The message

The nature and content of the message may be uncomfortable for the doctor or the patient or both (Table 4.3). This applies to emotionally charged, complex or subtle content such as sexual problems, malignant disease, drug abuse, bereavement, malingering and psychiatric disorders.

Table 4.3 Negative communication related to the message

Language difficulties Complex problems Emotional problems Uncertainty and doubt


• sexuality, such as incest, STDs

• malignancy

• multiple complaints: 'the shopping list'


• unwanted pregnancy

The patient may find the message difficult to comprehend because of inappropriate delivery or explanation by the doctor. Failure to use good follow-up strategies, including appointment times and appropriate patient education material, will aggravate communication breakdown. Language difficulties can distort the message and generate frustration in both parties. Good interpreters often help. The doctor may also fail to appreciate that certain symptoms such as chronic pain or the presence of a lump mean 'cancer' to the patient. Failure to reassure the patient (where appropriate) distracts the patient.

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