The Five P’s of Communication


by David Scoville MM, R. EEG.T, CNIM

The operating room can be an acoustically chaotic environment. Oftentimes there are multiple conversations occurring simultaneously; from nursing and anesthesia staff, to the surgeons and instrument techs in the sterile field. There is the hiss and whir of countless electronic devices, from the white noise of the ventilator and patient warmer, the purr of the venous compression system, the whine of electrical cautery devices, and the wailing of pneumatic drills, etc. And through the din we are required to deliver critical, time-sensitive information promptly and clearly. The task is daunting, and miscommunication can be catastrophic. Even when a message has traveled through the noise, the means of delivery can commonly create undue stress for participants in the room.  

And this isn’t true for only the operating room. The Intensive Care Unit (ICU) experiences bursts of activity, waves of noise and flurries of staff swarming like protective bees around their patient in stressful moments.  Busy floors, families with wailing children, you name it, at some point you will be faced with the need to communicate important information in a noisy environment. 

Even in the relative calm of the clinical exam room, you have to compete with the internal noise of your patient’s thoughts and all their worries, such as anxiety over their current test, their current condition, the ever-expanding to-do list in their mind, reviewing previous conversations, media distractions, texts and e-mails, etc. No matter the setting, you are in constant competition to be heard regardless of whether the barriers are physical or mental.  

Spoken language is so innate, so second nature, that it is most often neglected. By the time we learn the formal rules of grammar in school, we have already learned them informally and use them deftly. But our voice is, for most of us, the most essential way we interact with patients and coworkers, and yet we seldom spend time to develop it. 

In the performing arts, specifically music and theater, one’s voice is one’s life blood. An actor’s career depends on his/her ability to communicate with an audience; a singer’s likewise. As such, these artists devote countless hours strengthening their vocal anatomy, perfecting their natural instrument. But many of the same techniques, if applied in some small fraction to our everyday lives, can elevate every interaction. If applied to our professional lives, these techniques can work wonders. This article seeks to bring aspects of professional vocal technique and communication to the medical professional world.  

The Five Ps of Professional Communication 

The First P: Precision  

We live in an increasingly casual society, but we work in an increasingly technical field. First and foremost, use of accurate vocabulary is paramount, both the correct medical terminology and specific language together.  And this means practicing new terminology whenever it is encountered. Spoken language is also one of the most effective ways to reinforce memory. Discussion with colleagues is crucial in order to recall terminology during stressful or critical moments. In short: If you come across something new, “Say It to Save It.” 

Being clear and considerate is a hard line to walk, but a challenge we must all accept.

A consideration when interacting with patients: Use appropriate vocabulary. Speak to their level of knowledge. This means walking a fine line between being overwhelmingly technical, and condescendingly simple. This is a hard line to walk and you won’t get it right every time but if you pay close attention to cues your patient gives you, you can sharpen this difficult and subtle skill. Remember, the way you communicate with your patients can have a significant effect on their entire experience.  

The Second P: Pacing  

Believe it or not, how fast you talk has a profound effect on not only being understood, but how you, as a professional, are perceived. If you’re rattling off something at a mile a minute, you’ll often appear nervous, jittery. If talking with patients, this can have the undesired effect of making what is for them an already stressful situation, even more so. And it also raises the chance that you’ll be misunderstood. On the other hand, excessive slow pacing will make you appear unsure, and will have the undesired effect of losing the interest of your listener. In a world of constant distractions both internal and external, holding someone’s attention is critical. In short: “Take Your Time but Hurry Up!” 

The Third P: Pronunciation  

Many of our patients are hard of hearing. Keep that in mind and say exactly what you mean.

Everyone who speaks a language has an accent. Accents add flavor and nuance to a spoken language. Influenced by where you learned the language, where you have lived and other languages you speak, accents are unavoidable. But all accents have pitfalls; too much emphasis on the unique characteristics of your accent can lead to communication breakdown for those who don’t share your particular brand of pronunciation. Overcoming your accent can be tough, but it is not impossible. And it usually simply involves energizing the muscles that shape your speech, i.e. your lips and tongue. Speech takes a lot of subtle and precise movement. I like to equate it to performing a gymnastics routine inside your face. It’s a lot of work. Accents often arise when we collectively take short cuts. The best way to overcome those shortcuts is with tongue twisters that engage the front of your face. The phrase, “The Lips the Teeth the Tip of the Tongue,” is one of my personal favorites to practice. 

