Understanding: A vital component of effective patient care

How we communicate with our clients can be a source of mutual understanding and positive action, or one of misunderstanding and frustration. In this context, communication is a vital component of providing highly effective patient care. In Part 1 of this three-part series, we discussed the art and science of listening, Part 2 focused on speaking and this month we will consider the topic of understanding.

In Part 1, we noted that successful communication with our veterinary clients is dependent on our ability to listen and understand their needs and feelings in addition to speaking so as to be understood. This prompts the question: How can we determine if we are speaking in a way that others can understand?

In veterinary practice, being understood often requires that we use the language of a non-medical person. If clients do not understand us readily, we may become to them like someone speaking a foreign language. It is of interest that this point is emphasized in the Bible, at 1 Corinthians 14:9-11: "Unless you speak in a way that is easily understood, how will it be known what is being spoken? You will in fact be speaking into the air. If I do not understand your speech, it will be as though I am a foreigner to the one speaking, and the one speaking is a foreigner to me."

To foster understanding, we must use discernment so as not to give the impression that we are talking down to our clients. Avoid being too technical or too simplistic. And, our conversation should be gracious as well as sensible. Won't you agree that clients are most likely to feel our respect for them if we speak in an understandable, dignified and caring manner? Thought and practice often are required to express the right things in the right way at the right time.

We began this series by asking which, in your opinion, is the most important aspect of effective communication: listening, speaking or understanding? Answering that might be analogous to trying to decide which is the most important leg on a three-legged stool. If one leg is missing, the stool will not stand. If the three legs are not of equal length, the stool will lose its stability. All three legs are important for the stool to function effectively. Similarly, effective communication requires the proper balance of listening and speaking so as to achieve understanding. Thus, listening, speaking and understanding are the foundation stones of effective communication.

Here is a summary of some key points related to effective communication:

• Empathic listening is motivated by the intent to understand.

• How we communicate with our clients can be a source of mutual understanding and positive action or one of misunderstanding and frustration.

• Too often we do not listen with the intent to understand because we have developed the habit of listening with the intent to reply (reactive listening).

• We learned that empathic listening is our capacity to understand and acknowledge our clients' feelings and viewpoints, whether we agree with them or not.

• Good listening skills are essential in conveying interest in the overall welfare of patients and clients.

• We must listen to understand the meaning of words and note the feeling with which they are said. To be good listeners, we also must note what is not said.

• A warm smile tells others we have a kindly feeling toward them. In addition, a smile can help clients relax and be more receptive.

• Maintaining friendly eye contact often promotes trust, and can add emphasis to what we say. On the other hand, clients may doubt our sincerity or competence if we avoid respectful eye contact during conversation.

• A primary goal of good communication is to paraphrase or summarize a client's concerns and viewpoint so that they recognize that we empathically understand them.

• We must separate conversations that talk about someone from those that talk against someone. We must recognize the difference between harmless and harmful conversation.

How? When considering whether to share gossip of a personal nature, ask yourself these questions: Is it kind? Is it true? Is it necessary?

• Good communication depends on an open mind as well as an open door.

• Before contradicting any clients, first try to understand them.

• In addition to learning how and when to listen, we must want to listen. This requires patience, openness and a desire to understand.

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.