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Verbal communication is the use of sounds and words to express yourself, while nonverbal in contrast uses gestures, facial expressions, tone of voice, eye contact, body language, posture, and other ways people can communicate without using language. Both ways are essential to communicate effectively and appropriately to assure the safety of the patient and to provide the necessary treatment. Communication is one of the pillars that are essential to survive in our life; however, many people lack those communication skills which hinder the preventable mistakes. The interaction with the patient can be exhibited in many different ways and knowing the appropriate way to approach a patient is a key to make sure that the patient is getting what they need and what they deserve. Furthermore, improving the communication skills of health care professionals is a very essential skill and a quality that each caregiver needs to obtain and improve. Consequently, the relationship between the caregiver and the patient will improve and the medical mistakes would be avoided. There are many ways to make sure that communication is effective such as face-to-face conversations. On the other hand, not having the appropriate communication can lead to many avoidable problems such as an increase in workload, medical mistakes, wasting the time of both the caregiver and the receiver, economical problems, and treatment delay. According to a narrative review of the literature and practical recommendations, “Poor communication can indeed lead to various negative outcomes: discontinuity of care, compromise of patient safety, inefficient use of valuable resources, dissatisfaction in patients and overworked physicians and economic consequences, which is often hidden”. In addition, in the movie Patch Adams, the actor Robin Williams said, “every human being has an impact on another, why don’t we want that in a patient-doctor relationship”.

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Patch Adams (8/10) Movie CLIP - You Treat a Person (1998) HD

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Different culture and different language can lead to health communications problems

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Different culture and different language can lead to health communications problems

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Due to the different cultures that exist in the United States of America and the fact that there are many people who speak different languages, many healthcare professionals fail the communication process when their patients do not understand them. As a result, an increase in medical mistakes that would have been prevented if the communication process was successful. Many experts believe that speaking to patients through interpreters while at the same time considering that cultural factors can affect their decisions may reduce the communication problems and can lead to an effective interaction. in the article, Language as a Communication Barrier in Medical Care for Hispanic Patients, "the results demonstrated that Hispanic patients seen by bilingual physicians had better recall and asked more questions than did Hispanic patients seen by monolingual physicians". Therefore, this demonstrates that if patients felt excluded from the situation because they can not keep up with the caregiver, they tend to avoid asking more questions about their medical situation and hence, they do not receive the required care.

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This model is the exchange of messages between sender and receiver where each take turns to send or receive messages. Then, each person shapes what they hear from the other person depending on their culture, age, gender, background, emotions and their relationship with the other person. Therefore, being able to adjust the information’s and making sure that each person is on the same page is a very important step to eliminate those common mistakes. Moreover, giving the patient a chance to express their feelings will help the caregiver to reach a common understanding. In addition, this will shape the way the patient perceives information and interact with the caregiver to impact the expectations and get the best services.

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How different language and culture play a huge role in the communication

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How different language and culture play a huge role in the communication

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In Saudi Arabia, there are many different cultures as well and many healthcare professionals from all over the world. Due to the wide variety of the cultures in the kingdom, foreign caregiver usually lacks the knowledge about the traditions and miscommunicate with a patient. In addition, most foreign healthcare professionals in Saudi Arabia tend to speak in English while the majority of the population speaks only Arabic which creates a barrier between the healthcare professional and the patients that prevent the effective treatment from taking place in some settings. According to Dr. Khalid M. Almutairi in his article, he said, "Not only do cultural backgrounds differ among these healthcare workers, but language differences also serve as a barrier to effective communication. This language barrier is often not immediately an issue because of their proficiency in English". Therefore, patients are at risk of miscommunication and the quality of care may not be effective. Moreover, the difference between cultures may result in many problems such as non-Muslim caregivers lack the knowledge about Muslim practices such as family involvement in taking decisions, different cultural values, mingling with men and spiritual needs. An example of the miscommunication that takes place and the reason behind the struggles that the patient and the caregiver feel when they cannot reach a mutual language to speak with each other is attached.

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Cultural and language barriers with patients

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While language and culture barriers are taking place in the communication problem. Not being able to translate the complex medical terminologies for patients who do not have enough knowledge and making the explanations easier to understand, many people struggle and leave the healthcare provider without any benefits. However, if healthcare providers were able to use simple language to make it easier for patients to understand this will increase patient adherence, and establish a good doctor-patient relationship. All of this allows the patients to feel included in the situation and allows them to know what is happening with them.

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Obviously, this is an exaggeration, but the problem is that sometimes it really happens. The relationship between a caregiver and a patient certainly has a significant influence, because it can be determined by many factors. They believe that the professional knows what to do, and the patient does as instructed is absolutely not a healthy option for patients who seek to improve their quality of life. In this way according to the article Do we need a new word for patients, "The user becomes passive; the provider becomes all knowing, all healing, all-powerful". Communication is a challenging process and establishing a friendly environment that facilitates the equal relationship can really improve the desired outcomes.

