Communication Skills in MedicineCommunication Skills in Medicine

Tjakra W. Manuaba

Dept’ of General Surgery

School of Medicine. University of Udayana

Sanglah Academic Hospital. Bali

Tjakra W. Manuaba

Dept’ of General Surgery

School of Medicine. University of Udayana

Sanglah Academic Hospital. Bali

“An inquiring, analytical mind;an unquenchable thirst for newknowledge; and a heartfelt compassion for the ailing – theseare prominent traits among thecommitted clinicians who have preserved the passion for medicine

Lois DeBakey

What is Communication

Is the act by which information is shared between humans. Such encounter might cover:

Desires

Needs

Perceptions

Knowledge

Affective states

Is the act by which information is shared between humans. Such encounter might cover:

Desires

Needs

Perceptions

Knowledge

Affective states

The ability to communicate wellThe ability to communicate wellwith patients with patients to build up a to build up atrusting relationship within whichtrusting relationship within whichcuring relieving and comfortingcuring relieving and comfortingcan take place, is a great challengecan take place, is a great challenge

Why good medical communicationWhy good medical communicationis important? is important? better care for ourbetter care for ourpatientspatients

Sir Charles FletcherSir Charles Fletcher

Medical Communcation

Medical communication is the usual communication encounter between doctor and the patient

It can be classified according to the purpose of the interview into 4 types

– History taking

– Consultation

– Obtaining “Informed Consent”

–Breaking bad news

Medical communication is the usual communication encounter between doctor and the patient

It can be classified according to the purpose of the interview into 4 types

– History taking

– Consultation

– Obtaining “Informed Consent”

–Breaking bad news

DOCTORS – PATIENTS RELATIONSHIP.

Not anymore paternalism

Should be partnership basis.

Doctor-Patient collaboration vs health problem

Equal

Not anymore paternalism

Should be partnership basis.

Doctor-Patient collaboration vs health problem

Equal

CommunicationCommunication

To solve problemTo solve problem

To alleviate distressTo alleviate distress

To make DecisionTo make Decision

To form & maintainTo form & maintainrelationshiprelationship

ReassuranceReassurance

To Convey FeelingsTo Convey Feelings

To giveTo giveinformationinformation

To persuadeTo persuade

Communication Purposes (Lloyd & Bor, 1996)Communication Purposes (Lloyd & Bor, 1996)

By Understanding The Whole Process in Medical Communication

BETTER COMMUNICATIONBETTER COMMUNICATION-Clearer Clearer -More effective & efficient communicationMore effective & efficient communication-Honesty & openness.Honesty & openness.-TrustTrust-Mutual respectMutual respect-PolitenessPoliteness-AdherenceAdherence-Collaboration.Collaboration.-More accurate informationMore accurate information-Prevention of violent situationPrevention of violent situation-Informed consentInformed consent-Legal aspectsLegal aspects

Bad News

Inevitable part of medical practice

Not widely taught in medical schools

Studies how patients/ families cope with bad news “not the process of breaking bad news”

Bad news is a relative concept & should depend on patient’s interpretation of information & their reaction to it where patients feel the news will adversely affect their future

Inevitable part of medical practice

Not widely taught in medical schools

Studies how patients/ families cope with bad news “not the process of breaking bad news”

Bad news is a relative concept & should depend on patient’s interpretation of information & their reaction to it where patients feel the news will adversely affect their future

BREAKING BAD NEWS….BREAKING BAD NEWS….

CONDITIONINGPLANNINGEXPLANATION

Conditioning…familiesstep by step….

Family learns to accept the bad situation

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 patient’s existing family roles/ structure

Not knowing the patient, their resources & limitation

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

Fear of the patient’s emotional reaction

Uncertainty as to what may happen next and not having answers to some questions

Lack of clarity about one’s own role as a health care provider

Lloyd and Bor, 1996

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 patient’s existing family roles/ structure

Not knowing the patient, their resources & limitation

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

Fear of the patient’s emotional reaction

Uncertainty as to what may happen next and not having answers to some questions

Lack of clarity about one’s own role as a health care provider

Lloyd and Bor, 1996

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

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

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

Personal preparation

The Physical Setting

Talking to patient and responding to concerns

Arranging for follow-up or referral

Feed and handover to colleagues

KEY CORE SKILL FOR BREAKING BAD NEWSEXPLANATION & PLANNING.

Preparation

Summarizing

Negotiating the Agenda

Listening

Picking up Cues

The use of Silence

Discovering the patient’s concern and ideas

Encouraging the expression of feeling

Picking up the non verbal cues

Preparation

Summarizing

Negotiating the Agenda

Listening

Picking up Cues

The use of Silence

Discovering the patient’s concern and ideas

Encouraging the expression of feeling

Picking up the non verbal cues

ConclusionsConclusions

Doctors do need communication skill

If Doctors have more times, “bad news” should be given “step by step” by “conditioning” patients and family

Doctors should convey “bad news” without delay

“Bad News” should be carefully and systematically “prepare”, by learning the background of the patient and family

Doctors do need communication skill

If Doctors have more times, “bad news” should be given “step by step” by “conditioning” patients and family

Doctors should convey “bad news” without delay

“Bad News” should be carefully and systematically “prepare”, by learning the background of the patient and family

Thank youThank you