This document discusses communication skills and medical ethics. It defines communication as the meaningful exchange of information between people with the goal of creating shared understanding. The communication process involves a sender encoding a message and transmitting it through a channel to a receiver who decodes the message. Effective communication considers the context, and can be impaired by noise such as psychological, physical, physiological, semantic, or channel issues. Barriers to communication include cultural differences, attitudes, systems design, and noise from the environment or transmission of the message.