PROVIDER-PATIENT RELATIONSHIPS

Provider-patient relations is the study of interpersonal communication patterns and the resultant development of interpersonal relations between providers and consumers within a health-care delivery system. Both health-care providers and consumers depend on effective communication to seek and provide relevant health information in receiving and providing competent health care, and the relationships established between health-care providers and consumers have major influences on the quality of communication between these individuals.

Interpersonal Communication and Health Care

Interpersonal communication is a primary channel for information exchange for both consumers and health-care providers. For example, to diagnose health-care problems, doctors and other health-care providers depend on communication to gather relevant information from their clients about the specific symptoms these clients are experiencing. Without accurate diagnostic information, it is a hit or miss proposition to develop viable treatment strategies. Health-care treatments that are based on inaccurate or incomplete diagnostic information are unlikely to be effective. Health-care providers depend on communication to furnish consumers with information about how to carry out treatment strategies, such as the correct use of prescription drugs or therapeutic regimens.

Health-care consumers also depend on their abilities to communicate in describing their symptoms to health-care providers and in interpreting the recommendations of the health-care providers. Consumers use interpersonal communication with their health-care providers to gather relevant information about the diagnosis of their ailments, their prognosis for recuperating, the specific health-care treatment strategies that are recommended for them, and the costs and benefits of these treatments. Typically, patients have a lot of questions about health care that can only be answered if they can establish effective channels of communication with their providers.

Communication and Relationship Development

People develop interpersonal relationships to establish and maintain social agreements related to interacting with one another in cooperative and coordinated ways. The interpersonal relationship is the basic building block of social organization. People develop numerous interpersonal relationships in their personal and professional lives. These relationships range in their development from incipient (just beginning) to intimate.

All relationships are based on the development and maintenance of implicit contracts, mutually understood agreements to meet one another's (often unspoken) expectations for each other. In incipient relationships, these implicit contracts are few and are generally quite rudimentary, but as relationships develop, so do the agreed upon mutual expectations (i.e., the implicit contracts).

It takes a good deal more time and effort to develop intimate interpersonal relationships because of the many implicit contracts that govern how relational partners are expected to interact and cooperate. In intimate relationships, people learn over time to fulfill the many, often subtle, expectations they have for each other. Through the norm of reciprocity, which encourages individuals to respond in kind to one another, relational partners are encouraged to reciprocate with one another when their expectations are met. As more expectations are met and implicit contracts are established, the intimacy of the interpersonal relationship grows. This is known as the process of relationship development. When individuals fail to meet relational expectations, the norm of reciprocity encourages reciprocal violations of expectations, leading to a process of relationship deterioration.

Furthermore, individual expectations and cultural norms for role performances are continually changing, necessitating periodic updates in implicit contracts. To maintain effective interpersonal relationships, then, people must use interpersonal communication to continually identify their relational partners' different and emergent expectations, to let relational partners know that they intend to meet those expectations, and to share their expectations with the relational partners.

Relationship Development and Health-Care Delivery

Interpersonal relationships are central to providing health care. Consumers and providers must establish clear implicit contracts for coordinating activities in the health-care enterprise. Interdependent health-care provides, as well as support staff within the health-care system, also depend on the development of cooperative relationships.

It is critically important to develop and maintain effective health-care relationships between the many interrelated participants in the modern health-care system. However, relational development depends largely on the levels of communication competence that are engendered by health-care participants. Competence in relational health communication requires the ability to listen empathically, be sensitive to verbal and non-verbal cues, encode and decode messages, and manage interactions.

Complex health-care situations demand high levels of relational communication competence between providers and consumers if they are going to accomplish the goals of health communication, such as increased interpersonal satisfaction, therapeutic communication outcomes, cooperation between providers and consumers, social support, and health education. Insufficient competence at relational communication will surely limit fulfillment of these important health-care goals.

One of the most important competencies related to relational communication in the modern health-care setting is the ability to be sensitive to the two basic types of interpersonal communication. Personal communication (i.e., communication that demonstrates respect for others) is a humanizing form of interaction that encourages relationship development and cooperation, while object communication (i.e., communication that demonstrates disrespect for others) is dehumanizing, leads to relationship deterioration, and undermines interpersonal cooperation. There is far too much object communication in modern health care, and participants in the health-care system should work toward treating one another with respect to promote cooperation and relationship development.

For example, object communication can occur when a health-care provider conveys object-oriented messages to a client by spending more time looking at a patient's chart than providing direct eye contact during interviews. Providers can also express object communication by dominating the conversation during an interview. Lack of eye contact and failure to encourage participation are likely to suggest that the provider does not think highly of the client and believes the patient is not as important as his or her chart. Such behavior can discourage the client from speaking up during the interview and providing full and accurate information to the provider about relevant symptoms and health history. Failure to provide such information can limit the accuracy of diagnosis and the effectiveness of suggested treatments. By using a more personal interpersonal communication style that includes providing direct eye contact, engaging the client in conversation, and treating the client with warmth and respect, the provider can begin to establish an effective interpersonal relationship with the client, encourage the client to disclose relevant information, and gather pertinent data for making effective diagnostic and treatment decisions.

Patients should also be aware of the potential influences of their use of personal and object communication messages when communicating with health-care providers. It is not uncommon for patients who are in discomfort to be very demanding of their providers' time and attention, sometimes forgetting to use common courtesies (e.g., waiting their turn, speaking calmly, and using polite terms such as "please" and "thank you"). Demanding and tactless behaviors (i.e., object communication) can suggest a lack of respect for providers and may discourage providers' development of empathy and concern for patients. Expressions of courtesy and respect are more likely to encourage cooperation and concern from providers than are less civil discourse. It is a very good idea for patients to communicate in ways that will encourage cooperation and concern from their providers in order to promote the best possible health care.

Content and Relationship Messages in Health Care

Relational communication has both content and relationship dimensions; that is, every time people communicate with one another, they provide each other with both content information about conversational topics and relationship information about the nature of their relationship with one another. The relationship between the participants in the communication process affects how the message is interpreted. In a similar manner, the messages influence the development and interpretation of relationships.

Often people are so concerned about crafting the content of their messages that they neglect the monitoring and controlling of the relational aspects of their communication, especially since relational messages define the relationship being developed between the people. In fact, every time people say something to someone else they have a potential positive or negative influence on the development of the relationship with that other person. Messages that violate the cultural expectations of the recipient provide relational information that will inevitably lead to relational deterioration because these messages demonstrate a lack of respect for the relational partner. However, messages that validate the cultural expectations of the recipient enhance relationship development. Therefore, it is important for health-care participants to be aware of both the content and relationship implications of the messages they send and to monitor how these messages influence the development of cooperative healthcare relationships.

See also:Health Communication; Interpersonal Communication.

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Gary L. Kreps