The Victorian Medical Board lists poor communication as the most important factor causing complaints from patients and relatives against doctors. 5
Effective communication depends on four interrelated factors concerning the message—the doctor (the sender), the patient (the recipient), the message itself and the environment in which the message is sent (Fig. 4.1). 6
Fig. 4.1 The four key factors affecting communication
The physical environment is important (Table 4.2). The appearance, size and layout of consulting rooms, waiting rooms and patients' rooms will affect communication, sometimes adversely, especially if privacy is threatened by, say, leaving the consulting room door open. The doctor can create an obstacle simply by a physical 'barrier', for example a large desk distancing the doctor from the patient (Figure 4.2).
The hospital environment will encourage the 'sick' role and generally is not conducive to good communication because of a low level of privacy.
A busy practice affected by time constraints on doctor or patient will influence communications seriously. A doctor in Wales has a notice in his waiting room: 'If the doctor is a long time with a patient don't get mad: it might be you'.
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