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Journal of Medicine and Life Vol. 11, Issue 2, April-June 2018, pp.


Interpersonal communication in healthcare

Chichirez CM, Purcărea VL
Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

Correspondence: Cristina - Mihaela Chichirez

PhD Assistant, Department of Marketing and Medical Technology,
Carol Davila University of Medicine and Pharmacy, Bucharest
8 Eroilor Sanitari Boulevard, 050474, Bucharest, Romania
Phone: 0742814902, E-mail:

Received: May 14th, 2018 – Accepted: June 8th, 2018

Taking into account that the medical practice and health systems have evolved considerably nowadays, medical establishments
require the implementation of marketing guidelines to help maximize performance, with beneficial effects from the social, economic,
and medical point of view, to differentiate from competitors.
Communication is a fundamental clinical skill that, if performed competently and efficiently, facilitates the establishment of a
relationship of trust between the medical staff and the patient-customer, a truly therapeutic alliance.
In addition to the medical personnel’s competence and the facilities at the doctor’s disposal, the willingness manifested during
consultation, kindness, openness and attention are offered to patients-customers. The way medical personnel responds to their
needs and requests is an element that boosts performance, contributing to an increase in the prestige of the medical unit and the
growing interest of patients-customers in it.
Keywords: skills, communication, marketing, health

Health services’ marketing includes activities information and of meanings between persons in a given
carried out for the purpose of development, placement, social situation”. In the author’s opinion, “the
pricing, or promotion of medical services. Communication communication cannot be conceived as a simple process
is a very important component of the marketing mix. It is of transmission, based on interaction, being always a
the instrument through which an entity participates in the transition between speakers: issuance and reception are
exchange of information with the various components of simultaneous, the broadcaster being at the same time
the business environment, informs about their presence broadcaster and receiver and firstly broadcaster and
and the services offered, to create a favorable attitude receiver (the mutual is also valid)”. In his work “Language
and stimulate consumers to purchase services [1]. as a means of social power”, Blakar [6] emphasizes that
Organizations that provide health services, medical “the broadcaster is a creator who, through his message,
personnel (doctors and nurses) and auxiliaries (nurses, provides a whole set of information with respect to his
administrative staff, security guards) are a distinctive own person, to his vision of the object of communication
element of the marketing mix, adding value in healthcare and the social situation he wishes and perceives, which
through the way they interact with customers. Besides the will be perceived, interpreted and evaluated by the
training of medical staff and medical advancements in the interlocutor, causing reactions, commitment and blocking
field of diagnosis and treatment, the human component is
them”. Certo Samuel [7] recommends the receiver “to
a very important factor, over 40% of the therapy's success
always remain open in relation to people who
being provided by the patient-doctor relationship [2].
communicate and be careful not to convey any negative
In health, the tools of the communicational mix
attitude through their communication behavior” and, as
are based on an interpersonal communication.
receivers, they should try to take into consideration the
Interpersonal (inter-human) communication was the first
value of the message that they receive, without taking into
human spiritual tool of the socialization process [3] and is
account attitudes toward the source. Otherwise, many
defined by Floyd [4] as being the communication that
valuable ideas will be lost if they allow messages they
occurs between two people in the context of their
receive to be influenced by personal feelings.
relationship and that, as it evolves, helps to negotiate and
It should be considered that medical system
define the relationship. In his work “The psychology of
communication takes place in an environment that is
communication. Theories and methods”, Jean-Claude
complex, where favorable and adverse factors coexist
Abric [5] defines communication as “the ensemble of and continuously exchange places and importance. In
processes through which it carries out exchanges of
Journal of Medicine and Life Vol. 11, Issue 2, April-June 2018

