The Art of Communication



Author: Raymond H. Hull, Ph.D.

Conventional wisdom states that nurses are the most proficient communicators of all professionals within the health sciences. Why is that so? In working within schools and colleges of health professions, both administratively and as a faculty member for more than 28 years—and being closely associated with faculty, students and the curricula of schools of nursing, I understand why this may be true.

Students of nursing are taught to be technically skilled, but also to be nurturing providers of health services. They are taught the art of communication with patients, and counseling is an important part of their curricula and practicum experiences. In truth, nursing students are carefully selected for admission based not only on their grade point average, recommendations, pre-nursing examination scores, and other such measures. In the interview process as a part of their application to nursing programs, they are selected on the basis of their skills in interpersonal communication. They are to display a caring, nurturing personality.

Where does that leave the profession of audiology? When I am asked to present at workshops on “The Art of Communication in Professional Practice” within the U.S. and throughout other countries, I always ask the audience, “How many of you during your preparatory programs have had coursework on how to communicate with your patients?” I have become accustomed to seeing no hands raised among those in the audience. I also ask the question, “How many of you have had good coursework and/or practicum experiences in counseling during your undergraduate or graduate education?” A few hands are usually raised, but I do not ask about the type and degree of preparation.

This is a sad commentary for our field, particularly when we are members of an important health services profession that engages in one-on-one interpersonal communication with our patients and their family members on a daily basis. Counseling and interpersonal communication are critically important parts of what we do each day, yet our graduate programs may offer a course in counseling that students only take because it is a requirement for graduation. Our preparatory programs generally concentrate on a wide array of diagnostics, making recommendations for referral, the fitting and dispensing of hearing aids and other assistive listening devices, balance assessments, tinnitus assessments, and others, but usually without preparation in the “art of communication” with our patients.
The Art of Communication in Professional Practice

I am often dismayed when I attend presentations at various state and national conferences by the inability of members of the field of communication disorders to speak before an audience. Public speaking is an art form, if it is done well. It is something to be taken seriously, so that speakers don’t embarrass themselves or their colleagues. Successful communication is an art. It is an art, but it is also a science. There are so many intricate components that are involved in interpersonal communication. On the other hand, the many components of successful interpersonal communication can be learned. That is the purpose of this article, to instruct audiologists on the many elements of this oftentimes misunderstood and nearly mystical system of purely human interaction, called verbal and nonverbal communication.

Why Is It Important to Study Interpersonal Communication?
Much of what we do in our day-to-day interactions with patients, colleagues, friends, significant others and the public, involves communication in one form or another. As we work to be successful in our practices and our personal relationships, or as we strive for advancement in any organizational structure, it is imperative that we become familiar with the processes involved in effective interpersonal communication and its potential impact on all that we do. Importantly, interpersonal communication goes beyond talking. Much beyond simply talking, interpersonal communication includes the creation of an “atmosphere” of communication that results in positive and constructive interaction with others.

The better we are in this aspect of our life, the more successful we will become. All else being equal, it is often the basis upon which we choose our physician, our dentist, our favorite place to eat, the family member everyone goes to when there is a problem, our place of worship, the politicians we vote for, our child’s babysitter, and our audiologist!

We are drawn to those who make us feel most comfortable, who communicate with us in a positive and supportive manner, who seem to understand our problems, those we trust, and who we would go to in times of difficulty. It is, in the end, what separates those who are successful in their life and in their work, from those who are less successful. It signifies who we are, or who we want to be. So, what does it involve?

Interpersonal communication not only involves what we say, but very importantly what we do in our communicative interactions with others. What we do may involve our manner of dress, body language, gestures, manner of eye contact, and personal grooming. In many instances, the non-verbal aspects of communication are not only important, but can be even more important than what we say. The intended result of those verbal and non-verbal interactions may be a change in attitudes, behaviors, or beliefs of the person with whom we are communicating. Or, perhaps it can result in the development of constructive resolution of difficulties through constructive problem-solving when, otherwise, there may have been conflict. But, the characteristics of unpredictability and the inherent complexities of interpersonal communication make it particularly challenging.

Why Do Some People Seem To Have Difficulty Communicating Well With Others?
For some people, the complexities that are inherent in interpersonal communication are the catalyst for the difficulties that they experience in their ability to communicate effectively with others. Why is that? It is because some people may not do well in attending to all of the complex events that can occur during communicative exchanges, or they have not been formally or informally prepared in this complex aspect of human behavior. Their personality or behaviors may be getting in the way of positive and constructive interpersonal interaction with others. During their earlier years, they may have been exposed to poor models of communication and have not learned effective communication strategies

As I tell my patients who have difficulty hearing, “Whether we want to or not, we live in a world of people who do not communicate well.” I continue by saying, “But, we also live in a world of people who do not possess the knowledge or skill to be good communicators!” Their communication habits may be less than desirable. I am witness to too many people who speak with such speed that most listeners’ central nervous systems simply cannot keep up with all of the words that are being uttered. Therefore, it is difficult to understand what they are saying, or, their ability to respond to us in a positive and constructive manner when we are attempting to communicate with them is lacking. Perhaps they do not attend to us when we are speaking to them, or have poor eye contact, or less than desirable body language as they interact with us. Perhaps their manner of standing or sitting while communicating with us is distracting, or they do not exhibit the poise and attentiveness that assures us that they are actively listening to what we are saying.

However, in order to be successful in our daily interactions with those with whom we interact, whether it be in matters of love, family, business, public speaking engagements, or even political campaigns, it is imperative that we learn how to effectively engage in this complex but important aspect of our life that is called “human communication”.

