Post 8: Channels of communication

Emotional and Cognition channels

In the past post, we discussed that expressing empathy is a key to many of the conversations. We also discussed how one can express empathy (with our presence, our actions, and our words). The question is how do you know when to consider that you need to use these skills?

This entire post can be summarized in the image above. In all of our conversations, whether they are with our patients, friends and family or in work environment, we communicate in at least two channels: Cognitive and Emotional channels.

When one person is tuned into a channel, speaking in another channel will not facilitate any communication. In medicine, we have the opportunity and the responsibility to be on the right channel. In most instances, medical professionals are on the cognitive channel “trying” to communicate facts while the patient is on the emotional channel.

So, how do you know you are on the wrong channel? How do you know that there is “inadequate communication?”

1. The conversation keeps going in circles

2. The patient is not paying attention (they have looked away, they are in tears)

3. The patient or family keeps asking the same question

4. You dread thinking about having the conversation

So if you are trying to communicate facts, you must change the channel you are communicating on, switch to the empathy channel, and help patients emote. Once they emote, then we can continue with discussing facts (cognitive channel).

In the rare case that you are trying to communicate emotions (trying to be empathic) then consider changing to providing information.

Here is an example:

Doctor: The CT shows that cancer has progressed. So let’s talk about the next steps. We can do a different type of chemotherapy.

Patient: What? Cancer is worse?

Doctor: Yes, CT shows that it is worse. The last chemo stopped working but we can start this new therapy.

Patient: My cancer is worse? [tearful and looking away]

—

The oncologist can continue to talk about the next line of therapy, the side effects and the possible benefits, can give an extensive pharmacological lecture on why it is the best thing for the patient. The patient is not really hearing any of it.

So what can the oncologist do? Address the emotion. Express empathy. By staying silent, by naming the emotion (‘I sense that this result is really upsetting you’), or by exploring statement (‘tell me what is going through your mind’).

While the example above is in a medical encounter, the skills highlighted above and the channels of communication can (and should) be used in all of our communications: with our family and friends, colleagues, and our team members including trainees.

I would love to hear your thoughts on how you think about channels of communication and how do you recognize the need to change the channel?

Biren Saraiya MD