medicine, communication has many forms and can be disease is a scientific and objective problem, for the
seen in various situations, the most important of them patient it is an emotional and subjective problem [9].
undoubtedly being that between patient-doctor, which Thus, the doctor-patient relationship becomes a role, an
provides much of the data necessary for the asymmetric and consensual relationship, the doctor
establishment of the diagnosis. Interpersonal having a position of superiority, being the active element
communication is born through the combination of verbal seeking a solution for the patient suffering from a disease,
forms (an oral and written language), nonverbal (gestures, with the patient being the passive element that recognizes
mimics, posture, movement, appearance) and paraverbal the authority of the doctor.
forms (by voice attributes accompanying the word, such Depending on the degree of involvement of each
as intonation, the inflection of voice, tone, rhythm, verbal part, Talcott Parsons [10] distinguishes between three
flow). It can be influenced by a number of factors [8]: situations in the doctor-patient relationship:
 the degree of closeness or spatial proximity;  activity-passivity, in which the doctor is active
 the limits and the extent of physical contact and the patient is passive;
in these relationships;  managing-cooperation, in which the patient
 the friendly or authoritative style of follows the medical advice;
communication;  mutual participation, in which the doctor
 the exchange of glances that form visual guides the patients through helping
communication; themselves.
 the volume and pace of the interactions; George Ionescu [11] specifies that it is necessary
 the dynamics of reciprocal self-development. to rebalance the doctor-patient relationship and to
Taking into consideration the importance of the establish a communion through a mutual effort of
information content of patient-doctor communication (the understanding. Thus, the doctor will have to understand
diagnostic process, treatment), the emphasis is more on the subjective condition of the person in front of them and
verbal communication in the medical system. Non-verbal treat the patient regardless of their state, as an existence
and paraverbal forms are important from the perspective with a high degree of subjectivity. In turn, the patient will
of their emotional effect and reliable capital formation and have to understand the meaning of the therapeutic act, to
sympathy that must exist between the two sides, these accept it with conviction and accept its efficiency and
forms being devoid of semantic and logical values. usefulness.
In their works, Cosman and Tudose emphasize Under the given circumstances, the relationship
the elements of specificity of communication in medicine. between the two parts must, in time, become a special
In the healthcare system, the relationship between the and true one, because the glue is a disease, which
two parts, medical personnel-patient, is much more determines a particular behavior. The way each part will
complex, involving a higher-level therapeutic play their role can create the premises for a satisfactory
communication of the existential type through the basal and efficient relationship, or for a suspicious, frustrating
level of the therapeutic level. The higher-level therapeutic and disappointing one [12]. Communication facilitates the
communication of the existential type is involved in establishment of a doctor-patient trust relationship, a real
medical communication because the medical act therapeutic alliance, with a purpose of improving the
interferes with the patient's destiny, connected in turn by health status of the patient and the doctor's prestige,
elements of uncertainty and individual instability [9]. generally grown in the private and medical unit.
On the other hand, the position of the two entities, Another feature of the communication within the
medical personnel-patient respectively is different and doctor-patient relationship is the fact that this relationship
unequal. This relationship is established between is direct, being carried out face to face, without the need
members of two distinct social groups in terms of their of an intermediary and a meaningless formalism. The
prestige, power, and guidelines. Thus, the doctor has an patient comes to the doctor with the hope that he will be
extremely high status, given the level of abstract understood and that his suffering will relieved, that the
information and specialized orientation towards the doctor will be competent and will deal with his personal
profession his full authority and monopoly being admitted. health. Between the two, there is a continuous exchange
The social role of the patient legitimizes its temporary and of information, which will lead to the achievement of the
permanent vulnerability, being forced to ask for support, objectives proposed and to finding out some answers on
assuming the doctor's inability to solve the health the state of the disease and its evaluation, the therapy
problem. In this situation, the patient is the most proposed for its elimination and practical intervention
disadvantaged person, being under the influence of procedures. This type of connection provides a real
physical and mental suffering, feeling the disease as a physical power over the medical team and the patient's
source of uncertainty and insecurity, while the doctor is psyche. [13].
seen as a person with multiple qualities, full of energy and Studies in the medical services domain noted
sometimes with magical powers. If, for the former, the that interactions between patients and healthcare
professionals affect both patients' satisfaction and