Considerations: When dealing with patients with hearing deficits, clarity is often more important than volume. Pacing and pronunciation often reinforce each other. If you take the time to speak clearly, your pacing is often spot on.   

The Fourth P: Production  

Throughout our lives, many of us adopt habits that can muffle our voices, making us less likely to be heard in anything but a noiseless room. Tension can clamp down on the vocal apparatus and dampen the sound of your voice. Being heard in any room is as much about resonance as it is about volume. In many cases, the former is even more important. The human voice is almost like any other musical instrument with one major exception: it has the ability to alter the shape of its resonating chamber, giving the voice enough ring to be heard across a noisy room, or muffling the sound before it even escapes your mouth. By relaxing your throat, relaxing your tongue, elevating the soft palate, you can create a voice that is clear and bright and strong. Finding your natural resonant voice is not as difficult as it may seem. A few simple exercises listed below can help you: 

The “Eureka” Moment: Imagine you just had a brilliant idea or found the answer to a question that has been troubling you for weeks. Revelation hits you and, equal parts relieved and surprised, you call out “AHA!” That is your voice! That energized, bright sound is where your voice wants to be if it wants to be heard. Try it. Try it in the car, or in the shower. Anywhere that you are comfortable and uninhibited. Tension is your enemy. When tension creeps into your body, the voice becomes strained, so practice where you are most relaxed. 

The Food Moment: Imagine you just bit into your favorite dessert.  A perfect cheesecake, a rich chocolate mousse, hot apple pie with vanilla ice cream. You can’t keep quiet about your delight. With your mouth closed, you utter “MMMMHNNN!” Pay attention to your face. That buzzing feeling in the front of your face, in the roof of your mouth or your cheeks or sinuses; that buzzing will add brightness and resonance to your voice.  

The Yawn. One of my personal favorites! Go ahead and yawn. Pay attention to what happens to your throat; how open and relaxed it becomes. The jaw relaxes, the back of the tongue droops down. Now take a big yawn and sigh when you exhale; “AHHHHH!” The open relaxed feeling is you expanding your resonating chamber. Put these three exercises together and you have a bright, relaxed, resonant sound that will cut through the noise; a sound that will be heard. 

The Fifth P: Poise 

Being heard and understood is just the beginning. If you are going to build up your professional relationships, if you want to present yourself as an expert of your field, if you want to create a more positive experience for your patients and help mitigate their anxiety, you have to have poise. You have to appear confident and in control. This is not the same as pretending to know every answer. Poise and confidence are not dishonest, but they will elevate your every interaction. Real confidence isn’t about having all the answers. It is about self-honesty and acceptance.  

Self-confidence comes with experience. But it puts our patients at ease. Remember why you love what you do and do it like you love it.

A good portion of poise is established through body language. The first step to confident body language is posture. Much like our voice, our posture often suffers from a lifetime of bad habits, but a confident posture is simply a healthy posture: A tall, aligned spine. Relaxed shoulders in a neutral position. Head high and neutral. Hips squared, knees loose (if you’re standing). A healthy sitting posture is just as important. You may have heard that sitting is the new smoking, a behavior with long-term detrimental effects on your health. That’s only half the truth. Sitting with poor posture for long periods of time is more likely the culprit. A tall, confident posture will help your health and help your interactions with others.  

There’s more to your body language than just posture. Eye contact is key. Eye contact conveys confidence, but it also commands the attention of your audience. It turns a passive listener into an active listener, and an active listener is more likely to remember whatever it is you have to say. It doesn’t matter how precise and clear your delivery is, if your audience isn’t paying attention, you might as well be whispering in a crowded room.  

So, stand up (or sit up) straight and tall even when delivering bad news. Even when you don’t know the answer to someone’s question, if you stand with confidence and speak clearly and with resonance, your interactions will be healthier, and your coworkers, your patients will be more receptive to what you have to say. When that happens, the professional confidence you are conveying will become confidence you actually feel, and all your future interactions will benefit from it.  

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