Application of the communication models in the health care system.

Communication is a very important aspect of the health care system. Such is its importance
that it was my first topic of study during my clinical part of my medical studies. History
talking has been and is still one of the most important part of communication with patients.
Communication is a vital part of the health care system. Perhaps, the health care is one the
services whereby all the models of communication have their importance. It is only
segregating the services provided by the healthcare services bit by bit that we can see how the
different models of communication: linear, interactive and transactional are used in the health
care system. When we speak about use of communication models used in the health system,
only the transactional model seems to prop in our minds.
Let us start with the first of the communication models- the linear model or Shannon and
Weaver model of communication. This model of communication plays an integral part in the
preventive (prophylactic) and educative part of the primary health care system (first contact
of patient with the health care system). Every day, few minutes of the prime time on
television is dedicated to health promotion purposes. Videos on exercise and dieting, how to
prevent the propagation on infective diseases by keep our neighbourhood clean and prevent
accumulation of water to stop proliferation of mosquitoes is played on television. Similarly,
radio another form of linear communication is used to inform people about the dangers of
smoking. Alcohol abuse, drug addiction and sedentary life style.
Posters another form of linear communication are used to inform patient about:

Dangers of smoking,

Signs and symptoms of diabetes mellitus,

Complications of diabetes mellitus,

Importance of exercise in the prevention of diseases like diabetes mellitus,

hypertension, and ischaemic heart disease

Balanced diet

Prevention of sexually transmitted diseases

Pamphlets still another form of linear communication are widely used by the Ministry of
Health and Quality of life. They are used to sensitive the general population about a variety
of things starting from:
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Diet for diabetic patients

How to prevent proliferation of mosquitoes

Hand washing techniques

Use of contraception methods

The Ministry of Health also uses the linear method of communication to inform people about
blood donations, screening programs for non-communicable disease, screening for HIV etc.
The health system involves lots of other services except the first contact of the patient with
the system( contact with nurses and doctors). The laboratory services and radiological
services are linear form of communication offered by the health services. The laboratory
technician only works on the investigations requested and transmit the messages but he
cannot inform the patient if something is wrong. Similarly, the radiologist can only detect any
abnormality on the film of the patient but he cannot inform the patient about the anomaly.
The interactive model of communication is one whereby there is a feedback and both the
sender and receiver can act as receiver or sender. Here the interaction is taken into more
consideration than the message itself. There are many instances in the health service whereby
this model of communication is used. Some of them are described below:
1. If a patient is sent for a radiography, he does come out of the department but he can
not interpret it. He either has to go back to the doctor who requested it again or has to
wait for the radiologist to report the film.
2. According to the interactive model of communication, both the patient and medical
practitioner must be on the same cultural or linguistic level for proper communication
to take place. Well, I am posted at Rodrigues Island at present for my tour of visit and
I came across such situation. During my first days here, a patients told me: mo tifi
content malad which literally means my daughter likes to be sick. To this I replied
Kifer ou tifi content malad which means why your daughter likes to get sick. What
the lady wanted to tell me was that her daughter gets ill often which I interpreted as
described earlier. Use of the same language does not imply that the patient and doctor
understand the same thing by the same word.
3. Another common situation is when patients using Bhojpuri language or creole
language come to hospital for treatment and come across someone who does not
understand it, especially our foreign colleagues.

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4. Another instance of interactive communication in the health service is when a patient

