received by others.

1692910-3034ENCODING:
Transfer ideas to words phrases gestures
00ENCODING:
Transfer ideas to words phrases gestures
-191911-1693IDEA INITIATION:
Know what you want to communicate.

00IDEA INITIATION:
Know what you want to communicate.

46284418026900
-63568368FEEDBACK
00FEEDBACK
3725333272627DECODING:
Derive meaning
00DECODING:
Derive meaning

4852670125236
3759200224296ACTION:
Perform
00ACTION:
Perform

Furthermore, communication can be Interactive, Trans active, Intentional and Unintentional. First of all, Interactive communication is an exchange of ideas where both participants, whether human, machine or art form, are active and can have an effect on one another. It is a dynamic, two-way flow of information. Secondly, Trans active communication occurs when sources transmit messages to one another simultaneously and send back acknowledgment messages. Thirdly, Intentional communication is the display of communicative signals that are sensitive to the state of the receiver. Lastly, Unintentional also known as unconscious communication which is the subtle and unconscious cues that provide information to another individual. It can be verbal (speech patterns, physical activity while speaking) or the tone of voice of an individual.

TYPES OF COMMUNICATION
Communication can be categorized into three basic types: verbal communication, in which you listen to a person to understand their meaning; written communication, in which you read their meaning; and nonverbal communication, in which you observe a person and infer meaning. Each has its own advantages, disadvantages, and even pitfalls.

In verbal communication, the medium of the message is oral. For example, the Message is being conveyed from the Sender (the physiotherapist) to the Receiver (the patient) during regular ward rounds. We’ve already seen how the physiotherapist to the patient. (Sir, how are you feeling today?) Now let’s look at how the same Message can travel successfully from Sender to Receiver.

Physiotherapy is talking to the patient: “Sir, how are you feeling today?”
(By calling the patient, the physiotherapist is establishing a clear, personal link to the Receiver.)
Physiotherapist: “Your body recovery are looking great.”
(The physiotherapists’ recognition of the patient’s recovery in a winning situation further personalizes and emotionalizes the conversation.)
Physiotherapist: “Our next step is to achieve the short goal which is walking from the main entrance to the ward. Could you try your best to achieve the goal? We set the time limit in only half or one hour. You could try it within one month.”
(The physiotherapist breaks down the task into several steps. Each step consists of a specific task, time frame, quantity, or goal.)
The patient: “Sure! I would like to try walking from main entrance to the ward. I’ll try my best to achieve the goal with one month.”
(The patient, who is good at active listening, repeats what he has heard. This is the Feedback portion of the communication, and verbal communication has the advantage of offering opportunities for immediate feedback. Feedback helps the patient to recognize any confusion he may have had hearing the physiotherapist’s Message. Feedback also helps the physiotherapist to tell whether she has communicated the Message correctly.)
According to the passage above, verbal communication consists of many advantages such as the receivers able to get the first hand information, message conveyed, informal, direct impact and commitment from receiver. However, there’s also disadvantages for verbal communication. One of the disadvantages is we need time to prepare what we want to express.

In the other hand, what you don’t say can be even more important, that’s nonverbal communication. In the nonverbal communication, you could voice out the important messages via visual, planning and terminology which is forming the specific short term. Based on a research also shows that 55% of in-person communication comes from nonverbal cues like facial expressions, body stance, and tone of voice. According to one study, only 7% of a Receiver’s comprehension of a Message is based on the Sender’s actual words; 38% is based on paralanguage (the tone, pace, and volume of speech), and 55% is based on nonverbal cues (body language) (Mehrabian, 1981). During visual, there’s no guarantee of understanding but the impact is better than writing.
During writing, the legality issues that can be recorded by hand writing but there is no guarantee of understanding and no personal contact with the receiver. Besides, the example of the communication also consists of telecommunication which is the use of technology to aid and enhance distance communication. Encoding and decoding of a message included in the digital telecommunications. The encoding of a message is the production of the message whereas the decoding of a message is how an audience member is able to understand and interpret the message. Then, it’s also consists of digital transmission media which including telegraphy and computer network and consists of analogue telecommunication such as TV radio.

