Communication Skills in Clinical Practice

Aim

• Give the patient adequate opportunity to express his feelings

• Help to elicit as accurately as possible, the information needed to make a diagnosis and plan treatment in the limited available time

DEFINITIONS

The exchange of thoughts, messages, or information, as by speech, signals, writing, or behavior.

Interpersonal rapport. The art and technique of using words effectively

to impart information or ideas. The field of study concerned with the

transmission of information by various means, such as print or broadcasting.

Any of various professions involved with the transmission of information, such as advertising, broadcasting, or journalism

Definitions

Standard Definition

Communication is a process whereby meaning is defined and shared between living organisms. Communication requires a sender, a message, and an intended recipient, although the receiver need not be present or aware of the sender's intent to communicate at the time of communication

SOME HARD FACTS

• 77% of patients don’t express their reason of attendance during consultation

• 50% of patients leaving doctor’s office with insufficient information on their illness

• 50% of patients leaving doctor’s office don’t know how to use their medication

Patient Communication

70% of the patients can be diagnosed by only communication

Patient satisfaction increases when he/she can have a good communication with doctor

Doctors who are good communicators are less suited by their patients

CONTD

Components of CommunicationSource Mess

age

Vehicle

Receiver

Feedback

Vocabulary• The doctor should ask questions in clear,

unambiguous language suitable to the patient's age, education, and cultural background.

• The pattern of questions should follow some logical grouping and sequence. If the doctor does have an after-thought, he should explain himself.

• Topics that the patient may feel sensitive about should usually be introduced in the latter part of an interview when confidence and rapport have been established.

Causes of Reticence• The presence of a third party

• Sometimes the fact that the doctor is also the family doctor may inhibit an adolescent from speaking freely.

• The patient may fear that revealing his complaints will lead to the realization of his worst fears.

• A reluctance to take up the doctor's time with concerns that the patient may feel are undeserving of his time and attention.

• Embarrassment or shame about the nature of the complaint

• Cultural barriers

Ways Of Facilitating Communication

• By Non-verbal (body) language

• By speech

• By appropriate use of silences

Non - Verbal

• Unhurried manner • Head nodding• Eye contact• Smiling• Discarding pen and notes• Leaning forward towards the patient• Active (attentive) listening• Appropriate use of touch• Empathy: the capacity to sense what it is like to be

the patient

By Speech• A variety of simple short responses from the doctor will encourage the

patient to continue speaking. e.g. “Yes, I see”, “Go on”, “I understand”. • Reflecting: encouraging the patient to continue speaking by reflecting

back to him a phrase, idea, or significant word from what the patient has said.

Patient: "The period pain are not too bad, but the headaches I get

before the periods starts to make me desperately miserable for three or four days every month"

Doctor: "You feel desperate at that time? Patient: "Yes, to be honest I do. Recently there have been several

times when I have thought of doing away with myself, because at that time it felt as if there was nothing to live for"

• Clarifying: make clear to the patient what he is trying to put into words

e.g “Are you trying to tell me that you are really afraid this is something very serious? Is that what you feel?

• Summarizing: summarizing all or part of the patient's accounts of things

e.g "So if we could just go over the main points of what you

have told me so far. Your periods were perfectly normal and regular until five months ago. Then you missed two periods completely and then bled heavily for three weeks. Since that time there has been some scanty loss most days, but no pain at any time. Is that correct?

CONTD

Appropriate Use Of Silences

Silence can occur when the patient runs out of words or is unsure about expressing his feelings:

- Resist the temptation to disarm the silence with

a new question on a new topic. - Let the silence remain unbroken for a little time

while continuing to look at the patient with a facial expression of unhurried, interested and concerned.

- Signal “Go on” either verbally or non-verbally.

Facilitating The Open Expression Of Deep Feelings

Resist the temptation to jump in with distracting questions or a less motive topic.

Do not exhort the patient to cheer up or to "take a grip on themselves"

Remains silent for a moment and continue to look towards the patient with an expression of concern

Mirroring: letting the patient see what his non-verbal expression show (like holding a mirror)

“You were almost biting your teeth when you mentioned your son"

If the patient shows evidence of suppressed emotions the doctor should:

Confrontation: a more blunt and direct way of saying what the patient appears to be going through.

“You were very angry when you mentioned your son”

CONTD

SPECIAL SITUATIONS

Breaking the Bad News Difficult Patient Patient Centered Approach Decision Making Art of Presentation

Special Considerations

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.محرم