Communication is everything. Communication factors into every aspect of physiotherapy service delivery, from building a therapeutic relationship, completing an initial assessment, and obtaining informed consent within treatment to managing conflicts and challenging situations. But how often do physiotherapists think about their communication skills? Their default communication style? Tailoring their approach to the patient in front of them?
As highlighted in the Essential Competency Profile for Physiotherapists in Canada physiotherapists must incorporate robust written, verbal, non-verbal, and paraverbal communication skills into their professional interactions and must adapt their communication practices and approach to the context and individual they are communicating with. There’s a reason that communication is one of the domains on the Essential Competency Profile. Although referred to by some as a “soft skill”, communication is one of the hardest skills to master and one that physiotherapists can spend their entire careers developing and refining.
It should come as no surprise that communication is often a factor in the complaints received by the College. Regardless of the subject of the complaint, ineffective or unskilled communication is often a contributing factor. Patients filing complaints regularly report that they felt they were not heard, were disrespected, or that their needs and perspectives were disregarded.
Communication is also one of the underlying themes identified through the College’s analysis of the recent increase in complaints regarding sexual abuse and sexual misconduct. From that analysis, we found that the comments physiotherapists make during their interactions with patients have contributed to the complaints received. In November, the College released the Words Matter: Comments & Sexual Misconduct infographic to raise awareness of this issue. In December 2023 we published a College Conversations podcast episode elaborating on the role that communication has played in recent conduct matters related to sexual misconduct. We encourage all physiotherapists to review these resources if they haven’t already.
The College has also found that communication and issues related to informed consent are often intertwined and inseparable. Effective communication skills are needed if a physiotherapist is to develop a therapeutic relationship and gain informed consent for physiotherapy services. Often in the span of an hour or less, physiotherapists are called upon to develop enough trust and connection with their patients to:
- get information about their patient’s values, goals, and priorities,
- gain the patient’s ongoing informed consent to an assessment,
- effectively explain the physiotherapy treatment options available to help the patient,
- have meaningful discussions about the risks and anticipated benefits related to the treatment options,
- answer the patient’s questions, and
- obtain the patient’s informed consent to treatment.
The physiotherapist’s attention to the patient and the patient’s concerns, demonstration of empathy, use of active listening, and development of connection through intentional self-disclosures are all essential to the development of that therapeutic relationship, and all rely on communication.
When conduct matters arise related to issues of consent, they are often related to:
- the physiotherapist’s failure to proactively explain their actions during an assessment or treatment,
- a lack of patient understanding of what the physiotherapist said,
- the physiotherapist’s inattention to the patient’s verbal, non-verbal, and paraverbal communication indicating discomfort or that consent had been withdrawn, or
- a failure to effectively communicate and ensure that ongoing consent was in place.
While all physiotherapists would prefer to avoid complaints, the main reason for us to reflect on and seek to improve our communication skills is to provide safe, quality, and effective patient care.
Patient-centred care requires:
- building positive therapeutic relationships and inspiring patient trust and confidence in the physiotherapist.
- providing reliable, high-quality, and accessible information, at appropriate times, in an understandable way that also supports people to make informed decisions and manage their own care.
- involving and empowering patients in decisions about their health and care. Physiotherapists should work with patients in equal, reciprocal partnerships, and should respect people’s choices and preferences.
- showing empathy and respect. For care to be compassionate it must be delivered with respect, sensitivity, and appreciation of the person as an individual.
All these principles rely on effective communication between the patient and the physiotherapist. Although it is certainly true that it takes 2 parties to communicate, it is also true that as health professionals, it is the physiotherapist’s responsibility to take the lead in establishing effective communication with the patient.
Although it is certainly true that it takes 2 parties to communicate, it is also true that as health professionals, it is the physiotherapist’s responsibility to take the lead in establishing effective communication with the patient.
Having made the case for why communication matters, the next question is how. How can a physiotherapist improve their communication skills? What do they need to consider?
Although people may approach communication as something that’s just “automatic” or intuitive, skilled therapeutic communication can and has been analyzed and broken down into component parts. These parts include communication attitudes, styles, and techniques or tools. Like any skill, communication can be learned and improved with time and effort.
Communication attitudes can include demonstrating empathy, being honest, facilitating professional dialogue, and having self-awareness. Communication styles include such elements as active listening, using open vs closed-ended questions, non-verbal communication, speech patterns and organization of communication. Communication techniques include seeking permission, explaining questions, paraphrasing what is heard, and validating the patient’s experience.
A new communication module discusses these aspects of communication in detail and provides resources to support physiotherapists in their efforts to refine their communication skills. The module was developed through a partnership with several Canadian physiotherapy regulators and is available on the Courses page of the College website.
No matter how busy a physiotherapist is, it is important to invest time and effort into learning and improving their communication skills. Enhancing communication can save time and improve patient outcomes. For example, investing up front in the communication completed as part of the subjective history portion of a new assessment can reduce the time required in the objective history, speed the development of a therapeutic relationship, enhance patient outcomes, and help avoid time-consuming conflicts, misunderstandings, and challenging situations later.
Although continuing education offerings often focus on technical skill development, physiotherapists recognize that effective communication is as important to patient care and to patient health outcomes as technical knowledge and skills. The new Communication Module is an important resource for physiotherapists seeking to enhance this essential element of their practice.
References
- Picker Institute Europe. The Picker Principles of Person Centred Care. Available at https://picker.org/who-we-are/the-picker-principles-of-person-centred-care/ Accessed January 8, 2024.