As Harold Dwight Lasswell says, he is well known for his comment on communications:-
Who (says)
What (to)
Whom (in)
What Channel (with)
THE REASONS OF COMMUNICATION IS ESSENTIAL FOR OPTIMUM TREATMENT OF PATIENT
Effective physiotherapist-patient communication is a central clinical function, and the resultant communication is the heart and art of medicine and a central component in the delivery of health care. The 3 main goals of current physiotherapist-patient communication are creating a good interpersonal relationship, facilitating exchange of information, and including patients in decision making. Effective communication is determined by the physiotherapists’ “bedside manner,” which patient judge as a major indicator of their physiotherapists’ general competence.

Good physiotherapists-patient communication has the potential to help regulate patients’ emotions, facilitate comprehension of medical information, and allow for better identification of patients’ needs, perceptions, and expectations. Patients reporting good communication with their doctor are more likely to be satisfied with their care, and especially to share pertinent information for accurate diagnosis of their problems, follow advice, and adhere to the prescribed treatment. Patients’ agreement with the physiotherapist about the nature of the treatment and need for follow-up is strongly associated with their recovery.

Studies have shown correlations between a sense of control and the ability to tolerate pain, recovery from illness and the daily functioning of the body parts. Enhanced psychological adjustments and better mental health have also been reported. Some studies have observed a decrease in length of hospital stay and therefore the cost of individual medical visits and fewer referrals.
A more patient-centred encounter results in better patient as well as the physiotherapists’ satisfaction. Satisfied patients are less likely to lodge formal complaints or initiate malpractice complaints. Satisfied patients are advantageous for physiotherapists in terms of greater job satisfaction, less work-related stress, and reduced burnout.
A side-effects of a poor communication between the medical participants can lead to medical errors. Additionally, with the inclusion of extra participants in the communication channel, the risk of error increases. Intrinsically, maximum communication errors take place during the transfer of patient information between different caregivers. Any instance of incomplete exchange of information can lead to: wrong treatment procedure, treatment delays, and delivery of incorrect medication to the patient. Thus, such instances can have grave consequences for the patient which may lead to severe health complications or even death.

3160325417406Try to slow down the pace when providing the information to patients so that patients have sufficient time to comprehend the new information. Other than pausing frequently and reinforcing silence with appropriate body language, it’s crucial to give the patients who lack of medical knowledge extra time to formulate the questions. Based on research, physiotherapist usually wait only 23 seconds after a patient begins describing his complain before redirecting the discussion. Such premature redirection may lead to late-arising concerns and missed opportunities to gather important information. Thus, a dialogue punctuated with pauses leads to deeper comprehension on both sides.

00Try to slow down the pace when providing the information to patients so that patients have sufficient time to comprehend the new information. Other than pausing frequently and reinforcing silence with appropriate body language, it’s crucial to give the patients who lack of medical knowledge extra time to formulate the questions. Based on research, physiotherapist usually wait only 23 seconds after a patient begins describing his complain before redirecting the discussion. Such premature redirection may lead to late-arising concerns and missed opportunities to gather important information. Thus, a dialogue punctuated with pauses leads to deeper comprehension on both sides.

-405977564092Using a simple concepts that your patients can work with and understand, you’ll be more likely to communicate with your patients. However, a poor communication starts when there’s too much of jargon is used when meeting with patients. It’s the fact that has been reported by THE WALL STREET JOURNAL. “Medical speak” is appropriate when speaking with other medical professionals but it’s not an ideals way to use the medical terms around patients. We should always remember that even you understand what you’re saying doesn’t mean that your patients will able to understand what you’re saying. It’s your responsibility to bridge this gap and to share relevant medical knowledge to patients in an understandable manner.

00Using a simple concepts that your patients can work with and understand, you’ll be more likely to communicate with your patients. However, a poor communication starts when there’s too much of jargon is used when meeting with patients. It’s the fact that has been reported by THE WALL STREET JOURNAL. “Medical speak” is appropriate when speaking with other medical professionals but it’s not an ideals way to use the medical terms around patients. We should always remember that even you understand what you’re saying doesn’t mean that your patients will able to understand what you’re saying. It’s your responsibility to bridge this gap and to share relevant medical knowledge to patients in an understandable manner.

