INTRODUCTION TOBLOCK MEDICAL COMMUNICATION

Putu Sutisna

Communication:

imparting, conveying or exchanging of ideas, news, knowledge etc.

Several forms of communication.

Purposes of Communication

to form & maintain relationship to give information to convey feelings to persuade to solve problems to alleviate distress to make decisions to give reassurance

Communication in Medicine

• Doctor – patient/family

• Doctor – doctor

• Doctor – community

• In what parts of doctor-patient consultation does communication take place?

Main areas covered in Block MC1. Communication with patient

A.Taking medical history & review of body systems

B. Giving information to patientC. Special approach to specific

patient/situation2. Paper presentation and discussion3. Writing medical letters & notes, and Cur Vitae4. Scientific writing5. Health education & health promotion for

community

Good communication skills can be learnt. What are needed?

Written instructions (references) Opportunities to practice Feedbacks (SGD) Discussion on performance (SGD)

BASIC CONCEPTS OF COMMUNICATION

WITH PATIENT AND FAMILY

Putu Sutisna

Doctor-Patient Communication

Influencing Factors1. Patient-related factors

- Physical symptoms

- Pathological factors related to illness

- Previous experience of medical care

- Current experience of med care

2. Doctor-related factors-Training in communication skills- Self-confidence in ability to communicate- Personality- Physical factors (e.g. tiredness)- Psychological factors (e.g. anxiety)

3. Interview setting requirements- Privacy- Comfortable surroundings- Appropriate seating arrangement

Guidelines for conducting interview (anamnesis) with patient

A. Beginning

1. Greet patient by name, shake hand (?)

2. Ask patient to sit down

3. Introduce yourself

4. Explain purpose of interview

5. Say how much time available

6. Explain need to take notes

B. Main part of interview

1. Maintain +ve atmosphere, warm manner, eye contact

2. Use open questions, esp at beginning

3. Listen carefully

4. Be alert and responsive to verbal & non verbal cues

5. Facilitate patient verbally & non-verbally

6. Use closed questions when appropriate

7. Clarify what patient has told you

8. Encourage patient to be relevant

C. Ending

1. Summarize what patient has told you

2. Ask if patient wants to add anything

3. Thank the patient

• Three key skills for communicating effectively with patient

1. Questioning

2. Listening

3. Facilitating

Questioning Main purpose of interviewing patient:

to obtain information about patient’s condition that is accurate, complete and relevant

Good communication with patient alone contributes to correct diagnosis in about 80% of cases

• Open questions – should be used as much as possible– to obtain great deal of information from patient

“Would you please tell me how you have been feeling in the past few days?”

“I understand that you have had pain. Would you please tell me more about it?”

“Can you tell me what brings it on?”…etc

• Closed questions– Give patient little choice in the way to answer– Usually elicits little information, only “yes” or

“no”.

“Have you been feeling unwell today?”

“I see from your GP’s notes that you have had chest pain. Do you still have the pain?”

“Was it tight or dull pain?”

“Did it go down your arm?”

“Did it get worse when you exercised?”

Advantages of open questions More relevant information in given time Patient feels more involved Patient can express all concerns and

anxieties about problems

When to use close questions? To obtain specific information not yet given

by patient In emergency cases

ListeningAdvantages of active and effective listening: Gathering and retaining information accurately Understanding implications for patient of what is

being said Responding verbal & non-verbal signals or cues Demonstrating you are paying attention and

trying to understand

Facilitating Part of effective listening, aims to help patient to

talk fully about his/her problem. By verbal way

“Please go on and tell me more about your pain”.“Yes, I understand—please continue”.

By non verbal wayLeaning slightly forward toward patientMaking eye contactNodding head at appropriate time

Communication with Patient’s Family

How the family can help? Provide emotional & social support Provide practical support Provide understanding of belief about illness &

treatment

Provide information about family historyHelp avoid/overcome bad patient’s

complianceOvercome difficulties arising from secretsAnticipate/address problems that may

affect other family members

Patients appreciate/respect doctors who are warm and sympathetic are easy to talk to introduced themselves appear self-confident listen to the patients and respond to their

verbal cues ask easy-to-understand questions

Patients complain most frequently about doctors who

would not listen would not give information showed lack of concern or lack of respect

for the patients

Students who were given communication training vs those who were not:

Get 3 times more accurate information about patient’s problem

Are more emphatic More self-confident More able to use open questions and respond

to verbal cues Given higher ratings by the patients

Summary The ability to communicate effectively and

sensitively is essential in medicine Communicating effectively with patients

involves the core skills of questioning, listening and facilitating

Good communication leads to: accurate history taking and diagnosis, patients’ compliance with treatment plan, patients’ satisfaction with the care given

The skills of good communication can be learnt and retained

Having all the advances in medical science and technologies, we may not ever forget…..

the essential aim of a physician since the ancient time:

“To cure sometimes,

relieve often,

comfort always……”

THANK YOU

Lecture’s main objectives: To describe the importance of good

communication with patients To describe the factors that may influence

the outcome of communication between the doctor and patient

To explain the technique of conducting effective communication with patients that involves questioning, listening and facilitating

Non-verbal cues:Eye contactPostureGesturesFacial expressionsWay voice is used

Pitfalls in communicationAsking too many or complicated questionsNot allowing patient to tell story in his/her

own wordsUnnecessary interruptionFailing to pick up important verbal & non-

verbal cues