Principles and Elements of Interpersonal Communication
Learning Objectives
After studying this chapter, the graduate pharmacy student should be able to:
- Diagram and explain the five components of the interpersonal communication model
- Differentiate between verbal and nonverbal messages and their congruence
- Analyze how perception influences message interpretation in healthcare settings
- Apply feedback techniques to verify message understanding and prevent misunderstandings
- Identify strategies to overcome perceptual barriers in pharmacist-patient communication
- Evaluate the role of context in assigning meaning to verbal and nonverbal messages
Introduction: The Complexity of Interpersonal Communication
Interpersonal communication is a common but complex practice essential for effective pharmacy practice. While we engage in countless interactions daily, successful communication requires understanding the underlying process that occurs when one person tries to express ideas or exchange information with another.
Case Study 2.1: George Raymond
George Raymond, a 59-year-old man with hypertension, enters the pharmacy holding an unlit cigar. He looks down at the ground and mumbles, "The doctor called in a new prescription for me, and can I also have a refill of my heart medication?" This scenario contains multiple layers of verbal and nonverbal communication that require careful interpretation by the pharmacist.
The Interpersonal Communication Model
The interpersonal communication process can be understood through a practical model based on the work of Shannon and Weaver (1949) and Gerbner (1955). This model includes five essential elements that interact dynamically during communication exchanges.
Interpersonal Communication Model
The Five Components Explained
- Sender: The individual who initiates communication by transmitting a message (e.g., Mr. Raymond asking for his prescriptions)
- Message: The content transmitted, containing both verbal (words) and nonverbal (facial expressions, gestures) elements
- Receiver: The individual who receives and decodes the message, assigning meaning based on personal interpretation
- Feedback: The response from the receiver back to the sender, completing the communication loop and verifying understanding
- Barriers: Interferences that disrupt accurate communication (environmental noise, language differences, psychological factors)
Key Insight: Transactional Nature
Communication is not a linear process but a transactional one. Individuals simultaneously send and receive messages through both verbal and nonverbal channels, regardless of who is speaking at any moment. This simultaneous sending and receiving makes communication dynamic and complex.
Verbal and Nonverbal Messages: Congruence and Incongruence
Messages consist of both verbal (spoken words) and nonverbal (body language, tone, facial expressions) components. Research indicates that 55% or more of a message's meaning may be transmitted nonverbally.
Definition: Message Congruence
Congruence occurs when verbal and nonverbal messages convey the same meaning. Incongruence happens when these messages conflict, creating confusion and mistrust.
Examples of Incongruent Messages
- A red-faced, agitated patron raises a fist and loudly proclaims, "I'm not angry, I'm just here to ask about a prescription error."
- A disappointed pharmacist meekly replies, "Oh, I'm just fine," when asked how he's feeling after failing to convince a physician to change an inappropriate medication order.
- A patient hands a pharmacist a prescription for a tranquilizer, then bursts into tears but responds, "No, I'm okay, it's nothing at all."
Pharmacy Application: Pharmacists must be aware of their own nonverbal communication and sensitive to incongruent messages from patients, as these often signal underlying concerns or emotions not expressed verbally.
The Role of Perception in Communication
Perception fundamentally shapes how we interpret messages. We assign meaning based on our perception of both the message content and the individual sending it. This perceptual process is influenced by past experiences, cultural background, values, and stereotypes.
Case Study 2.4: Nitroglycerin Patches
A patient returned to the pharmacy complaining of side effects from his medication. He had been told to "apply one daily" and had 27 nitroglycerin patches firmly adhered to his chest. His perception of the absolute instruction ("apply one daily") did not include the implied message to remove the previous patch.
Case Study 2.5: Nystatin Tablets
A young woman suffering from vaginal candidiasis was told to "use one tablet daily for two weeks." She returned complaining the tablets tasted terrible—she had assigned the wrong meaning to "use" and took them orally rather than vaginally.
Perception of Individuals
Our perception of the sender affects how we interpret their message. Stereotypes and biases create "perceptual barriers" that inhibit true communication. For example, assumptions about elderly patients' hearing abilities or mentally ill patients' compliance patterns can lead to communication breakdowns.
Preventing Misunderstandings: Context and Feedback
People assign meanings based on their background, values, and experiences. When sender and receiver have different frames of reference, misunderstandings are likely. Two key strategies can minimize these misunderstandings.
Strategy 1: Understanding Context
The context—including social relationships, environmental factors, and cultural backgrounds—profoundly influences how messages are received and interpreted. Pharmacists must consider the patient's context when communicating.
Strategy 2: Using Effective Feedback
Feedback verifies that the receiver's interpretation matches the sender's intended meaning. Explicit feedback is more effective than relying on intuition or assumptions about understanding.
Feedback Techniques for Pharmacists
- "I want to be sure I explained things clearly. Please summarize the most important things to remember about this medicine."
- "How do you intend to take this medication when you get home?"
- "Please show me how you're going to use this inhaler."
- "Describe in your own words how this medication will help your condition."
- "Before you leave, could you please tell me how you're going to use this medicine?"
Case Study 2.3: Anticoagulation Error
A patient in an anticoagulation clinic developed bruises with an INR of 6 (target 2-3). The pharmacist discovered the patient had been taking both his old 4mg Coumadin tablet and his new 3mg tablet daily—a total of 7mg. No one had told him to stop the 4mg tablet, and he had not received feedback verification of his understanding.
Cultural and Individual Differences in Perception
Effective communication requires recognizing and accommodating differences in perception based on cultural background, age, gender, health literacy, and personal experiences.
Guidelines for Cross-Cultural Communication
- Learn about patients' backgrounds and communication styles
- View diversity as an opportunity rather than a barrier
- Avoid condescending or patronizing behavior
- Discuss differences openly with a constructive attitude
- Use lay language rather than medical jargon
- Verify understanding through feedback rather than assumptions
Pharmacy Application: Pharmacists should assess each patient's unique background and avoid stereotyping. This includes being aware of cultural differences in eye contact, personal space, expression of symptoms, and health beliefs.
Application to Pharmacy Practice
The interpersonal communication model has direct implications for daily pharmacy practice:
- Sender Responsibilities: Pharmacists must ensure messages are clear, use understandable terminology, and are transmitted in conducive environments.
- Receiver Responsibilities: Pharmacists must listen actively, provide feedback, and verify understanding.
- Barrier Management: Identify and minimize environmental, personal, and cultural barriers to communication.
- Feedback Integration: Make feedback a routine part of all patient interactions, especially when providing new medication instructions.
- Perception Awareness: Recognize how patient perceptions of pharmacists influence communication and work to establish trust and credibility.
Research Evidence
Studies show that when pharmacists communicate effectively with patients, patient outcomes improve (DeYoung, 1996). Effective communication reduces medication errors, improves adherence, and enhances patient satisfaction.
Critical Thinking Questions for Graduate Discussion
- How might the interpersonal communication model explain medication errors that occur during transitions of care (e.g., hospital to home)?
- What specific strategies can pharmacists employ to overcome the perceptual barriers that elderly patients might have about younger pharmacists?
- How does the concept of message congruence relate to building trust in the pharmacist-patient relationship?
- In what ways might a pharmacist's nonverbal communication contradict their verbal instructions, and how can this incongruence be minimized?
- How can feedback mechanisms be systematically integrated into busy community pharmacy workflows without significantly increasing time requirements?