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While it is a common thing in many countries around the world to disclose the bad news to the relatives of the patients, due to cultural differences between the patient and the caregiver the relationship can be affected if the caregiver did not disclose the bad news to the family of that patient. For example, in Saudi Arabia patients usually, trust their relatives and allows them to take part in their lives and decisions. therefore, if the healthcare provider hesitated to tell the family about the situation many problems will arise because of this misunderstanding. According to Ali H. Aljubran, "They basically believe that patients are very vulnerable and should not be left alone to handle the stress of knowing the bad news or the stress of making decisions". Therefore, unlike many countries, a caregiver needs to build a strong relationship with the patient and the patient-family and provide them with frequent reports as the sociocultural background demand.

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Religion in Saudi Arabia according to the article Culturally Sensitive Caring for Saudi Patients, "They do not generally perceive illness as a form of punishment but rather as a way of atonement for one’s sins. Spiritual healing methods are widely practiced by Saudis for the whole spectrum of diseases, with particular emphasis on conditions for which no curative medicinal treatment is known. The common spiritual healing practices among Saudis are the ones advised according to the teachings in the Noble Qur’an and (or) Sunnah. These include the healing of conditions such as possession by Jinn (Al-Ashqar, 1998), mal-effects of an evil eye, and poisonous stings (Khan, 1994, p. 942). The main spiritual modality of treatment is the recitation of verses of the Noble Qur’an and specific sayings of the Prophet Mohammad (pbuh). Zamzam water (obtained from

Zamzam well in the Holy Mosque in Makkah), honey, and black cumin (Nigella seeds) are considered healing agents (Al-Jauziyah, 1999). The use of amulets is extremely rare in Saudi culture, as this practice was discouraged by the Prophet Mohammad (pbuh) (Khan, 1994, p. 611). Expression of respect toward spiritual healing practices by health professionals is likely to foster a good relationship with patients and families".

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Health literacy and the importance of building strong relationship

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Health literacy and the importance of building strong relationship

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Many believe that strong relationships will result in decent outcomes, except building such a relation can be difficult because of many factors. While building a prosper relationship depend on understanding each other and sharing the best goals between the patient and the caregiver. To be able to do so, both caregiver and patient need to find a mutual language and a way to communicate effectively to assure the safety of the provided services and to assure that all concerns are satisfied. What I mean by finding a mutual language is not only speaking or writing the same language, although making sure that caregiver and patient really understand each other, and the language used is simple. According to Yolanda Partida, “90 million American have trouble understanding and acting on health information, effective communication between patients and their doctors is a problem even when language is not a barrier”. Therefore, eliminating the language barrier is not the only solution to deal with the problem but more attention needs to paid to assure that all barriers are resolved. When it comes to thinking about the importance of simplifying the language for the patient, many think that it’s an easy thing to do. However, sometimes medical terminologies do not have an easier word that shares the same meaning, but the entire phrase needs to be explained, which make it more difficult than we think. According to Boodman, “A 2006 study by the U.S. Department of Education found that 36 percent of adults have only basic or below-basic skills for dealing with health material. This means that 90 million Americans can understand discharge instructions written only at a fifth-grade level or lower”. Many reports have linked poor health literacy, which excessively affects all members of society without discrimination lead to medical mistakes, unnecessary expenses, and even death.

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Meaningful communication is a crucial process to assure the safety of the patients and to make sure that prescribed medications are not used in the wrong way. Therefore, if the caregiver was able to have effective communication, they will be able to know how to treat the pain that the patient is dealing with effectively. I remember while doing one of my shadowing hours that a patient was explaining to the caregiver that he has a new prescription for a pain killer and that the medication is causing some unwanted problems. Therefore, the healthcare provider started to establish effective communication and started to eliminate the barriers to allow the patient to find better alternatives. According to the Substance Abuse and Mental Health Services Association (SAMHSA), more than 80 percent of heroin users start their drug abuse with a legally prescribed opioid. Most of those who were legally prescribed opioid ended up abusing the medications and tried to find alternative pathways to alleviate their pain might be because of the miscommunication between them and the caregiver. , according to MGMA president and CEO Halee Fischer-Wright, MD, “patient-provider communication strategies – when used alongside health technology to track patients who have already receive opioid prescriptions and targeted patient referral management – will work to tackle the opioid epidemic on the healthcare frontlines”.

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al-Shahri, M. Z. (2002). Culturally Sensitive Caring for Saudi Patients. Journal of Transcultural Nursing, 13(2), 133–138. https://doi.org/10.1177/104365960201300206

Partida, Y. (2007). Language Barriers and the Patient Encounter. AMA Journal Of Ethics, 9(8), 566-571. Retrieved from https://journalofethics.ama-assn.org/article/language-barriers-and-patient-encounter/2007-08

Boodman, S. (2011). Helping Patients Understand Their Medical Treatment. Kaiser Health News. Retrieved 25 April 2019, from https://khn.org/news/health-literacy-understanding-medical-treatment/

Patient-Provider Communication, Education Key for Opioid Prescribing. (2018). PatientEngagementHIT. Retrieved 25 April 2019, from https://patientengagementhit.com/news/patient-provider-communication-education-key-for-opioid-prescribing