Factors contributing to ineffective communication include:
· Differences in language, conceptual and cultural knowledge
· Incorrect assumptions about what patients already know
· Incorrect assumptions about what patients want/need to know
· Different understandings about function e.g. of heart and lungs
· Use of culturally specific metaphors e.g. quantification such as percentage, time, frequency and pain rating
· Use of the same words but with different meanings e.g. ‘serious’ equivalent to ‘terminal’
· Different communication protocols e.g. asking direct questions may be considered offensive – results in discomfort when health staff ask many questions and inhibits patients asking questions of health staff when they don’t understand or want more information
· ‘gratuitous concurrence’ – politeness convention to say ‘yes’ even when you want to say ‘no’ particular in situations of unequal power or with strangers
· Location of control / power relationships 10
· Inadequate staff /interpreter training
· Lack of policies, protocols, accountability to ensure effective communication – an organizational culture of ‘making do’
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