Does It Mean That I’m A Poor Communicator If I Don’t Communicate Perfectly?
Effective interpersonal communication does not mean always communicating perfectly. I have never met anyone who communicates perfectly. Rather it means being able to constructively create and convey appropriate responses to those with whom we are communicating, and to perhaps identify and explain creative solutions that are acceptable to them. It means motivating others to positive change through direct verbal interaction, non-verbal interaction (what we don’t say), our body language, and through a positive atmosphere of communication that we create.

I like the phrase, “…positive atmosphere of communication.” The reason I like it is that it provides a framework for communication that is constructive and successful. Rather than communicating perfectly, I like to think in terms of communicating constructively—or meaningfully. When we communicate constructively, we are more apt to be communicating in a meaningful way.

So, In The End, What Is It?
Recently I read a well written treatise on communication found on skillsyouneed.com, which is part of a UK Web Archive (2010). It said in part, “…interpersonal communication is the process by which people exchange information and feelings through verbal and non-verbal messages.” That is a very straight forward definition.The authors continue, “Interpersonal communication is not only about what is actually said – the words and language used - but how it is said, and the non-verbal messages sent through tone of voice, facial expressions, gestures and body language.” Again, very straightforward!

The authors explain that when two or more people are in the same place and are aware of each other’s presence, then one way or another, communication is taking place, no matter how subtle or unintentional, or how poorly it is being handled.

Using speech is not necessary. Without speech, an observer may be using cues of posture, facial expression, and dress to form an impression of the other’s role, emotional state, personality and/or intentions. Although no communication may be intended, people receive messages through such forms of non-verbal behavior.
Basic Principles of Interpersonal Communication

These principles are generally quite simple, but they often take a lifetime to master.

Interpersonal Communication is Not Optional
We may, at times, try not to communicate; but not communicating is certainly not an option.  In fact, the harder we try not to communicate, the more we are communicating. By not communicating we are communicating something, perhaps that we are shy, perhaps that we are angry or sulking, perhaps that we are too busy to talk.  Ignoring somebody is communicating with them. We may not tell them we are ignoring them, but through non-verbal communication we make that apparent.

Often, non-verbal communication can be more powerful than the words that we use.  Our body posture, positioning and eye-contact (or lack of it) is all important. Even the smallest and most subtle of mannerisms communicate with others.

Communication Is Irreversible
Interpersonal communication is irreversible. Perhaps we can wish we had not said something. We feel a sense of regret and apologize for something we said, but we can’t take it back. We often behave and therefore communicate to others based on previous communication encounters, but these encounters may or may not be appropriate points of reference. Because of these stereotypes, when we communicate with people we can carry with us certain preconceptions of what the other person is thinking or how they are likely to behave. We may also have ideas about the outcome of the conversation before it even begins. 

We need to start all interpersonal communication with an open mind; listen to what is being said rather than hearing what we expect to hear.  As a result, we are less likely to be misunderstood or say things that we later regret.

Endless Complexity
No form of communication is simple. There are many reasons why communication is taking place, how it is taking place and how messages are being broadcasted and received. Variables in communication, such as language, environment and distraction, as well as the individuals involved in communicating all have an effect on how messages are sent, received and interpreted.  Interpersonal communication involves an extremely complex mixture of human behaviors that are sometimes difficult to understand, or at the least, to manage.

When we communicate verbally, we swap words - words that have, even subtly, different meanings to different people in different contexts. We can communicate the same thing to several different individuals, and each person may have a different understanding or interpretation of the message.

At any point in communication, any misunderstanding, regardless of how small it may seem, will have an effect on the message that is being received.
The Context of Communication 

Communication happens for a reason. To help avoid misunderstandings, and therefore communicate more effectively, it is important that the context of the communication is understood by all.  Why is the communication happening?  It is important that participants are on the same ‘wavelength’ so that they understand why the communication is occurring.  We may think that “why” is clearly evident, but it may not be to all who are involved. There are things that can get in the way, including:

Timing
Timing is fundamental to successful communication. In addition to considering a suitable time to hold a conversation, you should make sure that there is enough time to cover all that is needed, including time to clarify and negotiate.  For example, talking to employees about a strategic decision five minutes before they were planning to leave the office for the day would probably not be as successful as having the same conversation the following morning.

Location
It should be fairly obvious that communication is going to be less effective if it is conducted in a noisy, uncomfortable or busy place. Such places have many distractions and often a lack of privacy. Depending on the reason for the conversation, a quieter environment may be appropriate, or perhaps for a more casual conversation, during lunchtime or a relaxing hour over a late afternoon cocktail at a local club may even be appropriate.

Purpose
We can develop misconceptions and false assumptions regarding communication and why it is taking place. When communicating, we may assume that all parties know what we are talking about. We may even think that we know the other person’s views and opinions regarding the purpose of the conversation. And, most disturbing to others involved in the conversation, we know that our opinion is right, and theirs is wrong. These can all be detrimental to constructive conversations in meetings, or even a street-side conversation, and must be avoided at all costs.

All of the elements above play a role in communication, and each of them can be a detriment or a boon to its success.    
Raymond H. Hull, PhD, CCC-A/SP, FASHA, FAAA is Professor of Communication Sciences and Disorders and Audiology/Neurosciences Coordinator, Doctor of Audiology Program, at Wichita State University. He can be contacted at ray.hull@wichita.edu.

Dr. Hull and Jim Stovall have a forthcoming book entitled “The Art of Communication—Your Competitive Edge.”