Transcript Document

Communication and
Patient Interviewing
Introduction to Primary Care:
a course of the Center of Post Graduate Studies in FM
PO Box 27121 – Riyadh 11417
Tel: 4912326 – Fax: 4970847
1
Land
Working
Man
Women
Family
Chatting 
2
Aim
• Aim: At the end of this session, the participants
are expected to have knowledge on
communication skills and patient interviewing.
• Objectives:
– Knows basic principles of communication
– Knows the place of verbal and nonverbal
communication in patient interview
– Is aware of the importance of nonverbal clues
– Know the importance of hidden agenda
– Can explain the interview process
3
What is communication?
• A process of production and submission of
knowledge/symbols, which are received and
interpreted by the other party.
• Sharing
4
The communication model
Signal
Source
Sender
Channel
Receiver
Target
Noise
Physical noise
Psychological noise
Shannon and Weaver
Neurophysiological
noise
5
Patient communication
• 70% of the patients can be diagnosed by
only communication
• Doctors who are good communicators are
less suited by their patients
• Patient satisfaction increases when he/she
can have a good communication with the
doctor.
Lussier MT. Doctor-Patient Communication. Canadian Family Physician. 2006;52:1401-1402
6
However
• Percentage of doctors interrupting patients
speech within the first 18 seconds:
– 69%
• Proportion from these patients who didn’t
even express their reason for encounter:
– 77%
Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Ann Intern Med 1984;101:692-6
7
Moreover
• Percentage of patients leaving doctors office who
do not have enough information on their illness:
– 50%
• Percentage of patients who do not know how to
use their medication:
– Around 50%
• Percentage of patients not adhering to the
suggestions of their doctor:
– 22-70%
8
The balance of power and relationship
John Mole. Mind Your Manners. Nicholas Brealey Publishing. http://www.johnmole.com/
9
Components of face to face
communication
• Verbal (% 7)
• Paralanguage (% 38)
• Body language (% 55)
10
Verbal communication
•
•
•
•
•
•
•
•
•
Things spoken
Things not spoken
Stumbling
Indecision
Hesitation
Avoidance
Whethering
Reflection
Hidden (masked) communication
11
Nonverbal communication
•
•
•
•
•
•
S (smile)
O (open posture)
F (forward lean)
T (touch)
E (eye contact)
N (nod)
12
Hand shaking
13
Forward lean
14
Personal distance
Robert E. Rakel. Textbook of Family Practice 6th edition, 2001
15
Personal distance
46 cm
Intimate
1.2m
Personal
1.2-3.6m
3.6m
Social
Common
16
Mimics
17
18
19
20
Respiratory avoidance
Ekman P, Friesen WV: Unmasking the Face: A Guide to Recognizing Emotions from
Facial Clues. Englewood Cliffs, NJ, Prentice-Hall, 1975.
21
Mirroring
22
Father: How does his heart sound?
Doctor: Sounds pretty good. He’s got a little murmur there. I’m not sure
what it is. It’s … it uh … could just be a little hole in his heart.
Mother: Is that very dangerous when you have a hole in your heart?
Doctor: No, because I think it’s the upper chamber, and if it’s the upper
chamber then it means nothing.
Mother: Oh.
Doctor: Otherwise they just grow up and they repair them.
Mother: What would cause the hole in his heart?
Doctor: H’m?
Mother: What was it that caused the hole in his heart?
Doctor: Doctor: It’s cause … uh … just developmental, when their uh …
Mother: M-h’m
Doctor: There’s a little membrane that comes down, and if it’s the upper
chamber, there’s a membrane that comes down, one from each direction.
And sometimes they don’t quite meet, and so there’s either a hole at the
top or a hole at the bottom and then … it’s really uh … uh … almost
23
never causes any trouble.
Mother: Oh.
Doctor: It’s uh … one thing that they never get SBE from … it’s the only
heart lesion in which they don’t.
Mother: Uh-huh.
Doctor: And uh … they grow up to be normal.
Mother: Oh, good.
Doctor: And uh … if anything happens they can always catheterize them
and make sure that’s what it is, or do heart surgery.
Mother: Yeah.
Doctor: Really no problem with it. They almost never get into trouble so
…
Mother: Do you think he might have developed the murmur being that
my husband and I both have a murmur?
Doctor: No.
Mother: No. Oh, it’s not hereditary, then?
Doctor: No.
24
Mother: Oh, I see. [Someone whistling in the room]
Doctor: It is true that certain people … tendency to rheumatic fever, for
instance.
Mother: H’mm.
Doctor: There is a tendency for the abnormal antigen-antibody reaction
to be inherited, and therefore they can sometimes be more susceptible.
Mother: Oh, I see. That wouldn’t mean anything if uh … I would … I’m
Rh negative andhe’s positive. It wouldn’t mean anything in that line,
would it?
Doctor: Uh-huh.
Mother: No? Okay.
Doctor: No. The only thing you have to worry about is other babies.
Mother: M’h’m.
Doctor: Watch your Coombs’ and things.
Mother: Watch my what?
Doctor: Watch your Coombs’ and things.
Mother: Oh, yeah.
25
Doctor: Your titres, Coombs’ titres. (p 68)
The body language
26
Hand-on-the doorknob syndrome
• Sometimes what hte patient says at the door
is his/her real reason for coming.
• The door is safe; patient can leave easily if
refused.
• Ask at the end: “Is there anything we have
not covered or anything else you would like
to ask me?”
Quill TE: Recognizing and adjusting to barriers in doctor-patient communication.
Ann Intern Med 111:51, 1989.
27
Patient interview
• Summary sentences
• Recognize deviations in perception/expectations
• Patient empowerment
• Patient participation
• Attentive listening
28
Traps in the interview
•
•
•
•
•
•
•
Direct questions
“Why” questions
Guiding questions
Yes-No questions
Sudden topic changes
Loss of eye contact
Loss of feedback
29
Problem patients
• Defensive patient
• Anxious patient
• Angry patient
• Selfish and demanding patient
30
Changing reactions to problem patients
• It is possible to change the process and
initiate a new behavior
– How did I interpret the patient’s statements or
behavior to make myself angry?
– Is there another way to interpret the patient’s
behavior?
31
Summary
•
•
•
•
What is communication?
What models of communication do you know?
1/2 of communication is by body language
The best doctor-patient interview is by sitting on
both sides of the table
• Nonverbal messages are produced intentionally
• In which body position is the patient most
receiving if you give some kind of education?
32