Communication between healthcare providers is very important to patient care. The stakes are high when healthcare providers interpret and respond to verbal and non-verbal messages. During the course of the day, there are countless interactions between pharmacists and nurses, doctors and respiratory therapists, social workers and physical therapists, and any combination of healthcare professionals. It is certain that each exchange has an element of benefit or risk to patient care. How our messages are communicated can improve the chances to benefit the patient or lead to medication or other treatment errors.

Earlier this year, I wrote an article (How to Communicate Effectively with Health Care Providers) using the concept of mitigated speech to encourage patients to understand their own communication style. Malcolm Gladwell, in his book “Outliers” describes the concept of mitigated speech first presented by Ute Fischer and Judith Orasanu. In mitigated speech, a person chooses their words carefully to reduce confrontation or demonstrate respect. The more avoidance or respect one is attempting to demonstrate, the more mitigated the speech may become. The more mitigated the speech the greater the chance of confusion. This phenomenon occurs between healthcare providers when in an effort to placate a particularly difficult colleague or to show respect for hierarchy, communication is less direct and confusing. There are six stages of mitigated speech. The following examples show how mitigated speech may impact care when questioning a physician's order.

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