Exploring the role of communication barriers in healthcare

To the Editor

Communication is a highly complicated process meant for exchange of ideas or information between two people.¹ Although communication is an everyday happening, there is no surety that both sides fully understand each other.¹ In fact, the uncertainties of communication are manifold, especially when a group of people or the whole community is involved.² Furthermore, it has been observed that the public health systems of different nations are not well equipped to respond to a range of health challenges arising because of the amalgamation of people from different cultures, owing to the effects of globalisation/international travel/medical tourism/acculturation.³

Different types of barriers such as physiological (difficulties in hearing or expression); psychological (emotional disturbances, neurosis, levels of intelligence, language, or comprehension difficulties); environmental (noise and invisibility); and cultural (illiteracy, levels of knowledge and understanding, customs, beliefs, religion, attitudes, socio-economic class differences, language, and cultural variability) have been attributed to the failure in communication between the doctor/health worker and the community.^2,3 These barriers have been recognised as the key reasons for limiting the quality of care and eventual health-related outcome of patients in heterogeneous settings.^4,5 All these barriers suggest that, in spite of easy accessibility/affordability of healthcare services, the socio-cultural barriers pose a serious threat to the achievement of change in health-related behaviour.⁶

The communication barriers in the health sector have been identified in three major domains, namely lack of communication between doctors and nurses, problematic communication between the healthcare team, patients, and their families, and cultural challenges.^4,6,7 Both physician (poor communication skills, no special training during under-graduation, not listening to complaints of patients, use of medical terminologies, and minimal knowledge about the prevalent socio-cultural practices of the community) and patient/relatives (illiteracy, myths and misconceptions, and poor awareness about health issues) related factors have been accounted for the observed gaps in communication.^2,7−10 This poor communication has resulted in serious consequences in different areas such as poor clinical outcomes (diagnosis — lower diagnostic confidence and increased perception that ancillary tests are needed to narrow the diagnosis, and therapeutic — administration of a wide range of unnecessary drugs or non-compliance from the patients regarding consumption of drugs);^11,12 patient satisfaction (minimal understanding among patients of their diagnosis, treatment options, and administered therapies and, thus, poor satisfaction level among patients and family members);^4,8 poor health education outcomes because of the poor doctor–patient relationship;⁸ excessive rise in cost of medical care;³ and poor quality of care.³

However, parameters like no mandatory training of the medical students to improve their communication skills; emphasis on acquisition of clinical skills rather than communication skills in medical institutions; lack of team approach (perception of doctors that nurses/other paramedical staff do not play an important role and, thus, are not involved in most of the decisions); minimal attempt by the doctors to get acquainted with the local cultural patterns; and minimal use of principles of marketing by the programme managers to develop an appropriate message which is suitable to the general population, have definitely contributed towards the further aggravation of the problem of communication barrier.^{1,3,8,11,13,14}

In order to improve the clinical outcome, strategies to facilitate effective communication are of prime importance and, thus, principles of communication (sender’s and receiver’s perceptions being as close as possible; bilateral communication; preferably direct — face-to-face communication; message being simple/specific/appropriate and timely; involving as many sense organs as possible; and communicator talking in local language/listen to patient and community/always ask for feedback) should always be adhered to.^1,2,8 In addition, implementation of other strategies like organising sessions to facilitate learning of communication skills, especially in undergraduate medical education for doctors;^1,3 involving nurses thoroughly in the care of patients;^3,13 organising training programmes to specify the unique role of nurses;¹³ encouraging use of an interpreter;³ advocating development of an individualised approach by facilitating collaboration between all stakeholders;³ selecting appropriate use of audio-visual aid depending on type of setting;^1,3 and developing health awareness messages in people’s local language;² can also be carefully planned in a tailor-made manner in different settings.

To conclude, it is high time to ensure effective communication between the physician/health staff and the patient/community, and develop innovative and customised approaches desired to meet the needs of vulnerable people accessing healthcare.