Top of Form Background: Last week the class rea

29

CHAPTER 3
Interpersonal and Gendered
Communication

For the purpose of this text, we are going to use the following as working
definitions:

? Communication competence: the ability to effectively exchange and process
information with others

? Context: setting or situation

? Empathic listening: letting speakers talk without interruption and demon-
strating the listener?s support without evaluating the speaker or provid-
ing instruction, instead encouraging the speaker to find a solution

? Feedback: using statements or questions to demonstrate listening to a
sender or to encourage clarification from a receiver

? Gender: gender may not be constant or easily determined by others and
is different from a person?s sex; it is demonstrated by how an individual
chooses to behave/act, that is, masculine, feminine, or more likely some-
where in between

? Gender identity: a person?s perception of his or her masculinity or
femininity

? Goal competence: the capability to construct goals and choose a plan(s) to
accomplish them

? Interpersonal (also known as dyadic) communication: interactions between
two people who know each other and share common goals (e.g., friends, lov-
ers, family members, professionals, and a provider and a patient); it is not
the same as an infrequent conversation between a customer and a store
clerk or a restaurant waitperson

? Interpersonal relationship: a bond between two people who share common
goals requiring effective interpersonal communication for its develop-
ment and/or maintainenance

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30 Health Communication for Health Care Professionals

? Nonverbal communication: behaviors that are not word based; messages
transmitted via observable or experienced actions (eye contact, touch, vocal
volume, tone, etc.)

? Role competence: the skill to assume various social/professional roles based
on the context and communicators? goals

? Self-disclosure: sharing highly personal information with only a very
limited number of most intimate friends/lovers

? Sex: male or female, generally anatomically obvious to self and others;
determined by presence of a vagina in a female or a penis in a male

? Verbal communication: literally what you hear or say when in a conversa-
tion with one or more interactants

? I N T E R P E R S O N A L C O M M U N I C A T I O N A N D
H E A L T H C A R E

As you may have surmised from the aforementioned definitions, interper-
sonal communication is critical to our interactions with friends, family, and
lovers, but it is also vital to successful outcomes in our professional lives.
Perhaps no profession depends on the effective use of interpersonal com-
munication exchanges more than health care. If you spend a minute to think
of a recent visit to your own health care provider, or an interaction you had
with a patient, you will likely understand that at the most basic level, almost
all health communication is interpersonal. Health care providers and patients
are constantly engaging in information sharing to assure effective diagno-
sis, testing, treatment, and outcomes. But just as critical is the interpersonal
communication between health care providers. Regardless of the channel
(air waves, electronic, written, etc.), and whether it is verbal or nonverbal,
providers needs to share information with other providers (intra- and inter-
professionally) in order to achieve their patient goals, minimize risk, and
attain successful outcomes.

Reflection 3.1. Thinking about a single interaction (with your provider, a colleague
provider, or with a patient), how would you describe the communication exchange?
Was it effective or problematic and why?

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3 Interpersonal and Gendered Communication 31

Understanding the role of interpersonal communication in health care is
critical to the focus of this book. Once we recognize that almost all of our
health care interactions are interpersonal, the value of understanding the the-
ories and skills needed to be an effective communicator becomes glaringly
obvious. And with that reality comes the recognition that for two people who
share common goals (a patient?s health), the importance of developing and
maintaining an interpersonal relationship becomes even more paramount. As
we know from our personal lives, those friends, family members, lovers, and
colleagues, with whom we have an interpersonal relationship are generally the
people whom we trust, share information with, and value the most. Therefore,
as a health care provider you will benefit greatly if you can strive to develop an
interpersonal relationship with your patients, as well as your peers, colleagues,
and superiors.

However, we cannot hope to accomplish effective interpersonal health
communication and relationship development without a clear understand-
ing of the impact of gendered behaviors on information exchanges, trust,
collaboration, and goal planning/attainment. Therefore, this chapter explores
how interpersonal and gendered communication in health care are so import-
ant to interpersonal relationship development and maintenance. And, as pre-
viously mentioned, in this culture we tend to share information more fully,
listen to, collaborate with, and trust those with whom we have an effective
interpersonal relationship.

? B U I L D I N G R E L A T I O N S H I P S

For the purpose of this text, we are discussing professional relationships
(provider?patient, provider?provider, provider?family member, etc.). As you
know from your own relationships, they generally begin when one person
becomes aware of another; in health care contexts, this may be the first time a
patient goes to a provider, or the first time a provider begins working with
another provider, and so forth. Based on the interpersonal communication

Reflection 3.2. Can you recall a situation in which you needed help from
someone, or that person offered advice about something? Did/would your
reactions to that offer change based on an interpersonal relationship with that
person? If so, why? If not, why not?

