Basic Communication

People often speak out of one particular language sensory system, and sometimes they express levels of understanding with a particular sensory language. In this regard, another form of mirroring is listening for which sensory system the patient is using and then joining that language system. Of particular importance are the visual, auditory, and kinesthetic language systems. For example, one person may say, "I see what you mean," and another may say, "I hear what you are saying," and another may say, "I am getting a feeling for what you mean."

When these sensory words are used, the physician can join that sensory system in the conversation: "Do you see what I am saying?" or "How do you hear what I am recommending?" or "How do you feel about my recommendations?" In each case, the physician is joining the patient's preferred way of expressing understanding.

The interviewing physician also learns to monitor personal feelings during the interview. Is there a hunch, an intuitive thought, or an uncomfortable feeling that is not logical, or even unrelated to the visit? It is important for the physician to pay attention to these internal messages so that important information is not missed. For example, a patient's seemingly harmless or even sarcastic remark about "most people in the medical field" may alert the physician to make an extra effort to build bridges of rapport, respect, and relationship with the patient, to increase the probability of compliance. A comment about car problems may mean follow-up appointments are at risk.

The conversational "give and take" during the interview provides the opportunity for the physician to learn about the context of the patient's life and relationships. More than just taking medical information, it is a biopsychosocial understanding of the patient (Brown, 2000; Engel, 1977, 1980). Coulehan and Block (2001) observe, "Good clinician communication does prevent malpractice suits. A patient who feels that the clinician listens to and understands him or her is not likely to sue that person, even if there is a bad outcome" [italics added].

Another element in the context of the relational environment is compassion, the "feeling with" the patient in the experience of illness and distress. As Rakel (2000) states:

Good interpersonal skills enhanced by compassion enable the physician to dissect out the tangled mass of personal difficulties that so often form the core of functional disease or magnify the symptoms of an organic condition. We all know that a broken spirit underlies a great deal of the problems we encounter in practice.

The physician is the one who, by rapport, respect, and interpersonal relationship, humanizes for the patient the medical experience of laboratory and technology. The physician models for the patient a real person who is in a relationship with another real person.

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