Mind Your Language

Why is language important in healthcare?

Language evolved in ancient human civilisations to bring people together, to foster community and coherence. This is exactly what language also does in healthcare. Language brings patients and healthcare professionals together in the struggle with disease and dying.

When we did focus group discussions with people living with Diabetes for our research, the first question the participants asked is - “What do you mean by Language? Is it Hindi, Marathi or do you mean the way the doctor communicates with us?” So yes, speaking in the native language of the person is very important in health care as that is the language the person experiences their condition in and the one in which they can best express their story.But beyond this, in healthcare, we see people who are struggling with their health conditions. Often, they are overwhelmed with worry, anxiety and the uncertainty of the diagnostic and treatment journey.Words serve as a powerful tool not only to communicate about the person's condition to them but also to allay their fears and anxieties, offer hope. Sometimes words that simply acknowledge or validate what the person feels can impact their outcomes.

Why does manner of speaking and word selection matter while communicating about Diabetes?

The word “connotation” means the implied meaning of the word. The same word can express both pleasure and displeasure. The way we speak the tone and volume of our voice, the facial expressions and body language while we speak greatly modulates the “connotation” of what we speak.

In essence, the manner of speaking decides what our words really mean.

A raised eyebrow, a smirk, a frown, a snide or sarcastic tone of voice accompanying our words changes their meaning completely.

The words we use can also convey bias and stigma (often unconscious bias) for people living with Diabetes. Using words like “diabetic” makes the person synonymous with their disease when in fact a person is far more than just their condition. Similarly, the word “morbid” obesity. The word morbid means moribund or almost certain death. Using the word Morbid quite literally implies a death sentence for the person.

Mindfulness of what we speak and how we speak is essential for every health care professional.

Can you dispel some myths related to using appropriate language?

The biggest myth is that many healthcare professionals think that offering the best treatment according to latest guidelines and standards of care is the limit of their responsibility towards the people they care for. The fallacy of this myth is that the best prescription is of no use if the person does not take the treatment. During the consultation, the language you use determines the trust the person has in you, which in turn determines whether the person is likely to do what you have suggested.

Another common myth is that good communication skills are innate and not learned behaviour. Good communication is a “skill” like any other and needs to be learned and rehearsed till it becomes second nature. Just like we learn to read an Xray or a blood report, we learn to communicate effectively and compassionately.

Can you discuss research which supports usage of appropriate language with regards to patient compliance and outcomes?

A systematic review and meta-analysis showed that empathic and positive communication reduced pain, anxiety and improved satisfaction with treatment. It reduced the length of hospital stay as well Another review from patient's perspective by Jin et al which analysed factors impacting therapeutic compliance cited the “patient- prescriber relationship” as an important factor. The authors found that good communication was important to help people understand their condition and therapy better. Many patients did not take hypertension medications when they felt their doctor was not concerned about their condition or did not stress the importance of the medication. Studies have found that compliance is good when doctors are emotionally supportive, giving reassurance or respect, and treating patients as an equal partner.

In a survey of program directors and recent graduates in Endocrinology, 97.5 per cent voted that communication skills were the top skill needed to make good leaders.

Howard Baum in a paper rated communication skills as one of the top 4 attributes for clinical excellence in endocrinology.

Research supports a significant impact of good communication on patient satisfaction with treatment, adherence to therapy and good outcomes as a result.

Do healthcare professionals need special training for improving communication?

It is often assumed in healthcare that good communication is “easy” or should be “innate”. Or that it can be learned by looking around at seniors and teachers.

Many doctors we interviewed felt they had good communication skills. But in the course of our research, we documented a lot of hurt, frustration, anger and resentment among people with Diabetes towards the communication experience they had with their doctors. There is much room for improvement and thus, training in communication is a core skill that all doctors need.

Communication skills training has been introduced in medical curriculum and is a much-needed step in the right direction. Communication workshops for doctors at various stages of their training and practice will also enable practising doctors to upskill.

Can you detail aspects that healthcare professionals need to be aware of, while communicating with people with Diabetes?

1) Always respect the person: Whatever may be the glycaemic control of the person in front of us - blame, shame and censure are counterproductive. The numbers do not reflect a person's character. So many times we use phrases like - “You are not serious about your Diabetes”, “You are lazy”. These should be avoided.

2) Avoid communication which takes away hope: Instead of using phrases like “You WILL get kidney failure”, you WILL get

gangrene, “You WILL become blind” phrases like “If you take good care of your Diabetes you can avoid kidney / eye problems”, “You will live a longer and better life if we take care of your Diabetes well”.

3) Focussed attention: When you are speaking to a person you are consulting, move away from the computer screen or look up from the paper you are writing on and look at the person. Make eye contact. Keep a neutral expression rather than letting your facial expressions reflect what you think about what you are telling them. Don't take calls or interrupt them. This kind of focussed attention will not only improve the quality of your consult but will give immense satisfaction to the person, build trust and greatly increase the chances of compliance and regular follow up. And believe me, when the patient leaves saying “Doctor, just by speaking to you, I feel better already”. You will sleep better that night.

4) Different strokes for different folks:

Everyone is different and we need to adjust our consultation technique accordingly. Some people have a lot of questions, some need a lot of reassurance. Some come with blind faith while some with stark animosity. We need to gauge the situation and deliver accordingly. This comes with deliberate practice.

To conclude

In recent years, due to improper communication there has been lot of distrust and friction between patients and doctors, and it pains me. I became a doctor for the good I could do. So, if there is one thing I could say, it is to remind patients and doctors that we are all in this together. We are all on the same side. We are all human. Both patients and doctors say and do things they regret. But forgetting and forgiving each other and moving forward in our common humanity is the way forward.

Dr Tejal Lathia is Consultant Endocrinologist at Fortis, Apollo and Cloud Nine Hospitals in Navi

Mumbai