goes to the laboratory for investigations and he or she is told that she will get the
results on X date.
5. Similarly, when an inpatient who asks for a vegetarian meal gets his meal for dinner
or lunch is an example of interactive model of communication.
6. The use of technical or slang language by medical practitioner with patients is another
form of interactive model of communication because the patient does not necessarily
understand what the doctor is implying.
7. Another example of interactive model of communication is when both medical staff
and patient are using the same language but due to the educational level of the patient,
the proper message can not pass. Before a high risk surgical intervention, we must
make sure that the patient understand all the risk and consequences of a surgery by
explaining to the patient or relative about the complication which occur after the
surgery.
8. Going to the pharmacist to take medication is another form of interactive model of
communication.
9. The services at hospital level are interdependent and for a simple blood investigation
requested, a whole lot of people required. Starting from the request by the doctor
followed by the collection of specimen by the nursing staff to the delivery of the
specimen by the hospital attendant to the laboratory till the collection of results by the
attendant are interactive in nature. Watching an educative video while sitting in the
waiting room of the hospital is interactive I guess.
10. Use of emergency services SAMU on 114 where a brief summary of the patient is
taken by a nursing officer and if need arises an emergency physician speaks with the
patient or relative.
11. With advance in technology, telemedicine has come into existence and using this
technology patients can take advantages of more experienced doctors.
In the health system, there numerous instances where the model of communication is
interactive. It has widely been used in the prophylactic and preventive aspect of health.
The health system is one where communication plays a vital and essential role. The
transactional model is the one which is mostly used in the doctor patient relationship. The
doctor patient relationship is the basis of the relationship between the doctor and the patient.
The transactional method is one where people are connected through communication. This
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method is based on the fact that each of us are sender-receiver, not just a sender or receiver.
Also, this model pays emphasis on the fact that communication affects all parties. As such,
communication is a dynamic and englobes other aspects of the environment.
The doctor patient is one where both share their experiences. Initially, the physician acts as
the receiver while the patient acts as the sender. The physician actively listens to the
complaints or talk of the patient. He tries to grasp the essential aspects of the conversation
and thinks about his previous experiences from contacts with other patients or from the
medical literature. He then formulates what he needs to talk and proceeds with the
conversation. He also moulds his communication skills according to his audience or
environment. This is an example of the transactional method of communication in the health
service. As per the transactional view, elements of communication are interdependent. In
other words, each element exists in relation to the other. In face-to-face conversations, which
is usually the case between patient and doctor, doctor and nurse, nurse and patient, the
conversation is moulded according to the cultural, emotional, psychological, and ethnicity of
the recipient.
The doctor as the active listener mindfully and attentively hears what the complaint of the
patient. Sometimes, just being present physically and psychologically to listen to a patient is
all that is needed by a lonely patient. The transactional view per se is present in the most
essential aspect of the doctor patient relationship. This relationship is built upon by active
listening, mindfulness, trust and empathy which a qualities that differentiates a good
professional in the health service. The patient comes to meet the doctor when he/she is sick.
He can wait for hours for this purpose. The doctor patient relationship I believe is based on
the human touch and the transactional model of communication is the one whereby the
environmental, cultural, socio-economical aspect of both the sender and receiver is essential.
Another instance is the interaction between the nurse and the patient. This is perhaps a
partnership which is sometimes not given its due consideration. The service the nurse
provides to the patient add value to the health care services. Here also, the human touch is
important. For a patient who is admitted in a ward, who has to adapt to a new environment
and accept the fact that he/she is suffering from a particular disease, it is not easy. The
helping hand and smiling face of the nurse however can help the patient in distress. As per
the transactional nature of communication, communication depends on the involvement of a
partner and our success in communicating depends on our interaction with other. In this case,
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the success of the nurse depends on her interaction with the patients. Innumerable is the use
of transactional way of communication. Be it from the administrative point of view or from
the clinical point of view, there are many people working in the health sector and most of the
time it is the transactional model of communication that is mostly used in the healthcare
system.
The health care system is a service where communication play an essential role. It has rightly
made use of all the forms of communication for the betterment of the population it is serving.
Depending on the situation, the use of linear, interactive and transactional models of
communication has been made. Nevertheless, the core means of communication in the health
services is the transactional one.

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BIBLIOGRAPHY

Coiera E. When conversation is better than computation. J Am Med Inform

Assoc.2000;7:277-86 PubMed

Coiera E, Tombs V. Communication Behaviours in a hospital setting-an observational

study. BMJ.1998;316:673-7 PubMed

Covell DG, Uman GC, Manning PR. Information needs in officer practice: are they
being met? Ann Intern Med.1985;130:595-9

Touissant PJ, Coiera E. Supporting communication in health care. Int J Med

Inform.2005;74:779-81

http://catalogue.pearsoned.co.uk/assets/hip/gb/hip_gb_pearsonhighered/samplechapte
r/0205930662.pdf

http://www.corwin.com/upm-data/13975_Corcoran___Chapter_1.pdf

http://www.austincc.edu/colangelo/1318/lecturech1.htm

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