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32 Health Communication for Health Care Professionals

of that initial contact, as well as the circumstances (patient?s wellness/illness,
health care team, etc.), interactants will make decisions about the other per-
son and future contact/communication. We need to constantly remind our-
selves how different health care, as a profession/context, is from other areas of
our lives. For example, we tend to have lots of everyday relationships. Some
illustrations of these affiliations are the barista at the local coffee shop or the
salesperson at the clothing store. While it may be nice to see a familiar face
each time you visit, you will likely not change your behaviors if there is some-
one else who replaces him or her. And although the person in these everyday
roles may be friendly, remember your name, clothing size, drink order, and so
forth, you do not share common goals. These everyday relationships gener-
ally revolve around your desire/need for something versus the other person?s
goal to sell something, keep his or her job, or influence the boss. As you can
see, for most health care professionals, this is not the type of relationship that
makes sense if you are trying to gather/share information. And while health
care employees certainly want to keep their jobs and impress their superiors,
generally speaking their primary goal is to help patients maintain or reestab-
lish their wellness and achieve the best quality of life possible?which are
almost always patients? goals as well.

Based on this understanding of an interpersonal relationship with shared
goal(s), provider?patient and provider?provider interactions need to have
some common understandings:

1. There are expectations that each interactant agrees to adhere to

2. Rules are needed to assure both confidentiality and privacy, as well as
trust and openness

3. An understanding that both provider and patient must be willing to
do the work of not only maintaining the relationship, but attaining the
shared goal(s)

In order for the relationship to develop and be most effective, both providers
and patients have a right to expect that the information shared is accurate,
complete, and effectively communicated. Therefore, if the patient refuses to
discuss his or her prior drug use, it needs to be understood that the provid-
er?s decisions, recommendations, and so forth may not be as effective as they
would have been if the patient had been more communicative. Similarly, if
the provider knows about risks or alternative outcomes, she or he would be
expected to share those with the patient. One of the often nonverbalized rules
in provider?patient health communication includes the need for patients to
fully disclose their present, past, family, and social histories, but providers will
not reciprocate. Another rule is that providers will not allow a conflict of interest
(financial or professional) to negatively impact the patient?s care, wellness, or
quality of life. Finally, the patient has a right to expect that the provider is not
only qualified to offer care, but uses continuing education to update knowl-
edge, decision making, information sharing, and so forth.

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3 Interpersonal and Gendered Communication 33

Now that we have discussed some of the important aspects of develop-
ing and maintaining an interpersonal relationship in a health care context, we
need to explore the communication competencies needed to help providers
effectively exchange information, enhance trust, and encourage collaborative
decision making with other interactants.

? V E R B A L A N D N O N V E R B A L C O M P E T E N C I E S

Verbal Communication
As you can imagine, being an effective interpersonal communicator relies on
your verbal and nonverbal competencies. Let us first focus, however, on your
understanding of verbal communication. It may seem like commonsense, but
when we refer to verbal behaviors we are literally discussing the use of spoken
symbols (language) to exchange information. The problem for many health
care professionals is the difference in their perception of shared symbols and
the reality for their patients and/or family members. We discuss the culture of
health care in more detail in Chapter 5, but it helps if we recognize that provid-
ers are assimilated into the health care culture (nursing, medicine, physician
assistant, physical therapy, etc.) in part by learning a new shared language?
medical terminology.

Because most health care providers have a bachelor?s degree at a minimum,
their literacy level is already advanced beyond that of the average American. To
further understand the problem, we should examine some statistics from U.S.
Department of Education, National Institute of Literacy (2015) regarding adult
Americans:

? More than 30,000,000 cannot read

? Nearly 50% cannot understand prescription labels

? Nearly 50% are unable to read an eighth-grade-level book

? Nearly 20% of high school graduates cannot read

Reflection 3.3. If you are in a relationship (platonic or romantic) and the other
person self-discloses something very personal, what do you think that person
expects in return? Why would that reality make it even harder for patients to
self-disclose to providers?

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34 Health Communication for Health Care Professionals

Although these numbers seem difficult to comprehend, they have remained
relatively unchanged for decades (U.S. Department of Education, National
Center for Education Statistics, 2015). Therefore, based on these data, there is
a high likelihood that many of your patients will have extremely low literacy
levels and have difficulty even with everyday American English. As a conse-
quence, health communication becomes even more problematic?patients
have limited literacy and providers typically use terminology that is not even
remotely part of the patient?s or family members? vernacular.

The first step then in understanding verbal competency for a health care
provider is to recognize the role symbol sharing plays in effective communica-
tion. Next, it is critical to recognize the importance of context in communication
exchanges. Perhaps if you think about a typical dinner with your family?in
that context you communicate verbally using symbols that you know are most
appropriate for such an audience. Suppose you go from dinner with your fam-
ily, to a bar/club to relax with your friends, will your use of language/symbols
change with the context? If you are like most Americans they will. Now what
do you think will happen to your use of symbols when you enter a professional
context? Again, they will likely change, perhaps drastically. As a health care
provider, you will need to use the appropriate language/terminology with col-
leagues and superiors, which requires symbols that are far different than those
at your family dinner or your evening out with friends. Like many Americans,
you will be able to subconsciously alter your symbol usage based on the con-
text. However, health care is unlike almost any other context because providers
must use the appropriate symbols/terminology with their peers and colleagues
and a very different level of symbol sharing with patients and family members.

