Speech: A vital component of highly effective patient care

How we communicate with clients can be a source of mutual understanding and positive action, leading to highly effective patient care, or a source of misunderstanding and frustration.

We established earlier that communication consists of three key components — listening, speaking and understanding. In last month's first article in this three-part series, we focused primarily on the art and science of listening. This month's essay centers on speaking, and next month we will consider what is involved in understanding.

What does the art and science of speaking encompass?

Most of us receive some formal training in speaking to learn how to express ourselves to others effectively. We learn that a fundamental requirement of good speech is that it be easily understood. In the context of practicing veterinary medicine, this often requires that we communicate with clients using the language of a non-medical person. If they do not understand our words readily, we may become to them like someone speaking a foreign language. Also, we must avoid rambling by being concise.

While striving to speak to clients in a way that fosters understanding, we must be careful not to give the impression that we are talking down to them. Avoid being too technical or too simplistic. And our conversation should be gracious as well as sensible. Won't you agree that our clients are most likely to feel our respect for them if we speak in a dignified and caring manner? To paraphrase Hippocrates, our words should first do no harm. Thought and practice often are required to express the right things in the right way at the right time.

How should we speak?

The message we convey often is influenced greatly by how we say it. We often impart latent as well as literal meanings. Messages as simple as "Look who's here!," "Guess who just walked in?" and "What next!" can convey sarcasm, irony or joy. Why? Because the tone, pitch, volume and modulation of our voice send powerful signals of what we are thinking and feeling. Even if you do not understand the language, you can usually tell by these qualities whether the speaker is impatient, arrogant, intolerant, critical and harsh, or whether he or she is humble, patient, kind and compassionate.

What is body language?

Nonverbal factors such as body position, facial expression and personal appearance are key components of communication. A classic study by UCLA psychologist Albert Mehrabian revealed that about 10 percent of what audience members remembered about feelings and attitudes from a speaker was verbal; about a third of the impact came from tone of voice.

More than 50 percent of the recall involved body language, including gestures, facial expressions, posture and movements (Mehrabian A. Silent Messages. Wadsworth Publ. Co. 1971 ISBN: 0534000592). Although the results of this study cannot be extrapolated to all types of verbal and nonverbal communication, they do emphasize the importance of body language.

More than any other nonverbal feature, our face (countenance) often reflects our true feelings. Our eyes, the shape of our mouth and the inclination of our head all play a part. Without a word being spoken, our face can convey indifference, disgust, perplexity, amazement, concern or delight. A face that is devoid of expression may raise questions about our sincerity. On the other hand, a warm smile tells others that we have a kindly feeling toward them. In addition, a smile can help clients relax and be more receptive.

A sage once said, "We speak with our eyes." We could add eyebrows to that. Our eyes and eyebrows communicate attitudes and emotions. They may convey surprise, compassion, fear, grief, doubt or dislike ("He gave her the evil eye!"). Maintaining friendly eye contact with others often promotes trust. Looking an individual in the eye when making an important statement can add emphasis to our words.

On the other hand, clients may doubt our sincerity or competence if we avoid respectful eye contact. Still, discernment is required. Some individuals may view intense or prolonged eye contact as rude, aggressive or challenging.

Our personal appearance may factor in, too, adding or distracting from our message. Dressing in a neat and attractive manner conveys respect for clients and those with whom we work.

What about gossip?

In describing principles of veterinary medical ethics, the American Veterinary Medical Association (AVMA) recommends: "Veterinarians should respect the rights of colleagues and other health professionals. No member shall belittle or injure the professional standing of another member of the profession."

To that end, we suggest promoting the positive aspects of gossip by using the following acronym for the word gossip: GOOD OR SUPPORTIVE STATEMENTS INVOLVING PEOPLE (Osborne CA. The ethics and etiquette of good gossip. JAVMA 206 pages 1534 to 1537, 1995).

To earn a reputation for making good or supportive statements about others, we must continuously work on breaking the undesirable habit of participating in negative gossip. Clearly separate conversations that are about someone from those that go against someone. Recognize the difference between harmless and harmful conversation. How can we do this? When considering whether to share gossip of a personal nature, ask yourself these questions:

Is it kind? Kindness has been likened to oil that takes the friction out of living.

Is it true? The greatest kindness we can offer is always to speak the truth.

Is it necessary? We should not only say kind things at the right time, but also learn to leave unsaid an unkind, though truthful, statement at the tempting moment.

Because we have the legal right to tell something doesn't mean that it is morally right to tell it. Is gossip ethical? It can be, if we talk about others in a way that we would like them to talk about us.

Dr. Osborne, a diplomate of the American College of Veterinary Internal Medicine, is professor of medicine in the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Minnesota.