THE WAYS TO MAINTAIN THE ESSENTIAL OF COMMUNICATION FOR OPTIMUM TREATMENT OF PATIENT
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3659929228600To maintain a good communication with patients, the physiotherapists should be prepared for a reaction. A small groups of patients who have difficulty forming a trusting relationship with their physiotherapist, they may receive a bad news with distrust, anger and blame. Facing with such patients, there can be extremely hard for establishing a lasting bond of trust with the physiotherapist but we can provide them some time to build up the believe on us. In responding to any of these feedbacks, it’s very important to be well-prepared. As a physiotherapist, trying to allow enough time for the patients and their family a full display of emotions. Sometimes we can encourage them to express their felling and listen to what the patients and family said.
00To maintain a good communication with patients, the physiotherapists should be prepared for a reaction. A small groups of patients who have difficulty forming a trusting relationship with their physiotherapist, they may receive a bad news with distrust, anger and blame. Facing with such patients, there can be extremely hard for establishing a lasting bond of trust with the physiotherapist but we can provide them some time to build up the believe on us. In responding to any of these feedbacks, it’s very important to be well-prepared. As a physiotherapist, trying to allow enough time for the patients and their family a full display of emotions. Sometimes we can encourage them to express their felling and listen to what the patients and family said.
1828237148870left262255THE WAYS TO MAINTAIN THE ESSENTIAL OF COMMUNICATION FOR OPTIMUM TREATMENT OF PATIENT
00THE WAYS TO MAINTAIN THE ESSENTIAL OF COMMUNICATION FOR OPTIMUM TREATMENT OF PATIENT

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-203200203623Instead of just follow the rules and procedures stated in the checklist, try using simple conversation when interacting with patients. This is because sometimes when working in medical field, you will easily forget that patients are people too. As a people, nobody would like being treated like a checklist that needed to be completed. Trying to talk less, listen more and communicate flexibly, the patients are more interested and more likely to be treated as a human being.

00Instead of just follow the rules and procedures stated in the checklist, try using simple conversation when interacting with patients. This is because sometimes when working in medical field, you will easily forget that patients are people too. As a people, nobody would like being treated like a checklist that needed to be completed. Trying to talk less, listen more and communicate flexibly, the patients are more interested and more likely to be treated as a human being.

261866978599Trying to “talk more with patients” but not “talking at the patient”. By “talking at your patients”, there’s no connection between a physiotherapist and patients. Instead, we could use few minutes to make a heart to heart talk with your patients, make eye contact with your patients in order to understand your patients well. Simultaneously, the patients will able to respect their physiotherapist as a partner in the journey to get better and they are likely to follow the instructions given.

00Trying to “talk more with patients” but not “talking at the patient”. By “talking at your patients”, there’s no connection between a physiotherapist and patients. Instead, we could use few minutes to make a heart to heart talk with your patients, make eye contact with your patients in order to understand your patients well. Simultaneously, the patients will able to respect their physiotherapist as a partner in the journey to get better and they are likely to follow the instructions given.

CONCLUSION
In conclusion, as a patient, the dialogue is not over yet even after the discussion of diagnosis, tests and treatment. For the patient, this is just a beginning; the news is sinking in. The proper way is, physiotherapists are supposed to anticipate a shift in the patient’s sense of self, which should be handled as an important part of the encounter.

Besides, the quality of one-to-one communication between the patient and physiotherapists can be greatly affected by simple choice of words, body position, information depth, speech patterns, and facial expression. Avoiding communication pitfalls and sharpening the basic communication skills previously suggested can help to strengthen the patient-physician bond that many patients and physicians believe is lacking of.
Lastly, although communication can be a tricky skill but with constant practices, communicating with your patients will be an easy task as long as having a good sources to practise on communication skills. A good rule of thumb to remember that a good communication is essential for optimum treatment of patients.

REFERENCES
https://en.wikipedia.org/wiki/Interactive_communicationhttp://open.lib.umn.edu/principlesmanagement/chapter/12-5-different-types-of-communication/https://www.healthcareguys.com/2017/12/04/effects-of-the-poor-communication-in-hospitals/http://hability.net/blog/5-donts-in-patient-communication/https://medlineplus.gov/ency/patientinstructions/000456.htm

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