Barriers to physicians' communication

Letter sent to Connecticut State Medical Society regarding the need for physicians communicate with each other, the public, their medical leaders, and legislators.

CSMS president Michael Krinsky, MD made several good points in his president’s address at the CSMS of House of Delegates Annual Meeting, September 16&17, 2011.1
Of particular importance was his appeal to physicians to “communicate, communicate, communicate”. With so many means at our disposal to communicate, however, we seem to do it less and to do it less effectively than ever.

Why is this? Here are some personal observations.

(1) We don’t always stay focused. This refers to those of us who can’t keep our thoughts restricted to the issue at hand. Whether orally or in written speech it is too easy to let our minds wander, with the result that instead of focusing and remaining focused, we get sidetracked and go off in all directions. Maybe some of us are garrulous by nature or become so when speaking in a group. But even experienced leaders who are accustomed to “communicating” sometimes are unclear or speak too long. Perhaps they fear that being pith and precise may be misinterpreted as indicating lack preparation or lack of interest.

(2) The communicator doesn’t think out his/her thoughts before expressing them. People often just shoot (or write) from the hip without having any good supporting evidence to give them credibility. An opinion takes on more credibility if accompanies by supporting evidence or good logical thought.

(3)Fear of being perceived as too far out of the mainstream. For most of us, expressing ourselves honestly can be distressing. It’s almost a truism that the opinions that we freely share privately we rarely express in group situations with our peers. I imagine that by the time we finish college and medical school our youthful idealism has succumbed to the years of conservative indoctrination and submission to authority that accompanies our training.

(4) Sometimes the listener or reader is too lazy to respond to what they have listened to or read. This is bad because communication, ideally, is a two-way affair. It is dialogue. Without hearing from others what we have said, how can we know if we are on the right track? A response may increase our convictions on a subject. And if it shows us that we were wrong or even only partly so we will have benefitted. For those who enjoy communicating, not receiving a response can give one self-doubt and dissuade one from continuing. Responses do not and should not always support what is being discussed, but they should be cordial and positive and constructive.

(5) Time is a big limiting factor in communicating. It is less so when one is on the keyboard of one’s computer than when one is participating in a group situation. Because we are all so busy with professional duties and personal responsibilities, the time we allow ourselves for communicating has become less and less. There is pressure on the person running the meeting to keep on schedule and finish on time. This can lead to the absurd conclusion that even though a meeting has not taken a few steps forward in solving a problem or clarified some point or other, since it has finished on time, the person presiding has done a good job!

(6) Some issues are emotionally charged and elicit zealous and even vehement feelings. Although the usual response is to enjoin the person speaking to calm down, I think that a short outburst if it is not scurrilous or prejudicial should be permitted. It clears the air, and sometimes it is the only way to make one’s point.

(7) Some of us take offense when we are contradicted in oral discussions. This can poison communication. I have seen it result in loss of collegiality. Confrontation is good and without it little is accomplished.

(8) Finally, communication needs to be spiced with occasional humor. Too much of it makes physicians forget what they have convened for. But too little humor, which is more often the case, stifles free and open discussion.

1. Krinsky M. Address of the new president: CSMS house of delegates, annual meeting, September 16&17, 2011. Conn Med 2011; 75:637-639.

Edward J. Volpintesta MD