Thoughts on Communication

Paul Gordon’s essay reminds me of one of my initial experiences living with Hmong villagers in Thailand, when I knew very few words. Oh, the agony of being mute. Oh, the suffering from not being able to speak, and the misery of not knowing how to interact appropriately. And I have the physical scars to show for my agony. One day after feeling super-frustrated about being a mute child with an adult consciousness, I ran crying along a jungle path. Shortly, I heard someone coming along the path ahead of me, and ashamed of crying, I threw myself off the path, only to wind up tangled in barbed wire from someone’s old cow pasture. This only made my communication challenge even greater: how to explain the tears on my face and the blood on my body?

As Paul shows, though, the agony and misery of immersion are good teachers if we’re open to learning. We can gain insights about ourselves, empathy for international medical graduates, and patience with immigrant patients. We can also capitalize on the opportunity to improve our communication skills. I most admire clinicians whose patient-centered communication skills include the ability to adjust their communication style to fit patients, going from outgoing and energetic to quiet and patient; making direct eye contact or avoiding prolonged eye contact; touching people in jest and in comfort or avoiding physical touch; all as patients prefer.

My toughest challenge is figuring out what patients prefer, what makes them most comfortable, and what most clearly communicates respect, as my assumptions and stereotypes can get in the way. But after working with immigrants and refugees for long enough periods of time, watching how they interact with each other, and paying attention to how they respond to me, I am getting better at it.

It’s a tough skill to teach students, but I believe that their personal experiences with immersion—with the accompanying agony and misery from not being able to communicate effectively—are invaluable initial teachers.

Competing interests:   None declared