Enfoque Sociocultural

The speaker should speak in grammatically correct sentences. Incorrect grammar can impede the clarity of the message and, just as important, can diminish the confidence the listener has that the speaker knows what they are talking about. The same holds true for pronunciation. Each setting

in which human interaction takes place has agreed-upon pronunciations for words commonly used, and it is important that the speaker remain mindful of the setting and use appropriate pronunciation. In a health-care setting, standard English pronunciation is appropriate. Correct pro-nunciation enhances understanding and rapport between the speaker and listener. Incorrect pronunciation inhibits understanding and can cause mistrust.

Tone

The tone with which the HCP speaks to the patient is vital to the thera-peutic relationship because it indicates an understanding of the patient’s needs and enhances the HCP’s ability to meet those needs. Tone accom-plishes this by helping both parties to understand their relationship and its tenor. Generally speaking, the tone the HCP uses should be relaxed and conversational, helping to establish rapport with the patient. Beyond that, there are three types of tone worth exploring: Expressive, Directive, and Problem-Solving.

Expressive Tone

An expressive tone is spontaneous, emotional, and uninhibited. We use this tone, for instance, when we express our feelings, tell jokes, or complain—when we socialize. When having coffee or dinner with friends, or when confiding in a family member, we talk about what we like or do not like, what we want or do not want. We express ourselves, and we use the expressive tone.

For example, while sitting in a café with a friend we might say some-thing like, “I really wish I had studied harder in math so I could do my own taxes.”

or,

“Can you believe how goofy Professor Martin’s haircut looks?”

or,

“I hate my boss. He never tells me I’ve done a good job, even when I work all night on projects. He can only say something about my work when he doesn’t like it.”

This is generally not a tone of voice the HCP should use when speak-ing to patients. First, for reasons explained more fully below, usspeak-ing the expressive tone is often inappropriate in a healthcare setting because it takes the focus of the discussion off the patient and puts it on the HCP.

The HCP should make every effort to let the patient know that the patient’s needs are the reason for the visit. Second, research indicates that patients do not usually appreciate an emotional or even joking tone from their HCPs. Relaxed and conversational, yes; full of feeling and fun-niness, no. The patient has come in for a serious reason, and they want the interaction with the HCP to be direct, empathic, and professional.

Directive Tone

A directive tone is authoritative and judgmental. This is the tone one uses to give orders, exert leadership, or pass judgment. When a supervisor at work asks you to complete a task, explains the scheduling needs for the coming month, or clarifies areas on your annual performance review in which you could improve, they use the directive tone. The directive tone is an indication that there exists a difference in professional rank between the speaker and the listener.

For example, a nursing supervisor in a hospital’s internal medicine clinic may say to a medical assistant, “Mr. Jimenez [a patient] is in Examination Room 3 and needs his vitals taken. Please take care of that right away.”

or,

“Can you see to it that Ms. Higgins is taken down to radiology at 2:00? They’re expecting her for a head CT.”

or,

“Mark [another medical assistant] needs to take Saturday off for a family funeral. Can you come in to work Urgent Care from 8:00 to 5:00?”

The directive tone is generally not an appropriate tone for the HCP to use when speaking to patients. Patients come into the practice seeking expert treatment that includes understanding and empathy on the part of the healthcare team. As part of that treatment, patients frequently need to receive instruction from their HCPs. However, it is important for the HCP not to confuse providing patient instruction with giving the patient orders. Consider the following two examples involving a nurse whose patient has an upper respiratory infection. The patient’s doctor has pre-scribed an antibiotic to fight the infection. In the first example, the nurse FIGURE 3-2. The Directive Tone versus The Problem-Solving Tone. A: Using the direc-tive tone with a patient can cause misunderstanding; (B) The problem-solving tone builds rapport, showing the patient you are there to help.

orders the patient to comply, and in the second, the nurse instructs the patient about the benefits of compliance.

Ordering the patient: “I’m telling you. Don’t miss a single dose of this pill. If you do, your infection won’t go away and you’ll feel even worse.”

Explaining to the patient: “Taking these pills regularly will achieve the best results. You’ll do a better job of fighting the infection.”

The patient is much more likely to respond positively to what the nurse says in the second example and is, therefore, much more likely to comply with the instruction.

PLAY

ROLE Hand Washing

With a partner, where one is an HCP and the other a patient on an in-patient infectious disease ward at a large hospital, act out the following scenario in which the HCP must instruct the patient in proper hand washing. Using their hands, the HCP must show the patient how to wash, and then instruct the patient while they wash their hands. Take turns using the Directive tone and a Tone that explains to the patient the benefits of good hand washing. Discuss which is more effective and why.

Problem-Solving Tone

A problem-solving tone is rational, objective, and unbiased. This is the tone we use to indicate to the listener that we are using the analytical portion of our brains to come to the correct answer about a certain set of circum-stances. When we provide complicated street directions to a friend who is visiting from out of town, describe a missed homework assignment to a classmate who was absent, or explain how to download a computer file, we use the problem-solving tone. This is the tone the HCP uses most frequently when serving patients’ needs. A significant part of the allied health profes-sional’s job consists of verbally collecting important information from the patient and providing explanations and solutions to the patient. The problem-solving tone is what the patient rightfully expects from the HCP.

Consider the following pairs of examples and choose the statement or question in each that would be more effective for an HCP to use with a patient. One statement or question in each pair uses the problem-solving tone, and one uses another tone, either the expressive or the directive.

Statement A: “Eating so many cheeseburgers every day for the past five years could be a contributing factor in your high blood pressure.

Cheeseburgers contain a lot of sodium, and sodium is often associated with high blood pressure.”

Statement B: “Eating so many cheeseburgers is going to make you fat and give you a heart attack. Is that what you want?”

In the first set of examples, Statement A uses the problem-solving tone and is more effective, whereas Statement B, which uses the expres-sive tone, is likely to offend the patient.

Question A: “Do you speak English?”

Question B: “Can I get someone to help you with English?”

In the second set of examples, Question A uses the directive tone and is less effective. The patient is likely to feel more comfortable responding to Question B, which uses a problem-solving tone, than to Question A, which uses a directive tone that sounds almost accusatory. In each case the patient would be more receptive to what the HCP is saying when a problem-solving tone is used to convey or retrieve information.

PLAY

ROLE Using the Correct Tone

With a partner, use your best problem-solving tone to play the role of the HCP and counsel the patient about one of the following situations.

Try to avoid using either the expressive or directive tone.

• The HCP is a dental hygienist who has to explain to the patient the benefits of daily flossing.

• The patient has poison ivy and wants to scratch the welts. The patient should not do this under any circumstances.

• The patient should not try to clean their ears with sharp metal tweezers because doing so can cause serious injury.

Emphasis

By this time, it should be clear that how you say something is often just important as what you want to say. Even within a sentence, the empha-sis you place on certain words or parts of a sentence can lead to vastly different interpretations by the patient. Consider the following versions of the same sentence: I believe you will get better. Each sentence has a different word emphasized.

■ Ibelieve you will get better.

■ The emphasis here suggests that the speaker is perhaps alone in believing the patient will get better.

■ I believe you will get better.

■ This sentence has an emphasis that says the speaker may have some doubt about the patient’s improvement, but really wants to believe it.

■ I believe you will get better.

■ This last version’s emphasis on the word “better” suggests that the speaker may not actually doubt the words they are saying about the patient’s improvement, but that the speaker still wants to cheer the patient on.

Clearly, in each of these cases how the speaker says what they want to say is as important as what they want to say.