Transcript Communication with Patients: “The Dance We Do”

Patient
Communication
“The Dance We Do”
Brian E. Wood, D.O.
Associate Professor and Chair,
Department of Neuropsychiatry and Behavioral Sciences
Edward Via Virginia College of Osteopathic Medicine
[email protected]
Communication
• a process by which information is exchanged
between individuals through a common
system of symbols, signs, or behavior
• exchange of information
• personal rapport
Meriam-Webster Online Dictionary
Why Communicate?
• To include someone in
interaction
• To impart to someone
something you want them to
understand.
• To attempt to understand
something about others.
• Innate human drive to seek
others.
– Fascination with the existence
of other life
– Personification in
fantasy/literature, etc.
Biology of Communication
Very complex interplay of physiological functions
controlled by the:
The Missing Link
• Brain functioning and communication are directly linked.
• The brain, when working properly, uses many complex
mechanisms of communication to “connect” with other
organisms.
• One of the predominant mechanisms is language but there
are others.
– Posture, physical presence
– Gestures and mannerisms
– Appearance and expression
Mental Status Exam
• Observation of brain functioning is the goal
• Complications/limitations
– Attempting to derive information about brain functioning
through observation of behavior and responses to tasks,
etc.
– Looking at brain functioning through overlay of learned
responses, behavior, dynamics, etc.
• Examination remains science with art
– Not unlike any other medical examination (ex.
Auscultation)
Characteristics of Patient
Communication
• Mental Status (functioning of the CNS) is
integrally involved
• There are two parties
– You
– The patient
• There is a constant two way street
– Communication to and from the patient
• There is a dynamic interplay
Language
• Language encompasses many complex processes.
• Not just speech
• Expressive language
– Written
– Verbal
– Prosidy
• Receptive language
– Written
– Verbal
– Prosidy
Non-verbal communication
• Patient appearance
– Anxious ?
– Distracted?
• Does the non-verbal communication conflict
with verbal ?
– Often when patients have barriers to verbal
communication (ambivalence, social barriers,
etc.), we see mixed messages from verbal and
non-verbal sources.
Eliciting Information
• Eliciting information from only verbal sources
– Content or fact oriented
– Very limited scope to patient communication
– Close ended factual information gathering
• Eliciting information from multiple sources
– Much more complete view of patient status
– Content (static) plus Process (dynamic)
information
– Open ended
Patient Interview Design
Information In
• Should incorporate
ways of getting both
content and process
information.
• Open ended questions
for sensitivity.
• Close ended questions
for specificity.
Open Ended
Process
Close Ended
Content
Information Out
Patient Interview
• Content
– Factual (ex.)
• History of illnesses
• Current living
arrangements
– Close ended
– Provided directly or
indirectly.
• Process
– Interaction based (ex.)
• Rapoirte
• Openess to examiner
– Open ended
– Based on observation of
patient and
environmental
interactions.
Effects of CNS Abnormalities
• Can abnormalities in brain functioning affect
content of information? What brain functions
might be involved?
– Fairly direct relationships.
• Can abnormalities in brain functioning affect
process information? Which brain functions?
– Much more complex issues
– May be subtle but very significant
Mental Status Abnormalities and
their Effects
• Content
– Factual errors
– Distortion of
information (ex.
Negativistic thinking)
• Process
– Inability to establish
relationship with
examiner.
– Inability to filter
extraneous
environmental cues
– Inability to understand
(capacity)
Factual Errors and Distortions
• May introduce error into elements of history
and thus diagnostic decisions.
• May be dependent on multiple factors
including patient functioning and
environment.
• Usually requires corroborating source of
information.
Inability to Interact with Examiner.
• May result in complete inability to acquire
reliable factual information.
• Be aware of your interactions and how the
patient is interpreting them.
• May require treatment of the patient and/or
adjustment of examiner technique in order to
engage patient in therapeutic interaction.
Capacity
• Ability to engage in some sort of cognitive
process
• Many different types or areas of capacity
– Capacity to understand
– Capacity to manage affairs
– Capacity to give informed consent
• Not an “all or nothing phenomenon”