Intro
On my community neuro placement, for the first time I met a service user who had something close to what people describe as "locked-in syndrome". He was young, only in his early 60s, and had had such a severe stroke that he has lost most movement, including in his face, and was non-verbal. His main forms of communication were a thumb wiggle for yes, a finger wiggle for no, and he could make a laughing face when he found something funny, although was unable to make any sound.
What Happened?
I observed this service user seeing two different physios, and noticed they both used very different ways of communicating with him. First physio showed a lot of compassion and concern for him, spoke very slowly and clearly with lots of pauses, and was constantly checking that he understood. The second physio spoke to him as normal, cracked lots of jokes which made him "laugh", and was generally very at ease with him.
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Feelings
I couldn't help but feel that the first physio was doing all the right things, but her manner of speaking to him was a little bit patronising. It struck me that she was speaking to him as if he was a child, or as if he had reduced ability to process and understand information.
I felt the second physio spoke to him like he was an adult, and as if he could understand everything he was saying. They seemed to have a much better rapport with each other, they had fun together and both of them seemed much more at ease. The more I got to know the service user over time, the more I realised that he really did understand everything that was being said, even if he couldn't verbalise it.
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Action Plan
By contextualising the e-learning material into observed practice, I can now recognise different communication styles and techniques to improve the quality of information-sharing and rapport-building, within the context of a therapy appointment.
I understand that an empathetic approach is preferred where possible, particularly where efforts are made to identify service users' communication needs, rather than assume them. Using the example of a non-verbal service user helped to make this comparison more clear, but these skills are applicable to all contexts of communication.
Particular points that I could apply to future practice are: to remove distractions (including that of time-pressure, something that I am particularly guilty of in primary care); to arrange the help of translators where appropriate, to maximise the quality of information-sharing and service user involvement; and to seek feedback to ensure the service user has understood everything, and give them an opportunity to identify any further concerns or needs.
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Evaluation
There were good points and bad points about both of their different communication styles. The first physio was more "proper" and formal. She showed a great deal of care and compassion, and allowed the patient multiple opportunities to give feedback or express concerns. It did however come across as a bit patronising, it felt a bit like she was acting as "mother hen", and I worried that the patient might feel a bit dehumanised.
I felt the second physio's method of communicating was something I would personally be much more comfortable with. They both seemed very at ease together, and interacted as equals rather than in a "doctor-patient" paradigm. He didn't explicitly ask the patient for feedback, but he seemed to already have a good understanding of his limits and preferences, I assumed they had known each other much longer than the first physio did.
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Conclusion
I found an e-Learning for Health course that explored communication styles in the context of palliative care, and tried to apply these concepts to what I had seen on my placement in order to help make sense of the two different communication styles I had witnessed. The main thing that I took away from the course was the difference between sympathetic and empathetic communication.
I realised the first physio had adopted a very sympathetic communication style. She wanted to comfort the service user and showed him a great deal of compassion and concern, but she made assumptions about his needs. She spoke to him in a child-like manner, without exploring whether this was the right method for him.
The second physio had a much more empathetic manner of communicating with the service user. He had taken the time at some point to assess the man's communication needs, and must have tested over time whether he needed to speak in a simplified manner or not. This took the individual needs of the service user in to account, and resulted in better rapport and a more comfortable communication experience for both parties. I did notice, however, that he didn't seek much feedback from the service user. This could potentially have been because they had a long standing relationship and he felt he was able to read the service user's subtle expressions as a method of feedback, however it could also signify that he was making assumptions that the service user was OK.
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Analysis
I realised that I wanted to find out:
What exactly was it that made these communication styles different?
Which one was more appropriate in this particular case?
And, which one displayed the most appropriate and relevant techniques to carry forward in to other similar contexts?
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