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COMMUNICATION IN PHYSIOTHERAPY PRACTICE: THE PROCESS OF COMMUNICATION - THE COMMUNICATION PROBLEMS
Much has been written about the communication problems experienced in the clinical interview (Ley and Spelman, 1967; DiMatteo et al, 1979; Kelly and May, 1982; Tuckett et al, 1985; Ley, 1988). Although most work concerns doctors it relates well to physiotherapy practice. DiMatteo et al. (1979) and Hyland and Donaldson (1989) use the term 'therapeutic relationship' 1° describe the interaction between health professionals and patients, but Fitzpatrick et al. (1984) point out that it is also a social encounter where the purpose, status and role of those involved will all affect communication-Stimson and Webb (1975) found, for example, that prior to visiting the doctor many patients experienced general anxiety and inhibition and were worried about discovering their diagnosis. It is very important that physiotherapists stop to consider the patient’s state of mind and how this may affect communication during assessment and treatment. It is also important to consider the needs of students. Physiotherapists can no doubt remember their first patients and the fears they had in evaluating the clinical problem, providing treatment and coping with the interaction.
Broverman et al. (1970), Kramarae (1981) and Henley et al. (1985) draw attention to the vast gender differences in both verbal and non-verbal communication. In a profession dominated by women it is disturbing that little if any attention to the research on gender differences and sexism in communication is given during undergraduate education. If the concept of 'consumerism' in health care is to be embraced wholeheartedly then perhaps this issue will need to be dealt with more academically, especially as women are major users and providers of health care. Avoiding stereotyping and maintaining a non-judgemental attitude towards patients is an essential element in effective, productive communication. We surely owe it to our patients to challenge stereotypical attitudes demonstrated in phrases such as 'walking old dears' and 'the hysterectomy in bed six'. Such terminology is patronizing, ageist, sexist and dehumanizing (Lillie, 1985). The use of disablist terminology must also be avoided (French, 1989).
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