Communication Skills in Medicine

7/28/2019 Communication Skills in Medicine

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Communication Skillsin Medicine

Tjakra W. ManuabaDept of General Surgery

School of Medicine. University of Udayana

Sanglah Academic Hospital. Bali


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What is Communication Is the act by which information is shared

between humans. Such encounter mightcover:

Desires

Needs

Perceptions

Knowledge

Affective states


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The ability to communicate wellwith patients to build up a

trusting relationship within whichcuring relieving and comfortingcan take place, is a great challenge

Why good medical communicationis important?better care for our

patients

Sir Charles Fletcher


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RECOGNITION OF THE PROBLEMS BYHEALTH PROFESSIONALS

In recent years, some medical practitionershave warned their colleagues of the trend awayfrom the treatment of the human being andthe commitment to the patient.

They recommend moving from a problemfocus to a person focus.

Dr. C. Everett Koop, former surgeon general,stresses that health care professionals have aspiritual heritage of cherishing life.

Gordon & Edwards 2006


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RECOGNITION OF THE PROBLEMS BYHEALTH PROFESSIONALS (continued)

Dr. Koop points out, however, that Weput too much emphasis on curing,especially when a disease is fatal, and notenough on caring.curing costs millions

but caring comes from the heart and soul.I hope Americans never run out of iteither

As scientific advances have proliferated, it

is widely believed that concentrating ontreating the disease has come topredominate over treating the illness ofthe patient.


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RECOGNITION OF THE PROBLEMS BYHEALTH PROFESSIONALS (continued)

It is also widely recognized that nursinghas become less patient-oriented andmore scientifically oriented.

Nurses increasingly are more involvedwith the technologyof care.

Complex machinery and excessivepaperwork...

As a result they may be distracted fromsome of their more caring functions.


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SOME RELEVANT RESEARCH FINDINGS

Some medical literature contains alarge number of research studiesthat have evaluated physician-patient

interactions and documented theundesirable results of ineffectivecommunication in such interviews.

A recent study found that inencounters lasting 20 minutes,doctors spent just a little over aminute giving information to their

patients.


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SOME RELEVANT RESEARCH FINDINGS(continued)

In medical school and in their internship orresidency training, physicians learn to askmany questions in taking medicalhistories, yet the interrogative mode in a

subtle way communicates, I am in chargehere.

Physicians who ask many questions are

keeping tight control over the relationship. No wonder so many patients complain

that the doctor doesnt listen to them.


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SOME RELEVANT RESEARCH FINDINGS(continued)

One way that improvement oftreatment should be realized byphysicians, is through increasing

patient compliance or cooperationwith the physicians orders.

Noncompliance with prescribed

medication regimens has beenshown to be a significant cause ofhospital admissions.


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DOCTORS PATIENTS RELATIONSHIP. Not anym ore paternal ism

Should be par tnership basis .

Doc tor -Pat ient co l labo rat ion vs health

problem Equal


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Med ical Ethic s respect theautonomy of pat ients

Paternal ism on ly to pat ientswho are no t able to be autonomous

The on ly way o f interfer ing w ith

indiv idual autonom y is where i t preventharm to th i rd party or sel f harm


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Specific Rules based onAutonomy

Tell the truth

Respect individuals privacy

Protect confidences Ensure that consent has been obtained for

medical interventions

When asked. Help others to make decisions


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Components of professionalismALTRUISM

HUMANISM

ACCOUNTABILLITYEXELLENCE

COMPETENCE

- RESPECT

- COMPASSION

- EMPATHY

- HONOR

- INTEGRITY

Standard of professional conduct

- CLINICAL +

COMMUNICATION

SKILL

- ETHICOLEGAL

UNDERSTANDING


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Dissatisfaction with Doctor-Patient

Relationships

Communication, between patients and healthprofessionals, is seen as the core clinical

procedure for diagnosing, treating, and caringfor patients.

Patients satisfaction is strongly influenced bythe quality of the communication that occurs.

Studies show that patients dissatisfaction canseriously reduce their compliance with theirtreatment regimen.

Gordon & Edwards


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Dissatisfaction with Doctor-PatientRelationships (continued)

Dissatisfaction in communication cantrigger patient doubts about the

competence of their physician. It can negatively affect how long it takes to

recover.

It can increase the frequency of patientmalpractice sue.


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The most frequent patients complaints

about doctors

Doctors would not listen

Doctors would not give information Doctors showed lack of concern & lack of

respect for the patients

Lloyd and Bor, 1996.


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Essentials of Patient Care

Physician Patient

Art & Science of MedicineCommunication

Medical HistoryPhysical Exam.

Literature & Art in Medicine

Hagen & Pauly 2006


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Communication Skills

To diagnose and treat diseases

To establish/ maintain a therapeutic relationship To offer information and educate


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To diagnose and treat disease andmaintain a therapeutic relationship:

- Data from the patient must be

objective, precise, and reliable

- You must demonstrate respect,genuineness and empathy

- These skills can be learned andpractice


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Pathophysiology &

Clinical Epidemiology

Human behavior& Social and

Cultural Context

Empathy

Science

Art

Diagnosis &

Disease treatment

Therapeutic

Relationship

Objectivity

Precision

Reproducibility

Hagen & Pauly 2006


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You must demonstrate

- Respect

- Genuineness- Empathy

These skills can be learned with practice


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Respect

Remember that every patient could be you, yourmom, your brother or your boy/ girlfriend

For example: How would he or she feel waitingfor the doctor to come into the room?


