Communication in hospital is a two-way process

The positive intention of health professionals is to make any hospital stay as pleasant and comfortable as possible for the patient. There is a major – and seldom discussed – difficulty in achieving this outcome.

What is perceived as excellent care by one person may be experienced as intrusive or insensitive by another. Criteria is the term we use to describe how we make distinctions between excellent, good and bad medical treatment.

It is unrealistic to expect health professionals to be aware of personal criteria. A nurse may assume that every patient receives the same quality treatment. The nurse is correct, and so are the patients who have different personal criteria for the care they desire.

There is little logic to how people respond emotionally, just as there is no accounting for taste. Two people can select the same meal from a menu. One thinks the food is delicious; the other complains that it is horrible. The food is not the issue. People simply have different preferences.

Health professionals are sometimes put in a no-win situation because what is perceived as good care for one person can annoy another. Perception is reality for every patient. There will always be differences in how people respond to the same situation.

Three patients being cared for by the same nurse can have very different experiences because they have genuine emotional feelings based on their personal criteria for what the nurse should do. Say a busy nurse gives a patient an injection. She quickly tidies the bedside locker before she moves it aside to get close enough to treat the patient. One patient may not even notice that the nurse moved the locker; a second may like that the nurse put things in order; and a third may feel annoyed with the nurse for disturbing personal things.

Most patients have expectations about how they should be treated by doctors and nurses. How well their expectations are met will have an impact on what they believe about the hospital experience. In theory, a person who feels dissatisfied about any aspect of medical care would talk to the nurse or doctor responsible. In practice, many patients feel too vulnerable to do so.

Illness robs patients of confidence and issues they once had the freedom to address become things to avoid. What happens for the person who no longer has the confidence to speak up is that minor annoyances grow into perceived problems.

Communication problem

The efficient nurse cannot know that a patient is upset when their personal belongings are moved, unless the patient says so. A communication problem arises when a patient, fearful of creating conflict, does not tell the nurse that there is an issue but complains to family members.

It’s surprising how many people fall into the trap of assuming that, regardless of what they say, they have made a request and people will understand exactly what they want for the patient. Telling the nurse, “She can tidy her things herself” is hinting at an issue.

A problem with hospital treatment can often begin when a relatively minor issue causes annoyance to the patient and goes unnoticed by a nurse. Many of the complaints about the poor communication that is at the root of some problems could easily be resolved if only the medical team were made aware of them.

No matter how much care and thought health professionals put in to giving patients excellent treatment, they can never achieve the impossible. We can never eliminate misunderstanding. Patients and their families who make complaints may expect doctors and nurses to take action, on foot of requests that may have been hinted at but never made.

Some people deify healthcare professionals. They assign godlike wisdom to them. They have an expectation that everyone on the ward should have the skills to mindread intuitively what the patient is not communicating.

People cannot be held responsible for failing to address a problem they don’t know about. Medical teams are not mindreaders. The success of any person-to-person communication depends on the level of respect between the people involved.

An unhappy patient may be reluctant to make an issue of something they recognise is small. Having a perception that this is important only to them, people refrain from making easily fulfilled requests that would make a huge difference to their comfort. Left unresolved, such issues cause resentment that puts a dark shadow over the hospital experience.

Would there be fewer complaints about lack of communication with health professionals if patients understood they have a role in making effective communication a two-way process?

Carmel Wynne is a life and work skills coach. See carmelwynne.org