Module 3: Interpersonal Communication (IPC)

“Effective interpersonal communication (IPC) between health care provider and client is one of the most important elements for improving client satisfaction, compliance and health outcomes. Patients who understand the nature of their illness and its treatment, and who believe the provider is concerned about their well-being, show greater satisfaction with the care received and are more likely to comply with treatment regimes.”(1)

3.1 Features of Effective Interpersonal Communication (IPC)(1)

Effective IPC is necessary to perform an accurate diagnosis based on a full disclosure of information by the patient, leading to an appropriate treatment that the patient can agree to. The provider must ensure that the patient understands his or her medical condition, as well as the rationale behind a treatment regimen. Both parties must be committed to fulfilling their respective obligations during the treatment period, with the provider providing the requisite counseling and the patient adhering to his or her prescribed treatment regimen.

After diagnosing and prescribing treatment for the illness, the provider should recommend concrete behavioral changes to the patient, suggesting specific steps, in order to prevent a relapse.(2) Besides offering a wide range of treatment options, the provider should motivate the patient to comply with the treatment regime. During a face-to-face visit, the provider should make sure that the patient understands how to take the medication, by asking the patient to describe treatment procedures. The patient should also be encouraged to ask questions for further clarification, as well as return to the provider should symptoms persist.

3.2 Impediment to a Sound Provider-Patient Relationship: Social Distance 

Social distance refers to the communication gap between the healthcare provider and the patient resulting from differences in economic, social and cultural backgrounds. These differences must be identified and overcome, or transcended so that constructive dialogue and exchange of ideas between provider and patient can occur as smoothly as possible. Patients must be encouraged to be candid and forthright about their needs.(3)

3.3. Enhancing IPC: Diagnostic Role Play(4)

One way to bridge the provider-patient gap is to perform a diagnostic role play. This is used to identify current attitudes towards healthcare in a specific community so that effective strategies can be developed to encourage alternative behaviors that promote health and wellbeing. By asking community members to simulate typical attitudes in a given situation, researchers and program facilitators come to understand their culture and belief systems. With this understanding, they can develop feasible methods to change specific attitudes, persuading their target audiences to adopt more responsible behaviors towards their health. Sometimes, the first role play is followed by a second role play which portrays how the participants could have reacted differently, in a way that is conducive to their health. Participants are asked to enact scenes and conversations that take place in their homes, such as a private conversation about HIV/AIDS between parents and their children, a talk about condom use, etc.

“DRP has a number of potential advantages. It lets researchers see real-life situations that they may not otherwise be able to see because they are private or very rare; for example, what happens in the home when a pregnant woman or child has a medical emergency (who gets involved, what do various people say, whose opinion decides?). It also illustrates behaviors, including social interactions, and ways people communicate that seem so normal to people that they will not talk about them otherwise. And because some behaviors are sensitive, people may be more willing to act them out and discuss them when they are not portraying themselves. Finally, options or solutions available to people can be discussed in a group using concrete examples.”(5)

3.4 Enhancing Interpersonal communication: Visual Aids as Teaching Tools

A research study performed in rural South India by a Unite For Sight Global Impact Fellow, Abraar Karan, indicates that in the effort to educate eye patients about their own medical conditions, visual aids are highly effective in raising their comprehension levels.  

3.5 Case in Point: A Conversation Between a Doctor and a Patient

Face-to-face interaction is a critical skill because healthcare providers seek to establish a positive rapport with their patients. During an interpersonal communication session, a provider should 1) strive to build a positive relationship with the patient throughout the session, 2) communicate with the patient properly in order to make an accurate diagnosis and appropriate treatment, and 3) provide counseling to the patient to ensure that he/she understands the condition and treatment.(6)

Consider the following encounter between a health care provider, Dr. A and a patient, Mr. B who recently discovered he had AIDS:(7)

“Good morning, Mr. B, how may I help you?”

“I have been coughing for the past 3 weeks.”

“How does it make you feel? How are your other activities affected?” Dr. A asks, inviting Mr. B to talk about his feelings. Mr. B discusses his condition and how he is worried about not being able to provide for his family once he falls seriously ill.

“I understand how you feel, as I have treated many patients before, and most people in your situation worry about the same thing,” Dr. A says, showing that he understands and sympathizes with Mr. B.

“I’ve been feeling depressed lately.”

“It seems that you have other things on your mind,” Dr. A invites Mr. B to elaborate further.

“I tested positive for HIV a few weeks ago,” Mr. B said, his head hanging low.

“I’m going to try my best to make you feel better,” Dr. A expresses his support. He reassures Mr. B, “You may feel weak and tired now, but with some medication, you can still live and be healthy for years.”

Throughout the encounter, Dr. A gives Mr. B his full attention, speaking in an agreeable tone of voice, in a manner and attitude that are appropriate and friendly enough so that the client will want to continue to talk. He expresses a genuine concern for the patient’s feelings, reassuring him that things will be fine. Aware that HIV/AIDS sufferers bear a lot of social stigma, Dr. A constantly expresses his respect for Mr. B by being courteous, and smiling. He never interrupts Mr. B in mid-sentence, and doesn’t answer the telephone during the meeting.

“Tell me about any symptoms or discomfort you’ve been feeling,” Dr. A encourages further dialogue.

“There is blood in my spit.”

“Tell me more.” Instead of jumping to conclusions which could lead to diagnostic error, Dr. A probes further, listening to Mr. B’s full story and delving deeper into the nature of his health problem. Sometimes, Dr. A even asks Mr. B for his opinion in order to evaluate Mr.B’s understanding of his own illness.

Dr. A concludes, “I think you may have TB. You will need to be tested.”

Then Dr. A asks Mr. B to describe his understanding of TB and corrects any misconceptions. Throughout the discussion, instead of medical jargon, Dr. A uses simple language, to convey his advice to Mr.B.

Mr. B leaves the meeting with newfound hope and a sense of peace and reassurance.

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Footnotes

(1) Negri, Bérengère de, Lori DiPrete Brown, Orlando Hernández, Julia Rosenbaum, and Debra Roter. "Improving Interpersonal Communication Between Health Care Providers and Clients." Quality Assurance Methodology Refinement Series Web.23 June 2009.

(2)Ibid.

(3)Ibid.

(4) "Guide to Diagnostic Role Play." CHANGE Project, with Save the Children/Malawi May 2002 Web.23 Jun 2009.

(5) Ibid.

(6) Ibid.

(7) Based on guidelines from "Guide to Diagnostic Role Play." CHANGE Project, with Save the Children/Malawi May 2002 Web.23 Jun 2009.