Reflection 3.4. Besides literacy, what do you think is another major obstacle in
the health care context for effective interpersonal communication and informa-
tion exchange?

When we think about the differences in health care communication and
most other contexts, one major problem seems to transcend all others?
patients? emotional responses. In the current health care system, we tend to
have an acute versus chronic care focus?both as providers and as patients.
For the most part, adults are not seeking care unless they have a problem.
Consequently, patients come to most health interactions with verbalized, or
often nonverbalized, concerns (e.g., quality of life, financial implications, pain,

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3 Interpersonal and Gendered Communication 35

survival). These emotional issues may add an additional layer of difficulty to
the provider?patient interaction.

Imagine if you will that you find a lump in your breast?male or female?what
is likely the first thing you may assume that lump represents? Even if you are
a seasoned health care provider, you are likely to be concerned that you could
have cancer. Now, try to consider what it would be like not to be a health care
provider with your knowledge of statistics for breast lumps for people of your
age group and sex. Patients not only may be terrified that they have cancer, but
some may be so concerned that they do not seek care immediately?too afraid
to even tell anyone about it. Others may seek care, but not want to disclose
all the information the provider is seeking in fear that by talking about a pos-
itive family history, or other potential signs and symptoms, they will increase
the chances that the lump is malignant. Therefore, one thing that the emo-
tions associated with many health care contexts contribute to provider?patient
interactions is a level of ?noise? that jeopardizes effective interpersonal commu-
nication and relationship development. Noise in this case is hindering the con-
veyance of information that providers need to help accurately assess the problem/
situation. However, emotional issues in health care contexts create another type
of noise that can be just as problematic for patients and providers?if not more so.

Another example of noise that interferes with effective information exchanges
is the emotional concerns that distract a patient (or a provider) and decrease his
or her ability to listen and assimilate what is being communicated. Think about
your response to Reflection 3.5; haven?t we all experienced distractions from out-
side events that made it very difficult to concentrate on what was happening in
the present? Even if you cannot recall such a situation, you likely can understand
how the death of a loved one, for example, might make it difficult to focus on a
lecture, an exam, or a workplace assignment. Therefore, you should be able to
see how a patient who thinks she or he has a serious illness, terminal condition,
requires surgery, can no longer work, and so forth, would have a great deal of
difficulty listening effectively to a provider who was trying to explain something,
or seeking more information or shared decision making. Remember the possible
breast lump? What if you?re sitting in the provider?s office and she or he says, ?the

Reflection 3.5. Can you recall an exam or a lecture during which you had
trouble concentrating because of something that had happened in your life?
What was causing your distraction (a breakup with a lover, a death of a loved
one, other unexpected joyous or sad news)?

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36 Health Communication for Health Care Professionals

biopsy shows that lump is a cancer??what would you hypothesize occurs at
that moment in the patient?s consciousness? Would it be surprising to learn that
for many people the word cancer has terrifying connotations (relational meaning,
e.g., that?s what killed grandma, or I won?t see my son get married) in addition to
the denotative (dictionary) realities that overwhelm the brain?s ability to process
incoming information?

In interpersonal communication, verbalized messages generally have
two distinct types of meaning?denotative and connotative. The deno-
tative meaning is literally the dictionary definition, cancer is a disease in
which cells divide abnormally and can destroy other cells and/or organs.
However, the connotative meaning of a message is much more personal,
abstract, and/or subjective. So to one person cancer might have a con-
notative meaning of death, that?s what killed Aunt Helen, or long-term
sickness from the chemotherapy. The connotative meaning often has lit-
tle to do with the denotative meaning?it is much more of an emotional
response based on a person?s knowledge, experiences, hearsay, or myth.
Thus, a provider may tell a patient that his or her breast tumor is a stage-
zero carcinoma, noninvasive?compared to more advanced stages, this
would be the best possible news for a patient. However, if the patient?s
connotative interpretation of the message is terminal cancer, it is highly
unlikely that the patient will hear little if any of the information the provider
attempts to communicate about the disease, treatment plans, or prognosis. In
this context, the connotative meaning and the patient?s emotional response
have created so much noise in the interaction that she or he will not be able
to process effectively the rest of the provider?s information.

Reflection 3.6. If you are delivering potentially emotionally charged news to
a patient and/or family member, how might you try to overcome that person?s
connotative response and obstructive noise in the interaction?

Once we r