The long-winded patient. That is me. I am also a registered dietitian-nutritionist and certified diabetes educator with limited time and a desire to provide all of my patients with the attention they deserve. From a patient’s point of view, I am wordy and focus on the emotional side of my disease. As a diabetes educator, I am also short on time and understand the challenges of all of my colleagues. This article provides tips to communicate with patients like me, the high-context communicator.
Working with High and Low-Context Communicators
To optimize the patient-provider relationship, it is vital to identify and address different communication styles. The term high and low context communication was coined by anthropologist Edward T. Hall. Context plays an important role in sending and receiving communication.
Low-context communicators tend to express themselves in an explicit and direct way. Their messages are simple and clear.
High-context communicators express themselves indirectly. The messages are implied and not directly verbalized (reading between the lines).
Example: Patient walk in the diabetes educator’s (DE) office and greetings are exchanged
DE: How are you?
Low-context communicator: My sugar has been high since Tuesday when I started having a throbbing pain in my right shoulder.
High-context communicator: I started removing furniture because my wife was nagging me all week about it. I started moving boxes. They were not heavy. I think I felt something but I did not pay attention. Later on that day, I was in pain. Oh boy!!!! I showered and then it got worse. Oh, and my sugar levels have been crazy. I don’t even want to think about it.
The low-context communicator provided specific information. The high-context communicator set the stage first and with prompting would have provided additional details pertaining to his visit. Low context communicators start with specific details and expand providing additional information while the high-context communicators provide general information first and specific information last.
When Provider and Patient Communications Collide: What are they really thinking?
The low-context health professional may characterize the patient as long-winded or wordy while the high-context patient may interpret the health professional’s direct questioning to be rude. They feel frustrated by the experience. “The doctor didn’t even let me talk!” is a common complaint.
The Impact of Culture and High and Low-Context Communicators
The United States, and other Western cultures such as England, Germany and France fall into the low-context category while China, Latin American and African countries fall into the high-context countries. High and low-context cultural groups fall between the extremes of the spectrum and some individuals of the group may have the share both communication characteristics.
High and Low Power Distance and the Impact on Patient Communication
Another cultural concept that affects how health providers and patients communicate is power distance. Power distance refers to how patients interact and relate with individuals that have different levels power. In lower power countries such as the United States there is more of an egalitarian relationship with health care providers. Patients feel empowered to ask questions, share opinions about their treatment and care plan. On the other hand, patients from high power countries such as Mexico and other countries in Latin America would likely accept recommendations from expert and high authority figures without questioning them. For example:
DE: I know we cover a lot today about carbohydrates, protein, fat and how to make food selections. Do you have any questions about the meal plan?
Low Power cultures: Yes, I do. I don’t understand how I am going to manage snacks, meals and insulin when I have to work the night shift. I am concerned because I am usually not hungry and if I am going to use insulin, then I am afraid I will go low. Are there other options?
High Power cultures: No.
Improve Communication During the Clinic Visit: Addressing your High-Context Communicators
Limited time is the driver to restricted clinic visits. If you have a high-context communicator, the following tips can help bridge the communication divide.
Greeting Goes a Long A Way
Good communication skills include eye contact, attentive listening, and a warm smile. You can never go wrong with this approach.
Added bonus: “Glad to see you today”
If you know the patient: “How’s the family?” “How was the drive?”
Let the Patient Know What you Need to Know: Setting the Stage
DE: “I am going to ask you very specific questions to learn more about what is troubling. I don’t want to sound rude but I may need to interrupt you because I want to have a clear picture of what is wrong so I can help you.”
Guide the Patient
Guide the patient to talk about signs and symptoms. Direct questions may be interpreted as a sign that the provider is hurried and wants to get the patient out the door. Patients need to feel that the relationship with the provider is personal and welcoming and that the provider cares about them, not just their symptoms. Here are some suggestions:
Patient: “I felt horrible. For a moment, I thought about calling 911. I felt so sick.”
DE: “Tell me exactly what you were experiencing when you felt so sick. ”
“I’m very interested in learning more about (insert patient’s complaints/feelings). Can you describe them in detail?”
Share Personal Experiences to Encourage Patient to Connect with Provider
Example: Patient has been experiencing above target blood glucose levels
DE: Many persons with diabetes have found it helpful to_____________
Many patients find it difficult when______________
Prepare the Patient for Success
At the beginning of the visit, patients have to complete forms and questionnaires. Don’t let it end there.
- Give the patient a patient encounter form to use during the visit. Divide it into 3 sections.
- Encourage the patient to write the information they don’t understand in one section and the information they want to remember and information they had never heard before in sections 2 and 3.
Leveraging High and Low Power Distance Communication
To leverage the power imbalance that some patients feel when talking to doctor, open ended questions elicit more participation.
Invite the patient to be a participant. You can say,
- “Do you know that patients who are involved in their treatment have better outcomes? I want you to be part of this process. Tell me what makes sense to you and what doesn’t.”
- Instead of asking, “Do you have any questions?” ask “What questions do you have?”
- Use Teach-Back Method. Ask, “Can you tell show me how you are going to use the insulin pen?” “Can you tell me what are you going to do when your blood sugar is under 70 mg/dl?”
Learn more about cross-cultural communication tips. On-Demand Webinars: Working with Diverse Populations