inseparable  in  the  total  communication  process. Conscious awareness of this aspect is extremely important for the health care provider whose pro- fessional effectiveness is highly dependent upon successful   communication. Ineffective   communication   occurs   when obstacles or barriers are present. These barriers can  be  classified  as  physiological,  physical,  or psychosocial.  Physiological  barriers  are  those  that result from some kind of sensory dysfunction on the part of either the sender or the receiver. Such things as hearing impairments, speech defects, and even  vision  problems  influence  the  effectiveness of  communication.  Physical  barriers  consist  of elements in the environment (such as noise) that frequently  contribute  to  the  development  of physiological barriers (such as inability to hear). The  final  kind  of  obstacle,  called  psychosocial barriers,  are  usually  the  result  of  one’s  inaccurate perception of self or others, the presence of some defense  mechanism  an  individual  employs  to  cope with  some  form  of  threatening  anxiety,  or  fac- tors  such  as  age,  education,  culture,  language,  na- tionality, and a multitude of other socioeconomic factors. This last category of barriers is the most difficult to identify and the most common cause of  communication  failure  or  breakdown. Listening  is  a  critical  element  of  the  com- munication  process  and  becomes  a  primary  ac- tivity for the health care provider who must use communication  as  a  tool  for  collecting  or  giving information.  When  one  is  engaged  in  listening, it is important to direct attention to both the ver- bal  and  nonverbal  cues  provided  by  the  other person. Like many other skills necessary for pro- viding a health care service, the skill of listening requires  conscious  effort  and  constant  practice. Listening skill can be improved and enhanced by developing  the  following  attitudes  and  skills: l  Want  to  listen. .  Develop  your  interests  and  knowledge. .  Look  at  the  content  of  the  message. .  Hear  the  speaker  out. .  Focus  on  ideas. .  Remove  or  adjust  distractions. .   Maintain   objectivity. .  Concentrate on the immediate interaction. 5-5 As a health care provider, you will be using the communication  process  to  service  a  consumer’s needs.  Briefly,  these  needs  can  be  classified  as either  short-term  or  long-term.  To  simplify  this discussion,  short-term  needs  of  communication will  be  discussed  under  the  heading  of  “contact point.” Long-term needs will be discussed under the   heading   of   “therapeutic   communications.” CONTACT  POINT To provide you with a frame of reference for the following discussion, the following definitions will clarify and standardize some critical terms: .    Initial  contact  point—a  physical  location where  the  consumer  experiences  his  or  her first communication encounter with a per- son representing, in some role, the health care  facility. l   Contact   point —the place or event where the  contact  point  person  and  the  consumer meet.  The  contact  point  meeting  can  oc- cur anywhere in a facility and also includes telephone events. Contact  point  person—the  health  care  pro- vider in any health care experience who is tasked  by  role  and  responsibility  to  pro- vide  a  service  to  the  consumer. The contact point person has certain criteria to meet in establishing a good relationship with the patient. Helping the patient through trying ex- periences is partially the responsibility of all con- tact point personnel. Such health care providers must not only have skills related to their profes- sional  assignment,  but  they  must  also  have  the ability to interact in a positive, meaningful way to  communicate  concern  and  the  desire  to  pro- vide a service. Consumers  of  health  care  services  expect  to be  treated  promptly,  courteously,  and  correctly. They expect their care to be personalized and com- municated  to  them  in  terms  they  understand.  The Navy health care system is a service system, and it  is  the  responsibility  of  every  health  care  pro- vider  to  improve  the  professional  nature  of  the system. The significance of the contact point and the responsibility  of  the  personnel  staffing  these  areas are   important   to   emphasize.   The   following message  from  a  former  Surgeon  General  of  the