Developing Effective Communication Skills
A practicing oncologist likely uses just about every medium to communicate. They talk on the phone, send e-mail messages, converse one-on-one, participate in meetings, and give verbal and written orders. And they communicate with many audiences—patients and their families, referring physicians, and office staff.
But are you communicating effectively? How do you handle differing or challenging perspectives? Are you hesitant to disagree with others, especially those in authority? Do you find meetings are a waste of time? What impression does your communication style make on the members of your group?
Be an Active Listener
The starting place for effective communication is effective listening. “Active listening is listening with all of one's senses,” says physician communication expert Kenneth H. Cohn, MD, MBA, FACS. “It's listening with one's eyes as well as one's years. Only 8% of communication is related to content—the rest pertains to body language and tone of voice.” A practicing surgeon as well as a consultant, Cohn is the author ofBetter Communication for Better Care and Collaborate for Success!
Kenneth H. Cohn, MD, MBA, FACS
Cohn suggests creating a setting in which “listening can be accommodating.” For example, don't have a conversation when one person is standing and one person is sitting—make sure your eyes are at the same level. Eliminate physical barriers, such as a desk, between you and the other party. Acknowledge the speaker with your own body language: lean forward slightly and maintain eye contact. Avoid crossing your arms, which conveys a guarded stance and may suggest arrogance, dislike, or disagreement.
When someone is speaking, put a premium on “being present.” Take a deep breath (or drink some water to keep from speaking) and create a mental and emotional connection between you and the speaker. “This is not a time for multitasking, but to devote all the time to that one person,” Cohn advises. “If you are thinking about the next thing you have to do or, worse, the next thing you plan to say, you aren't actively listening.”
Suspending judgment is also part of active listening, according to Cohn. Encourage the speaker to fully express herself or himself—free of interruption, criticism, or direction. Show your interest by inviting the speaker to say more with expressions such as “Can you tell me more about it?” or “I'd like to hear about that.”
Finally, reflect back to the speaker your understanding of what has been said, and invite elaboration and clarification. Responding is an integral part of active listening and is especially important in situations involving conflict.
In active listening, through both words and nonverbal behavior, you convey these messages to the speaker:
· I understand your problem
· I know how you feel about it
· I am interested in what you are saying
· I am not judging you
Communication Is a Process
Effective communication requires paying attention to an entire process, not just the content of the message. When you are the messenger in this process, you should consider potential barriers at several stages that can keep your intended audience from receiving your message.
Be aware of how your own attitudes, emotions, knowledge, and credibility with the receiver might impede or alter whether and how your message is received. Be aware of your own body language when speaking. Consider the attitudes and knowledge of your intended audience as well. Diversity in age, sex, and ethnicity or race adds to the communication challenges, as do different training backgrounds.
Individuals from different cultures may assign very different meanings to facial expressions, use of space, and, especially, gestures. For example, in some Asian cultures women learn that it is disrespectful to look people in the eye and so they tend to have downcast eyes during a conversation. But in the United States, this body language could be misinterpreted as a lack of interest or a lack of attention.
Choose the right medium for the message you want to communicate. E-mail or phone call? Personal visit? Group discussion at a meeting? Notes in the margin or a typed review? Sometimes more than one medium is appropriate, such as when you give the patient written material to reinforce what you have said, or when you follow-up a telephone conversation with an e-mail beginning, “As we discussed.…”
For one-on-one communication, the setting and timing can be critical to communicating effectively. Is a chat in the corridor OK, or should this be a closed-door discussion? In your office or over lunch? Consider the mindset and milieu of the communication receiver. Defer giving complex information on someone's first day back from vacation or if you are aware of situations that may be anxiety-producing for that individual. Similarly, when calling someone on the phone, ask initially if this is a convenient time to talk. Offer to set a specific time to call back later.
Finally, organize content of the message you want to communicate. Make sure the information you are trying to convey is not too complex or lengthy for either the medium you are using or the audience. Use language appropriate for the audience. With patients, avoid medical jargon.
Be Attuned to Body Language—Your Own and Others
Many nonverbal cues such as laughing, gasping, shoulder shrugging, and scowling have meanings that are well understood in our culture. But the meaning of some of these other more subtle behaviors may not be as well known.1
Hand movements. Our hands are our most expressive body parts, conveying even more than our faces. In a conversation, moving your hand behind your head usually reflects negative thoughts, feelings, and moods. It may be a sign of uncertainty, conflict, disagreement, frustration, anger, or dislike. Leaning back and clasping both hands behind the neck is often a sign of dominance.
Blank face. Though theoretically expressionless, a blank face sends a strong do not disturb message and is a subtle sign to others to keep a distance. Moreover, many faces have naturally down turned lips and creases of frown lines, making an otherwise blank face appear angry or disapproving.
Smiling. Although a smile may show happiness, it is subject to conscious control. In the United States and other societies, for example, we are taught to smile whether or not we actually feel happy, such as in giving a courteous greeting.
Tilting the head back. Lifting the chin and looking down the nose are used throughout the world as nonverbal signs of superiority, arrogance, and disdain.
Parting the lips. Suddenly parting one's lips signals mild surprise, uncertainty, or unvoiced disagreement.
Lip compression. Pressing the lips together into a thin line may signal the onset of anger, dislike, grief, sadness, or uncertainty.
Build a Team Culture
In oncology, as in most medical practices, much of the work is done by teams. Communication within a team calls for clarifying goals, structuring responsibilities, and giving and receiving credible feedback.
“Physicians in general are at a disadvantage because we haven't been trained in team communication,” says Cohn. He points out that when he was in business school, as much as 30% to 50% of a grade came from team projects. “But how much of my grade in medical school was from team projects? Zero.”
The lack of systematic education about how teams work is the biggest hurdle for physicians in building a team culture, according to Cohn. “We've learned team behaviors from our clinical mentors, who also had no formal team training. The styles we learn most in residency training are ‘command and control’ and the ‘pace setting approach,’ in which the leader doesn't specify what the expectations are, but just expects people to follow his or her example.”
Cohn says that both of those styles limit team cohesion. “Recognizing one's lack of training is the first step [in overcoming the hurdle], then understanding that one can learn these skills. Listening, showing sincere empathy, and being willing to experiment with new leadership styles, such as coaching and developing a shared vision for the future are key.”
Stated goals and team values. An effective team is one in which everyone works toward a common goal. This goal should be
