Journal of Sacred Work

Never underestimate the other person’s ability to miss your point.  – Erie Chapman

   We learn the trick of the nodding smile as young children. The school teacher says, "If Johnny had
three apples and Sarah had two apples, that means that together they have five apples, understand?" And we smile, in unison, "Yes, teacher." The truth is we may have no idea what she is trying to teach us.

  I remember getting lost in the middle of story problems wondering what kind of kid Johnny was and whether he and Sarah were pals – not exactly the lesson my teacher was trying to communicate. Understanding is difficult, even in the clearest of situations, because every human communication is informed by so many other factors besides the words used.
   This is dramatically the case in doctor-patient communication….

   It is well established that when a doctor tells a patient they have
cancer, the patient often hears nothing after the word "cancer" comes into
their ears. Unless the doctor is especially perceptive, it is unlikely
he or she will notice this because the patient may be sitting silent.
Beneath the patient’s mask of compliance, fear swirls at such a furious rate that
understanding is deeply problematic.
   Repeated studies demonstrate that we pay more attention to the body language and tone of a speaker than we do to the words spoken. Extensive analysis reflects that a patient’s ability to understand a caregiver is influenced by culture, bias, education, context and concentration among other factors. How are we to penetrate the fog that floats between us?
   The first step may simply be to accept the magnitude of the challenge. Why waste words if we’re not being heard? What if we slowed down our communication and listened for the patient’s understanding?
   The deeper second phase of better communication is demonstrated by good oncologists who learn to sit with their patients after the delivery of bad news. These caregivers don’t weigh down their patients with a flood of instructions that the patient is not yet ready to hear. This is the role of loving care, to attend to the patient’s state of mind rather than trying to force our agenda.
   Unfortunately, many caregivers rely on a question like, "Do you understand?" This patient may do a "smiling nod" because they are afraid to display confusion.
   It may seem impolite to ask a patient to explain what they just heard yet this is a way we can really gauge a patient’s comprehension. I have heard good caregivers say things like, "Can you tell me what you just heard so I know if I explained this the right way?"
   Even then, understanding is not the same as compliance. Endocrinologists often report that the greatest difficulty in treating diabetics is often not the problem of the disease but the disinclination of the patient to follow instructions.
   Caregiver empathy with the challenges facing the patient can go a long way toward gaining a patient’s participation in their own care. Good communication is a partnership, not a unilateral process of information dumping.
   Let’s assume that you understand what I’ve just written and agree with it. Does this mean your own communication with others will change? Of course not. In the case of every communication, the question that overrides understanding is individual desire. We change when we are motivated.

  Hope is more important than raw data. What the patient wants to see in the eyes of their caregivers is support, a sense of competence, and the belief that they are in good hands. This is the kind of communication that
contributes to healing. This is when work becomes sacred.
   The Four Relationships central to Radical Loving Care and Sacred Work are the ones between:

• caregivers and patients,
• caregivers and team members
• caregivers and leaders, and
• caregivers with themselves (and God),

    Each relationship is grounded in communication that signals respect between the parties. We all have the ability to misunderstand each other every day. If we are not in partnership with each other, these misunderstandings can be not only troubling but potentially fatal. In loving partnerships, communication issues often resolve in ways that always advance healing.

-Erie Chapman