DR. SALAH R EL-FAQIH

The Concept of Communication Skills in Medicine

What is Communication

● Is the act by which information is shared between humans

● It is the process by which we relate and interact with other people.

● It is a mutual process between 2 sides (Dialogue) not a one sided monologue.

● It includes listening & understanding with passion & respect as well as expressing views & ideas and passing information to others in a clear manner.

COMMUNICATION THEORY

●Communication is a learned skill or a series of learned skills which is based on 3 pillars: Accuracy Efficiency Supportiveness All combined contribute to effective communication

Communication: Why?

● Effective communication is the basis of mutual understanding & trust.

● Poor communication causes a lot of misunderstanding & hinders work & productivity.

Types of communication

Verbal Communication

Speaking to the person Look straight in the eye make eye-ball contact Show respect

Clear message Relevant Use understandable language Support by illustrations if needed

Good listener Allow them to understand the message and reply Listen carefully Make a dialogue ant not one way instruction

Communication & Medicine

●Historically the emphasis was on the biomedical model in

medical training which places more value on technical

proficiency than on communication skills.

●Recently learning communication skills & evidence based

practice become integral part of modern medicine training.

●In healthcare institutions ,effective communication is

essential for patient safety

From the doctors What is required

● Support patients in caring for themselves to improve and maintain their health

● Work in partnership with patients

● Listen to patients and respond to their concerns and preferences.

● Give patients information in way they can understand

● Taking patient’s views into consideration when assessing their condition

● Respond to patients questions , keep them informed & share information .

● Support patients to self care

● Treat patients politely and considerately

● You must make sure, wherever practical, that arrangements are made to meet patient’s language and communication needs.

● Respect patients rights to confidentiality

● You must be considerate to relatives, carers and partners be sensitive and provide information and support.

continue-From the doctors What is required

● Communicate effectively with colleagues within and outside the team

● Make sure your patients and colleagues understand your role and responsibilities in the team and who is responsible for each aspect of patient care

● You must treat your colleagues fairly and with respect

● When referring a patient you must provide all relevant information about the patient.

Do doctors need communication?

● Doctors need to learn essentials of good communication more than other professionals because patients are humans with sensitive needs.

● Doctors cannot practice medicine without effective communication skills.

● Poor communication causes a lot of medico-legal and ethical problems.

Communication: With whom?

● Patients & care-givers● Nurses & auxiliary staff● Colleagues● Administrators● Evidence in court● Reporting research findings● Talking to the media● Public & legislature

Communication: How?

The medical interview is the usual communication encounter between the doctor and the patient.

It can be classified according to the purpose of the interview into 4 types: History taking Breaking bad news Consultations Obtaining informed consent

Effective communication

● Ensures good working relationship● Increases patients satisfaction● Increases patients understanding of illness &

management● Improves patients compliance with treatment● Reduce medico-legal problems● Reduce uncertainty

Principles of effective communication

● Ensures an interaction rather than a direct transmission process (telling someone what to do or only listening is not enough).

● Demonstrates involvement as well as flexibility in relation to different individuals and contexts.

Principles of effective communication

● Requires planning and thinking in terms of outcomes.● Follows the helical model ( i.e. what I say influences

what you say in a spiral fashion and coming back around the spiral of communication at a little different level each time is essential).

● Shows empathy & learn how to handle emotional outbreaks.

COMMUNICATE AS A TEAM

●patient

●family

●physician

●other health care providers

● psychologist

● nurse

● social worker

● dietician

Communication with peers

●Mutual trust & respect

●Exchange information

●Ask your seniors

●Do your share of work

Communication & Medical care

● Good communication should be established between the patient , the family and the treating multidisciplinary team.

● patient & family should be encouraged to participate and verbalize in the ward round discussion about: Offered medical care & treatment Rehabilitation Follow- up/re-admission plans Doubts & worries.

Communication & Medical care

● Proper information to patient and family regarding services available and how they can utilize them.

● Information should be made available on: Health Education/ Counseling & Psychiatry. Endocrine, Metabolic, Neurology & nephrology. Cardiology, Respiratory, GIT & hematology. Nutrition, Immunization & ambulatory care. Infections & infection control. Clinical pharmacy & therapeutics. Hygiene and Safety.

Communication skills: Some techniques

● Develope fluent dialogue with the patient● Use silence effectively, allowing patients enough time to express

thoughts or feelings● Actively encourage the patient through use of supportive words

or comments● Dialogue with patients is enhanced by effective use of non-verbal

behaviour● Use open, exploratory questions – inviting patient to become

actively involved● Adjusted language as appropriate, to suit particular needs of the

situation

Listening vs Hearing

● Hearing - a passive activity; no effort● Listening - requires

active involvement, attention interpretation of message understanding takes time and effort

Listen with Attention

● focus on patient or relative and give physical attention

● suitable environment - remove distractions and interruptions, make speaker feel comfortable

● eye contact● use positive body language

Barriers to effective communication

● Personal attitudes

● Language

● Time management

● Working environment

● Ignorance

● Human failings (tiredness, stress)

● Inconsistency in providing information

The Art of Consultation

● Gauging the correct amount and type of information to give to each individual patient.

● Providing explanations that the patient can remember and understand & which relate to the patient’s illness framework.

● Using an interactive approach to ensure a shared understanding of the problem with the patient.

● Involving the patient and collaborative planning increase the patient’s commitment and adherence to plans made.

● Continuing to build a relationship and provide a supportive attitude.

Initiating the Consultation

● Establishing a supportive environment.● Developing an awareness of the patient’s emotional

state.● Identifying as far as possible all the problems or issues

that the patient has come to discuss.● Establishing an agreed agenda or plan for the

consultation.● Enabling the patient to become part of a collaborative

process.

Closing the interview

● Confirming the established plan of care.● Clarifying next steps for both doctor and patient.● Establishing contingency plans.● Maximizing patient adherence and health outcomes.● Making efficient use of time in the consultation.● Continuing to allow the patient to feel part of a

collaborative process and to build the doctor-patient relationship for the future.

Consultation Framwork

Providing

Structure

Initiating the Session

preparation

establishing initial rapport

identifying the reason(s) for the consultation

providing the correct amount and type of information

aiding accurate recall and understanding

achieving a shared understanding: incorporating the patient’sillness framework

planning: shared decision making

Closing the Session

Building therelationship

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Gathering information

Physical examination

Explanation and planning

making organisation overt

attending to flow

• exploration of the patient’s problems to discover the:

biomedical perspective the patient’s perspective

background information - context

• ensuring appropriate point of closure• forward planning

using appropriate non-verbal behaviour

developing rapport

involving the patient

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Doctors-Patients Relationship

● Developing rapport to enable the patient to feel

understood, valued and supported.

● Encouraging an environment that maximizes accurate and

efficient information gathering, planning & and

explanation.

● Enabling supportive counseling as an end in itself.

Doctors-Patients Relationship/2

●Involving the patient so that he/she understands and is

comfortable with the process of the consultation.

●Increasing both the physician’s and the patients’

satisfaction with the consultation.

●Developing and maintaining a continuing relationship of

trust & respect over time.

Conclusion

● Communication between the patients, family and heath team play a vital role in the compliance to outpatient clinic visits and in-patient care programs.

● Good communication is essential for proper doctor-patient relationship and help avoids problems of misunderstanding.

● Effective communication is the key to success in professional career.

● Effective communication is essential to the practice of high quality medicine