Journal of Medicine and Life Vol. 11, Issue 2, April-June 2018

perceived quality of the medical services that they At the same time, the listening must be
receive, and can contribute to a better performance of the responsive (easy to pass over disturbing situations and
medical unit [2, 14]. treat the troublesome assertions of the speaker
Communication in the medical act is an active objectively) and involve some criticism (exaggerated
process of transmission and reception of information, and, tolerance towards the speaker will generate a form of
at least one of the partners of communication must have dishonesty which will adversely affect the relationship).
active listening skills, understanding of the message, and In achieving effective communication, the
answering some questions for interpretation of non-verbal medical staff must demonstrate availability towards
language, motivating the speaker to support the patients - giving them some time to be scheduled and
conversation [15]. attended to according to the objectives and priorities, with
In the medical domain, communication the maximum performance. The availability displayed by
represents a fundamental clinical skill that involves the the doctor during the consultation, the openness,
establishment of the therapeutic relationship, attentiveness and helpfulness of the staff toward the
understanding the patient's perspective, exploring patient and his family members are considered to be
thoughts and emotions, and guiding them towards intrinsic attributes for any medical service supplying
improving their health. The quality of the information establishment and they must be maintained at such a
obtained by the doctor during consultations is closely high level of performance to differentiate them from other
linked to the communication skills of the doctor and the units [21].
patient. In literature, it is mentioned that the listening, The speaker expects a verbal message to
explaining, and empathizing skills of the clinician can provide a solution to an uncertainty or to confirm an
have a profound effect on the patient’s health status and expectation. This message must be accurate, fair, and
functioning, as well as on their satisfaction regarding appropriate to the situation of communication, informative,
health care in the medical establishment [16, 17]. clear and prompt, respectful, without being unnecessarily
In the communication with the patient, listening formal, and without forgetting that the tone of voice
and time (availability) are elements that must maintain matters [19]. Thus, any information offered to the patient
attention to the speaker, regardless of the affective status, removes a certain degree of uncertainty, and clarity is an
mode of cognitive operation. “Knowing to listen” is the first example of a healthy way of thinking, as well as a proof of
rule of the dialogue [18]. A number of rules have to be respect and a way to assume responsibility. Tangled and
met for the listening to be efficient and profitable for the confusing answers affect the relationship. Located in front
doctors. It needs to be active, total, empathic, receptive of the patient, the doctor aims to define the disease and to
and with a certain criticism [19]. organize all the stages of the establishment of diagnosis
First, the listening must be active, which involves and treatment. The oscillation, hesitation, or excessive
besides mental participation (attention and concentration) delay in offering a solution has a negative influence on
also a physical mobilization. For example, a too relaxed their relationship, the reaction being an essential condition
body posture makes memorizing and understanding of its effectiveness.
difficult, while relatively uncomfortable positions generate The establishment of the diagnosis and
a vigilant status propitious for good listening. treatment, even though it remains the main purpose of the
At the same time, listening must be total, doctor-patient relationship, must be realized according to
meaning that in addition to receiving and understanding the patient’s need to be informed about items
the verbal message, particular attention must be given to complementary to those of clinical importance, but from a
the non-verbal component (gesture signals). Thus, if the medical perspective. If the patient is misinformed, they will
two partners of dialogue are positioned at the same level be uncooperative, confused, dissatisfied, the context in
they will communicate better. In a dialogue, it is advisable which any medical act becomes stressful [22].
to adopt an open, patient, and calm attitude amongst the Communication with the patient must be suitable to their
conversation partners. Eye contact must be maintained, status, insight and possibilities associated with elements
but not unnatural. Facial expression must be monitored so of support of a positive relationship. The acquirement of
that the patient does not feel concerned, frustrated, or strong communication skills, necessary for the purpose of
unmotivated. The listener must be empathic. Starting with establishing real specialized therapeutic alliances,
self-awareness and continuing with other sightings, this requires profound medical knowledge to diagnose and
cognitive and affective process allows the doctor to treat disease, the ability to gather information from the
understand what the patient thinks and feels, to patient, interpersonal skills to respond to the feelings and
encourage them to express themselves openly and concerns of the patient and the ability to create and
unrestrained. Empathy involves not just a mere sympathy maintain a therapeutic relationship as a concrete offer of
or intuition of the patient's emotions, but identification with information and medical education [15].
their feelings, with their biological and psychological The professional competence of the doctor is
status [20]. demonstrated through in depth theoretical and practical

Journal of Medicine and Life Vol. 11, Issue 2, April-June 2018

knowledge and applicative ability in a creative activity of 4. Let your fatigue be enlightened by faith and love.
individualized, personalized, and human care. 5. Never humiliate the sick, who is so humiliated by
The good philosophical training, psychological their illness.
and pedagogical approaches require that the doctor be 6. Never forget that the secret entrusted to you
able to analyze the multitude of information and feelings, about a disease is something holy that cannot be
mindsets and reactions so that they can diagnose not only betrayed, offered to another person.
the health state but also the patient's typology level, their 7. Do not see in your patients' worries a burden, a
cultural and mental state. At the same time, they must chore.
reveal the ability to recognize subtle ways through which 8. Never show incongruence at the success of the
patients are trying to communicate their issues and treatment on a sick person.
concerns and actively investigate the ideas and their 9. Not only benevolence but also science is
opinions on the health status. The doctor’s required in the care of the sick.
communication skills must continuously be learned and 10. Do not discuss medical prescriptions with the
improved. patient and never contradict them. You take
In the context of the communication relationship away their confidence in medicine; you destroy
between the medical staff and the patient-customer, their hope of healing.
compliance with professional ethics is required, the two The efficiency of communication is dependent on
parts being owed to their status of collaborators and not a what type of relationship is established between the two
distinction between the vanquished and the victors. In the partners, and the type of relationship, in turn, depends on
first half of the twentieth century, the Spanish professor B. the personality of each one of them [5]. The doctors
Masci [23] developed the most elevated moral, medical determine their personality traits, having the freedom to
document with the rules of medical ethics and deontology, choose their way of action so that the relationship with the
which will always be respected and that sums up as it patient is beneficial for both sides. In the healthcare
follows: system, communication becomes increasingly more of a
1. Honor your patient regardless of age. therapeutic technique, a clinical skill that creates
2. Offer the same gratitude and attention to the fundamental relationships and that can provide benefits to
poor as to the rich. those involved, considerations for which the appropriation
3. Respect your noble mission, beginning with your of high communicative skills must be a priority for health
very own person. professionals.


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