It is essential to remember the characteristics of effective communication when experiencing misunderstandings. All health professionals must learn to manage communicative interactions where there is a failure to understand or interpret words or events correctly, and to do so in a reasonable and calm manner (Holli et al 2003). Interactions involving misunderstandings are often uncomfortable. They may produce feelings of anxiety and regret, and, if serious enough, feelings of guilt and unfair judgement. Everyone experiences feelings of discomfort, anxiety and regret because of misunderstandings. Guilt, while a self-defeating emotion, is a typical reaction if lack of care on the part of the health professional causes a miscommunication. If inappropriately blamed for a misunderstanding, however, the health professional may feel misjudged. Both the health professional and the person seeking assistance may experience negative emotions because of misunderstandings.

It is interesting to note that communicating with care and the best intentions do not guarantee understanding (Bowe & Martin 2007, Tyler et al 2005). The perspective of the other person may affect the interpretation of a kind intention. For example, assisting someone after observing them struggling to complete a task may produce anger rather than expressions of thanks if the person was intent on proving they could complete the task themself. Conversely, not assisting a struggling person may also elicit anger. A means of avoiding such situations is to use a question or gesture designed to establish the desire or lack of desire of the person for assistance. Similarly, if a person seeking assistance expects a particular intervention that is outside the role of the health professional, this may cause miscommunication and requires immediate clarification. Misunderstandings decrease levels of trust and may severely affect the therapeutic relationship. This has implications for the health professional, the person seeking assistance and the ultimate outcome of the assistance.

Mutual understanding increases, although is not guaranteed, if the interacting individuals can communicate competently in a common language. Understanding is enhanced when individuals share the same meanings for particular words. Difficulties can arise if one person does not know the various meanings of a word used (see Ch 1) and thus does not recognise that word in a particular context. Lack of word recognition prevents understanding. In many languages, sounds and/or words can carry multiple meanings (Harms 2007, Nunan 2007), and this can make it difficult to understand the sound or word in an unfamiliar context. This may occur with the use of professional jargon or technical words but can also occur when communicating with a person who has learnt the language of the interaction as an addition to their first language.

Mutual understanding is also influenced by assumptions individuals make about meaning. Assumptions can develop because of previous experience, knowledge and understanding of the situation and context. The probability of achieving mutual understanding may be decreased if some of the individuals communicating are unfamiliar with the context of the communication, or communicate outside the expectations of the context (Nunan 2007).

Of the factors that limit the achievement of mutual understanding, it is necessary to consider which of these are relevant to the health professions. Health professionals relate regularly to individuals from different cultures (see Ch 15). Misunderstandings between people from different cultures may occur because of expectations as well as the meaning of particular behaviours and words. Openness, understanding and acceptance of the differences will assist those communicating to achieve mutual understanding. It is the responsibility of the health professional to demonstrate openness and acceptance because of the vulnerability of the person seeking assistance.

Among health professionals there is not always a common language. A health professional who specialises in a particular area may use jargon that a health professional from a different specialty might struggle to understand. For example, someone working in medical radiation science may not understand the terminology used by a person working in occupational rehabilitation. Individuals seeking assistance, even when they speak the local language, may not understand any health-specific jargon. If they are unable to recognise a particular word in the health context they may misinterpret the meaning. The individual struggling to understand a word will often assume the meaning if they feel uncomfortable about asking for clarification. Similarly, some Aboriginal and Torres Strait Islander Peoples will not express an inability to understand because experience tells them the health professional will not listen. In all situations the health professional has responsibility to negotiate mutual understanding. If misunderstandings do occur it is important that the health professional takes responsibility to repair the misunderstanding, regardless of the cause. Misunderstandings occur wherever people interact and thus the health professional will benefit from considering such events carefully to understand the causes and how to avoid them in the future (Higgs et al 2005).

The factors affecting mutual understanding – culture, language, word meanings, assumed meanings and context – can also contribute to misunderstandings. There are additional factors that can cause misunderstandings, however, and these are examined in this section.