Effective Verbal Communication in Healthcare

What I find the most challenging in the clinical setting as a new nurse practitioner, is effective verbal communication. Being able to succinctly deliver information to colleagues and patients alike, is a component ever so vital as successful practitioner, and something I still struggle with. I felt that this method of communication was not stressed enough in my education. We are constantly taking tests, reading books, and writing papers, however in the "real world" the majority of the communication in healthcare is verbal, not written. I have had plenty of experience with public speaking, and am not a poor public speaker. The difference with public speaking, however is that you have plenty of time to rehearse your presentation. When presenting a patient to a specialist or supervising physician, you don't have time to rehearse what you will say. I am adding this link to a blog post I found helpful from Little Bit of Lacquer, that discusses techniques to help with thinking on your feet.
 In nursing school and working as a RN, I did get experience with daily verbal communication during shift and nurse-to-nurse hand-offs, however in the provider role the reports given to other providers are more complex. As a nurse we learn the SBAR report format, which stands for situation, background, assessment and recommendation. Nurse-to-nurse reports are usually include the situation, (is the patient AAOx3), background (what has already been done in your care of the patient and recently), assessment (what is the diagnoses) and what is your recommendation (i.e. patient is nauseated need a PRN order).  The provider report is similar, however follows the SOAP (subjective, objective, assessment and plan) format, and requires you to come up with the plan, rather than just a recommendation. In my graduate education, I wrote plenty of SOAP notes in nearly all my graduate classes. I never had any problems with the written SOAP note. Presenting a patient verbally in this same fashion was difficult for me, and still is. In general I am shy around new people, and I tend to keep quiet around people I don't know too well. I think I enjoy blogging so much because I am a better written communicator, and it gives me time to process what I want to say and how I want to say it. In the medical field, your verbal communications skills must be strong or else you will not have the confidence and trust from your patients or your colleagues.  Here are some tips from my experience on how to effectively communicate verbally with your colleagues in the health care field.

1) Have a Plan
All so often I would have a situation in the ER I didn't know how to handle, a skyrocket high lab value, and I would run to ask the physician or another colleague  without organizing my thoughts. Big mistake. Rambling on and unorganized presentation are not tolerated well by busy providers. Put together what you have in an organized fashion (SOAP format) and if you are not sure what the plan is and research what you think is the best option and present that. If the supervising physician or other advising colleague disagrees with your plan they will tell you and modify it. Bottom line, always have a plan in mind before speaking.

2) Avoid slang and filler words
I was the queen of using slang and other informal vernacular, as well as my fair share of "ummmms and likes". It sounds so unprofessional and is incredibly distracting. My overuse of filler words was pointed out to me during clinicals by my preceptor, an internal medicine doctor. Ever since then I have made a concerted effort to eliminate these distractors in my speech. I attempt to slow down my speech, and pause instead of inserting these fillers. As a young, female provider, without MD behind my name, some patients and other colleagues already have a bias that I am incompetent before even speaking to me. Not speaking assertively and adding distractors will only decrease their confidence in your ability as a provider.

3) Use medical vocab and be as descriptive as possible
This seems obvious, but without practice it's easy to slip up and using layman's terms when presenting a patient. This was also was a habit I had to break. Instead of "a boil to abdomen" use descriptive language such as, a "3 cmx 1 cm erythematous nodule with surrounding induration to right upper abdomen."  Description is especially important when you are unsure of a diagnosis and are presenting a case to a consulting specialist. My former preceptor would put me on the spot in the room of a patient and have me describe a rash as if I was presenting to a dermatologist. I would stumble at first, but with time I improved.

4) Eliminate any distracting information
As in contrast from written documentation, when communicating information to a colleague eliminate all the unnecessary facts. In the subjective simply state the patient's complaints and duration of symptoms. Only state the past medical history and review of systems if it directly related to the patient's reason for the visit. For example, it is necessary to state a patient has history of uncontrolled diabetes with a patient presenting with cellulitis, however it's not necessary to mention the patient had an appendectomy two years ago. When discussing the physical exam, only report the abnormals pertinent to the complaint at this visit, and if there are none state "normal exam".

I will write another post on my tips on communicating with patients in the future. Please share your comments below.

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