According to Cameron (2007), ‘there is no such thing as a neutral language – but in any given time and place, some ways of talking will be more powerful and more consequential than others.’ This was recognised in 1948 when Morgan (1954) contended that for want of a common speech, jargon trapped specialists within their own areas of knowledge, ‘… and knowledge itself has grown farther and farther away from language.’
Jargon is an effective means of smuggling rubbish beneath the critical radar of unsuspecting readers and listeners. This was confirmed by Cyr and Lanthier (2007) who wrote a superbly written piece of nonsense on abolishing the law of gravity, and which demonstrated the authors' belief that ‘… using technological, statistical and medical jargon gives us the opportunity to defy the laws of physics, mathematics and medicine.’
How do pharmacists measure up when it comes to communicating with patients? My only experience of this was more than a decade ago, when my elderly dad and I attended a consultation with a hospital pharmacist. Her task was to explain to my dad why he was being given warfarin, how it would work and how the dose would be determined. I listened to the pharmacist but looked at my dad and I could tell that he could understand. I was impressed by the pharmacist's use of everyday language, the absence of jargon and, crucially … her patience and willingness to go back over ground that she had already covered to satisfy herself that my dad had a firm grasp of the points she was making.
So, I was interested to read an Australian study by Chevalier et al (2018), whose objective was to explore hospital pharmacists' and patients' views about what constitutes effective communication exchanges between pharmacists and patients. Twelve pharmacists each engaged four patients for a total of 48 pharmacist-patient conversations (resulting in 48 separate interviews with pharmacists and patients), with the overall goal of enhancing patients' confidence in their medication management at home. Themes included shared colloquialisms/slang, well-explained information, engagement, rapport, and empowerment. Significantly, ‘patients emphasised the need for well-explained information and reassurance from pharmacists' (Chevalier et al, 2018), which is what my dad had received. Further, while ‘patients focussed mainly on pharmacists' delivery of medication information and interpersonal behaviours, pharmacists' themes included building rapport, but also emphasised patients' understanding of their medications and their level of engagement as indicators of patients' confidence in self-managing their therapy.’
And from the results of the first national survey of communication skills training in UK Schools of Pharmacy, undertaken by Jalal et al (2018), it was found that newer graduates have received more communication training compared to older graduates. While highlighting the importance of person-centred care and building a partnership between the patient and healthcare professional, Jalal et al (2018) acknowledge that a professional relationship which is based on trust and mutual decision-making has created challenges for pharmacists: ‘As traditional models of medication provision are superseded, pharmacists have to develop innovative communication and consultation strategies, adapt new techniques, and reconfigure their service provision.’ One approach highlighted by Jalal et al (2018) is motivational interviewing (MI), which is based on collaboration, ‘drawing out’ the patient's ideas about change, and emphasizing the patient's autonomy: ‘In MI the interviewer should express empathy through reflective listening and develop discrepancy between clients' goals or values and their current behaviour’ (Jalal et al, 2018).
When it comes to communication with fellow healthcare professionals, Coomber et al (2018) note that effective communication enhances patient care, but communication breakdown can result in adverse patient outcomes and greater healthcare expenditure. In a study undertaken in four public hospitals in Australia, Coomber et al (2018) explored the communication methods between 257 doctors and 74 pharmacists in clinical settings. They found that more than 95% of doctors and pharmacists combined used face-to-face conversations and phone calls to communicate with each other, 70% used a medication management plan, and 62% used progress notes. However, Coomber et al (2018) point out that oral communication can pose challenges with recall and comprehension and suggest that ‘communication receipt and response functionality in electronic medication and record management systems may improve communication.’
Despite myriad means of mass communication at our fingertips, the growth of specialist knowledge risks impassable gulfs opening between healthcare professionals and their patients. My dad's pharmacist was aware of the danger … are you?