Chapter 1: Communication essentials

Compassionate communication

The paramedic says
The importance of silence (3:22)Video transcript
Making space for the family to take the lead (3:22)Video transcript
The grief expert says
Dr. Chris MacKinnon explains the power of silence. (3:22)Video transcript
The palliative care expert says
Dr. Mike Harlos outlines considerations for when and where to have have conversations. (3:22)Video transcript
Dr. Mike Harlos outlines considerations for where and when to have conversations. (3:22)Video transcript
Being face-to-face

Forming a connection is often easier when you’re eye-to-eye or side-by-side. Avoid standing and talking with someone who’s sitting; in this way, they don’t have to look up at you to make eye contact. If they’re sitting, ask if you can sit beside them. Being face-to-face and making gentle, intermittent eye contact can help to non-verbally convey that you care; but be aware of cultural variations in this and be alert for any signs of discomfort or displeasure. If you're unsure, ask or step back.

Tolerating silence

It’s not easy to sit in silence with someone, but sometimes saying nothing is best. Don’t rush to fill every gap in the conversation. Family members may need a few moments to collect their thoughts before speaking. Sometimes, given time to think through what they’ve heard and how they’re feeling, they’ll share the most important aspects of their experience.

Confirming

Ensure you understand what’s being said; what’s most important can be hard to say. Ask if you can clarify for  yourself what you think you've heard; and try reflecting back what they’re saying by using their words.

Tell me if I’m understanding this correctly. Did you say you’ve never experienced something this difficult? Can you tell me a bit more about that?

Is anything I’ve said unclear? Can I repeat or clarify anything? 

Touch

Physical touch can be a source of comfort but it also carries risks – for both you and for the patient or family member. You need to use good clinical judgment and observation skills to assess whether touching someone lightly will be helpful or harmful.

Some people don’t like to be touched unless they know the other person very, very well. In many cultures, physical contact by someone of the opposite gender isn’t welcomed. Touching can have many meanings, some of which are very difficult, for example for those with a history of sexual abuse. Without knowing someone’s personal history, you have no way of knowing what the meaning of touch is for them, so proceed carefully.

Part of navigating this tricky terrain is the question of who is initiating the touch. Patients and family members are vulnerable because they are coping with stress and are dependent on you. Even if you ask permission, be aware that the person may not feel comfortable saying “no” to you for fear that you may withdraw your support. Similarly, you may feel uncomfortable and have a hard time saying “no” to a family member who initiates a hug, for example.  You may feel guilty and motivated to return the hug in the guise of providing good care and being “nice”. Afterwards you’re left feeling compromised and uncomfortable. All this is to say, touching can blur professional boundaries and can re-create intense emotions such as feeling violated and trapped, so it is best to be very cautious here.

A final consideration that may help to guide you in coming to a decision about how to respond to a desire to touch is to ask the question, who is this for? (For example, what is this hug really about and who needs the hug?) Sometimes you may be at a place in your life when you are more vulnerable (e.g., a crisis in your own life such as a divorce) and that may drive you to seek out touch when it is not appropriate.

Physical touch can be a source of comfort but it also carries risks – for both you and for the patient or family member. You need to use good clinical judgment and observation skills to assess whether touching someone lightly will be helpful or harmful.

Some people don’t like to be touched unless they know the other person very, very well. In many cultures, physical contact by someone of the opposite gender isn’t welcomed. Touching can have many meanings, some of which are very difficult, for example for those with a history of sexual abuse. Without knowing someone’s personal history, you have no way of knowing what the meaning of touch is for them, so proceed carefully.

Part of navigating this tricky terrain is the question of who is initiating the touch. Patients and family members are vulnerable because they are coping with stress and are dependent on you. Even if you ask permission, be aware that the person may not feel comfortable saying “no” to you for fear that you may withdraw your support. 

Similarly, you may feel uncomfortable and have a hard time saying “no” to a family member who initiates a hug, for example. You may feel guilty and motivated to return the hug in the guise of providing good care and being “nice”. Afterwards you’re left feeling compromised and uncomfortable. All this is to say, touching can blur professional boundaries and can re-create intense emotions such as feeling violated and trapped, so it is best to be very cautious here.

A final consideration that may help to guide you in coming to a decision about how to respond to a desire to touch is to ask the question, who is this for? (For example, what is this hug really about and who needs the hug?) Sometimes you may be at a place in your life when you are more vulnerable (e.g., a crisis in your own life such as a divorce) and that may drive you to seek out touch when it is not appropriate.

Conversation Prompts

Can I put my hand on your shoulder? I can take if off anytime you wish. Would you like to hold my hand for a moment?