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Respect

Introduce yourself to the patient/ family

Explain who you are and your role

Shake hands, but dont force physical contact ifpatient is uncomfortable

Call the adult patient MrMrsMs (do not use

first name)


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Respect

Maintain privacy

Keep doors and curtain closed

Acknowledge and greet others in theroom

Maintain a professional appearance

clean, neat, conservative, white coat,name tag (professional authority)


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Respect

Make sure the patient is comfortable

Sit at the patient level

Be aware of the patients personal space (canvary among cultures)

Continue to consider the patient comfort during

history taking and physical examination


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Respect

Appear interested and ready to listen

Use your posture to do this

- S -- Sit square to the patient- O -- Open to the patient

- L -- Lean toward the patient

- E -- Eye contact with the patient

- R -- Relax


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Genuineness

The ability to be yourself in relationship despite

your professional role


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Genuineness It is OK to laugh at patients jokes

If patients spouse has died you might say: I

am sorry to hear that. How are you doing?

Show your true interest in the patient


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Empathy

Is the ability to understand the patientsexperiences and feeling accurately aswell as to demonstrate thatunderstanding to the patient

Is an active process

Is more than sympathy, or feeling sorryfor someone


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Empathy

If you are empathetic you will maximize yourability to gather accurate and objective data

about patients thoughts and feelings


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Empathy

Observe the patient

Pay attention to the patients nonverbalcommunication

Is the patient looking away, fidgeting or leaningaway from you while he or she talks?


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Empathy

Dont interrupt

In one study 69% physician interrupted patientswithin 18 seconds

77% of patients didnt get to fully explain theirproblem


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Empathy Enhance empathy by the way you respond to

what the patient says

Show the patient you have been listening to thecontent of their problem

Show the patient you understand theirperspective on the problem


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Empathy

Do not ignore what the patient says

Avoid minimizing his or her symptoms

Instead, reflect back to the patient


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Communication

To solve problem

To alleviate distress

To make Decision

To form & maintainrelationship

Reassurance

To Convey Feelings

To giveinformation

To persuade

Communication Purposes (Lloyd & Bor, 1996)


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Factors Influence Doctors Patients Communication

Patient Related Factors

- Physical Symptoms

- Psychological Factors anxiety, depression, anger, denial- Previous Experience of medical care

- Current experience medical care

- PTSD

Doctors Related factors

- Training in communication skills

- Self Confidence in ability to communicate

- Personality

- Physical factors (tiredness)

- Psychological (anxiety, PTSD)

The Interview Setting: Requirements

- Privacy

- Comfortable surrounding

- An appropriate seating arrangement


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Beginning an Interview?


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Patients Expression easethe interview

A comfortable setting

Being greeted by name & handshake

Being shown where to sit

The interviewer introducing her/himself &explaining the procedure

An easy first question The Interviewer appearing interesting in

your remarks


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Guidelines For Conducting an Interview Beginning The Interview

- Greet the patient (by names) & shake hands

- Ask patient to sit down- Introduce yourself as the doctor

- Explain the purpose of the interview

- Say how much time available

- Explain the need to take notes and ask if this is acceptable

The Main Part of The Interview

- Maintain positive atmosphere, warm manner, good eye contact

- Listen carefully

- Be alert to verbal and non-verbal cues

- Facilitate patients verbally and non verbally

- Use specific questions when appropriate

- Clarify what patient has told you

- Encourage patient to be relevant


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Guidelines For Conducting an Interview

Ending The Interview

- Summarize what patient has told you and ask if your

summary is accurate- Ask if they would like to add anything

- Thank the patient


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By Understanding The WholeProcess in Medical Communication

BETTER COMMUNICATION-Clearer

-More effective & efficient communication-Honesty & openness.-Trust-Mutual respect-Politeness

-Adherence-Collaboration.-More accurate information-Prevention of violent situation-Informed consent-Legal aspects


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BREAKING BAD NEWS.

CONDITIONINGPLANNING

EXPLANATION


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Bad News

Inevitable part of medical practice

Not widely taught in medical schools

Studies how patients/ families cope with badnews not the process of breaking badnews

Bad news is a relat ive con cept & shou ld

depend on patients interpretation ofin format ion & their react ion to i t wherepatients feel the news w il l adversely affect

their future


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Why is it difficult to break bad News The messenger may feel responsible and fears being blamed

Not knowing how best to do it

Possible inhibition because of personal experience of loss

Reluctance to change the existing doctor-patient relationship

Fear of upsetting the patients existing family roles/ structure

Not knowing the patient, their resources & limitation

Fear of the implications for the patient (disfigurement, pain, social andfinancial losses)

Fear of the patients emotional reaction

Uncertainty as to what may happen next and not having answers to somequestions

Lack of clarity about ones own role as a health care provider

Lloyd and Bor, 1996


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Managing difficult situation in breaking bad news To whom should bad news be given

Who should give bad news

When should bad news be given

How much bad news should be given

Should you give hope and reassurance along

with bad news


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How to give bad news Personal preparation

The Physical Setting

Talking to patient and responding to concerns

Arranging for follow-up or referral

Feed and handover to colleagues


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KEY CORE SKILL FOR BREAKING BAD NEWSEXPLANATION & PLANNING.

Preparation

Summariz ing

Negot iat ing the Agenda

Listening

Picking up Cues

The use of Silence

Discovering the patients concern and ideas

Encou raging the expression o f feel ing

Picking up the non verbal cues


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Conclusions Do doctors need communication?

Doctors need to learn essentials of goodcommunication more than under

professionals because patients arehuman with sensitive needs.

Doctors can not practice medicinewithout effective communication skills

Poor communication causes a lot ofmedico-legal and ethical problems


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Thank you

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Communication Skills in Medicine