Communication That Works For The Audience

Why We Must Tailor Our Communication To Our Audience

In my last post, I wrote about how doctors and executives communicate differently. Doctors tell the whole story before giving the plan. Executives prefer the plan first, then reasons, followed by details.

Let’s look at how this plays out in practice.

A Psychiatry Consult—The Usual Way

Imagine you are the psychiatry consultant asked to see a patient admitted to the medical floor (ward) after a suicide attempt. Here’s how the note might look in the standard order:

Chief Complaint: “I don’t want to live anymore.”

History of Present Illness: 42-year-old male admitted after taking too much acetaminophen. Reports six months of worsening depression, financial stress, and hopelessness. Past suicide attempt 10 years ago.

Past Psychiatric History: Major depressive disorder, previously treated with fluoxetine. Stopped medication one year ago.

Medical History: Hypertension, obesity.

Social History: Divorced, lives alone, employed as a warehouse worker. Sister nearby.

Mental Status Exam: Depressed mood, flat affect, suicidal thoughts, impaired judgment.

Assessment:

Major depressive episode, severe
High risk for self-harm

Recommendations:

1. Suicide precautions
2. Start sertraline 50mg daily
3. Psychiatry to follow daily
4. Admit to inpatient psychiatry once medically cleared

The Same Case—Flipped

Now here’s the same note in Dr. Smith’s “reverse order”:

Recommendations:

1. Admit to inpatient psychiatry once medically cleared
2. Psychiatry to follow daily
3. Start sertraline 50mg daily
4. Suicide precautions

Assessment:
42-year-old male with major depression, severe, and high risk for self-harm after overdose and ongoing suicidal thoughts.

History & Exam (brief):
Chief complaint: “I don’t want to live anymore.”
Overdose on acetaminophen
Six months of worsening depression
Past attempt 10 years ago
Divorced, lives alone, limited support
Depressed mood, suicidal thoughts, impaired judgment

What Changes?

The patient is the same. The facts are the same. But the order changes the experience.

For another psychiatrist, the first note is normal. It tells the whole story and feels complete.

For a busy internist with 18 patients who must be seen as soon as possible, the second note is easier. They see the plan first, then the reasoning, then the detail if needed.

The Lesson

Communication is not about what we want to say. It is about what the audience needs to hear.

When doing a medical note on the primary service, the full story matters. When doing consults, the plan comes first.

In business meetings, the same principle applies.

If we adjust how we present information, we avoid being misunderstood. We show respect for the listener’s time. And we make it more likely that our message will be heard and acted upon.

Closing Thought

Medicine taught me to think like a detective. Build the case. End with the big reveal. Business school taught me to think like an editor — start with the headline.

Leadership taught me something else: think like a bilingual interpreter and speak to the audience in a way that they will get it most easily.

When we do that, we stop talking past each other and start working together.

p.s. The case of the patient above is a made-up case, not a real one.