An evaluation of the effectiveness of patient - physician communication following traumatic brain injury

Despite the enormous importance of patent-physician communication for treatment and rehabilitation, the topic of interpersonal communication does not find a place in the curriculum of most medical schools. Medical practice in this respect is dominated by improvised solutions emerging from the individual physician's personal communication style, which in many cases leads to breakdowns in communication with patients. The purpose of this article is to describe the general principles governing patient communication and the problems encountered in this regard. Communication is discussed as a social process, which on the one hand runs its course in accordance with certain generally binding rules, and on the other hand is governed by the purposes (both open and hidden) and inclinations of the persons involved in the conversation. Several key concepts in communication are explained, including sender and receiver; text, subtext, and context; verbal and non-verbal communication. A simplified model of the communication process is presented. The research material consisted of a group of 36 TBI patients who underwent treatment at the various centers represented by the authors. The research results are presented on the basis of the assumptions described earlier as pertains to the effectiveness of physicians communication with patients. An example conversation is presented, involving two physicians and a patient, recorded as party of the research project. In order to illustrate the basic errors committed by the various speakers for the needs of specialist in orthopedics, traumatology and rehabilitation, the authors have discussed this conversation according to the qualitative method known as "conversation analysis". Patient drawings are also presented, illustrating their experiences in communication with physicians, along with an in-depth analysis of the messages found in these drawings, using the authors' own methodology of qualitative analysis of patient's self-expression. The results obtained points out some of the causes and effects of communication problems, including the divergent goals of physician and patient, the lack of sensitivity to the context and to the particular problems faced by the other parties involved in the conversation, and physicians' failure to control subtext and non-verbal signals. The conclusions presented by the authors emphasize the complexity of the problems researched here and the necessity to take steps to remedy them.