Doctor-patient communication

Dr Allan M Cyna DRCOG, DipClinHyp, FRCA, FANZCA, PhD

Senior Consultant Anaesthetist, Women’s and Children’s Hospital

Clinical Senior Lecturer, University of Adelaide

Consumer Enablement Spotlight Series – Communication

Little words BIG Impact!

Dr Allan M Cynaallan.cyna@sa.gov.au

Feb. 25th 2020

Doctor-Patient communicationDisclosures

•The subconscious affects everything we perceive and do

•No Financial or other known disclosures

Consumer Enablement Spotlight Series –Communication myths

•Effective communication can’t be taught?

•It is helpful to:• Warn patients about a sting if you believe it hurts?• Let the patient know you understand how they feel?

•Communication using logic is usually effective?

Doctor-patient communicationWords that hurt! Words that help!

•The GREAT LAURS of communication

•Subconscious communication

•The paradox of informed consent

Communication and Language

• A means of expressing how we perceive the world

• A tool for exchanging information and meaning• A way to connect with others• The human dimensions of communication

• The practical, social, linguistic, lyrical, subliminal…..

• The ability to inform, soothe or terrify!

Doctor – patient communicationWords that hurt! Words that help!

ConsciousSubconscious

Being in “two minds”

Being “besides oneself”

“Out of body experiences”

“Daydreaming”

“Tuning out”

Doctor patient communicationCommunicating pain in the main is plainly in the brain!

Doctor – Patient communicationSetting the scene

•Helplessness and dependence

• Loss of control

•A hostile system

•Patients may view themselves as Victims to their illness

•Recipients of incomprehensive technology

•Passive and Voiceles

Doctor – patient communicationGoals?

Clinician

•Safety•Comfort •Control

•Choices

Patient

•Control•Choices• Comfort

• Safety

Optimising Communication: Why bother?

•Facilitates cooperation

•Provides analgesia / anxiolysis

•Easy to administer / Rapid onset

• Inexpensive

•Minimal side effects

•Empowers the patient

Doctor-Patient communication The Language of the subconscious

• Imagery and Imagination

• Experiencing and eliciting a subconscious response!

Doctor – patient Communication

•Listening

•Acceptance

•Utilisation

•Reframing

•Suggestion

Doctor-Patient communication The 75 essential steps for Effective Communication

Listen Listen Listen- Listen- Listen - Listen- Listen- Listen Listen Listen- Listen- Listen- Listen- Listen- Listen- Listen-Listen- Listen Listen Listen Listen- Listen- Listen - Listen-Listen- Listen Listen Listen- Listen- Listen- Listen- Listen-Listen- Listen- Listen- Listen Listen Listen Listen- Listen-Listen - Listen- Listen- Listen Listen Listen- Listen- Listen-Listen- Listen- Listen- Listen- Listen- Listen Listen ListenListen- Listen- Listen - Listen- Listen- Listen Listen Listen-Listen- Listen- Listen- Listen- Listen- Listen- Listen- Listen

Listen, Listen, Listen

Reflective listening and checking in!

Did you hear what was said?

Did you understand what was meant?

Does the patient know they have been

heard and understood?

Doctor-Patient communication LAURS Acceptance - Appreciating different realities

1. The first reality

2. The second reality

3. The third reality

Doctor-Patient communication 2 sides of the same coin?

•Placebo

•Nocebo

Doctor-Patient communication

LAURS Acceptance - Appreciating different realities

“It’s a molten sword piercing my skin”

“It’s a horse needle”

Doctor-Patient communication LAURS

Utilisation

•Visual language• “I’m not looking forward to my blood test”• “I can’t see myself doing well”

•Auditory language• “That doesn’t sound good!”

•Kinaesthetic language• “I think what you’ve said feels OK”

Doctor-Patient communication

LAURS Utilisation

• Favourite activity

(?As a focus during potentially painful procedures)

• Favourite food Drink ?antiemesis

Doctor-Patient communication

LAURS Reframing

“The local anaesthetic stings”

LAURS Suggestion

• Direct / Indirect

• ‘Yes’ sets

• Truisms

• Reversed effect

• Double binds

• Use of Metaphor

Doctor-Patient communication

• “Let me know when you have pain!”

• “Let me know when you feel comfortable”

• “This is going to sting a little!”

• “This is going to numb the skin to allow us to finish the procedure”

• This may hurt!• This may or may not feel comfortable

Words that hurt! Words that help!

• “Try not to move!”

• “You will find you can stay still!”

• “Its only a Sharp scratch”

• “You may or may not feel something!”

• We’ll start placing the small needle• “We are just finishing!”

Words that hurt - Effects of negative suggestion!

Words that hurt! words that help! Metaphor

Velcro and Teflon

Doctor-Patient communicationLAURS in an emergency

“If you come near me with that needle, I’ll die!”

“Are you trying to do a hypnotic arm anaesthesia?”

“I can’t listen to you!”

Doctor-Patient communicationSabotage words

TRY

Pain

Apologising

Worry

Not

Communication and the doctor - patient interactionA GREAT way to communicate

•Greeting

•Rapport

•Expectations

•Addressing concerns

•Tacit agreement

Doctor-Patient communication

The GREAT acronym - Greeting

•What do you like being called?

•What do your friends call you?

•Is it Ok if I call you …….?

Doctor-Patient communication

The GREAT acronym - Rapport

•L•A

•U•R•S

Doctor-Patient communication

GREAT Expectations

•What is the goal of the interaction?

•Expectations of both staff and patients

•Mutual decision making

Doctor-Patient communication

The GREAT acronym – Addressing concerns

•Patient

•Family

•Clinician

Doctor-Patient communication

The GREAT –ThanksThanking the patient has 4 meanings

1. Tacit agreement

2. Thanking the patient

3. Reinforcing success

4. Terminating the interaction

Achieving the goal!

“A goal without steps is merely a wish!”

Yapko 2008

Achieving the goal! Asking permission- Is it OK to……..

stand next to you?......look at the arm?

put this tourniquet on, so the arm can feel sleepy?

tap the hand so it feels sleepier than it is already?

wipe the sensation away with the antiseptic?

Keep the arm still whilst we Finish?

Doctor patient communication for painful procedures

• Feel the arm relax….

• You don’t have to try

• As you focus…….

• Allow the arm go tingly heavy and sleepy

Doctor-Patient communication

Lived in imagination for children

The girl with abdo pain who loved musicals

The 5 year old boy with needle phobia

In Summary!

“Whether you think you can or whether you think you can’t – You are probably right!”

Adapted from Henry Ford

Doctor-Patient communication

•Appreciate the impact of language

•Believe that patients can do more than

• they think they can•you think they can

•Control and choices are important