Transcript 2 Communication in medical practice

Communication in medical
practice. Formation of the
medical staff and its impact on
the education of the individual.
Relations between the medical
staff of various units.
What can studying communication skills
offer us as medical practitioners?
Increased Job Satisfaction
Decreased Conflict Within The Consultation
More Accurate And Efficient Interviews
Better Clinical Hypothesis Generation
Increased Patient Satisfaction
Increased Patient Understanding And Recall
Improved Compliance And Disease Outcome
Decreased Medico Legal Complaints
Actual Savings In Time
More Structure And Control Of The Difficult Consultation
Treatment Outcome:
Effective diagnoses and treatment depends not only on
identifying physical symptoms of illness, but also on the
ability to detect and respond to verbal and non-verbal
cues, to elicit all relevant information (physical and
psychosocial), relevant to diagnoses and treatment.
Patient’s Adherence:
A poor communication skill is related to poor compliance.
Communication skill training has a positive influence on
patient compliance with prescribed medication. Effective
communication enables health professions to pass on
relevant health information, and to motivate patient to
pursue healthier lifestyle. This is a very important part on
health promotion.
Competence & Self-Assertion:
Research has also shown that better communication can
also contribute to the clinical professional and
personality (self-confidence) aspects.
Patient’s Satisfaction.
Many researches have also shown a significant
relationship between the clinician’s interpersonal skills
and patient’s motivation and satisfaction. When the
medical specialist dominates the interview, verbally and
emotionally, the result is always leads to dissatisfaction
of the patients and their relatives. This may also be
related to the patient’s expectation.
Patient’s satisfaction plays a major role in assessing
quality medical care in the newly adopted health system
(manages care) in the USA.
Cognitive Satisfaction: How satisfied is the patient with
their understanding of the diagnoses, treatment, and
prognoses. This is related to the Verbal Behavior.
Emotional Satisfaction: This is related to the nonverbal behavior. The ability to show care and concern
by tone of voice, eye gaze, facial expression, body
movement and posture.
INTERVIEWING
CORE COMMUNICATION
SKILLS: Core communication
AND
skills covers three
dimensions:
COMMUNICATION
• interpersonal skills
SKILLS
• Information gathering skills
• Information giving skills and
patient education
Advanced Communication
Skills
• Skills for motivating patient
adherence to treatment plans
• Other applications of core
communication skills in
specific situations.
Information gathering skills
A critical part of all interactions involves eliciting
information from patient. The core skills which are
needed to facilitate the process of information gathering
are skills which help to facilitate the patients’
involvement in the medical interview in away that
enables to arrive at an accurate diagnosis of a patient’s
problem or symptoms.
Using an appropriate balance of open to closed
questions
Open questions invite an extended answer, not a
“Yes/No” response. Generally questions such as “Please
tell me about your pain” are better at eliciting information
than closed questions such as “Is it a stabbing pain?”.
Open questions are particularly useful patients are being
asked to describe their problem; which they should be
allowed to do minimal interruption early on in the
consultation.
Silence
You need to learn to use silence appropriately as a way
to encourage express themselves more fully, raise
difficult topics and remember important
Clarifying patient expectations about the consultation
You need to clarify with the patient what their
expectations are consultation, and should avoid making
premature conclusions about the reason person’s visit to
the pharmacist. This may helps to reveal cases where
the symptom the patient is not in fact the patient’s main
concern, and will also help to avoid inaccurate diagnosis
of the patient’s complaints.
Clarifying the information given by the patient
You need to clarify the meaning of what the patient is
saying and the pharmacist perceives from the patient’s
non-verbal communication in order to he/she
understands the patient fully.
Sequencing of events
After eliciting a broad description of the patient’s
situation, students need to help the patient to sequence
events and experiences in order to develop a logical of
the patient’s situation.
Directing the flow of information
While it is important that patients be allowed the
opportunity to communicate at the same time the student
needs to learn to maintain control of the interview, by
guiding the interview content towards a diagnosis of the
problem.
Summarizing
Since a lot of information can be exchanged in
consultations, you should be able to summarize the main
issues raised during the consultation and should ensure
that a shared understanding of these.
Information giving
skills and patient
education
The medical interview usually involves the pharmacist in providing
information to the patient about their illness or problem, and when
appropriate he will give inform and advise about the proposed
treatment plan or treatment options.
Providing clear and simple information by monitoring jargon, and by
checking the patient’s understanding before (“What do you know
about asthma?”) and during (“Have I made myself clear?”) the
explanation process.
Using specific advice with concrete examples. Abstract or general
advice/inform should be exemplified in terms that make sense to the
patient “Don’t use acidic foods for example steer clear of fried
things”.
Putting important things first. Research suggests that what is said
first is remembered. A pharmacist should say first what it is most
important for the patient to recall
Using repetition. Repetition should be used carefully to a
level appropriate to patient. Often it is best to recycle
information using slightly different words, in case the
formulation has been only partly understood.
Summarizing. This is an important interview-closing skill
(see above). Sum should be brief, and repeat the main
points agreed in language, which is unambiguous clear.
Patients may also be invited to repeat the instruction to
ensure that they shared understanding.
Categorizing information to reduce complexity and aid
recall. Where the information to be conveyed is complex,
or where there is a lot to be said, it should be clearly b
down into manageable units which are clearly signaled
to the patient, using markers s “there are three things we
need to think about ... firstly/secondly/thirdly etc”.
Using tools: Complex information could well be
accompanied by a series of heading and
diagrams.
Checking patient understanding of what has
been said. Repeating instructions, using
diagrams, written instructions, and sometimestechnical aids to explain difficult concepts are
useful. The student must be competent in
summarizing the information given and in
checking patient understanding by asking the
patient to repeat what heard and understood.
Skills for motivating
patient adherence to
treatment plans
The list below includes skills for the promotion of behaviour. Realistic
compliance with treatment plans may require patients to make
significant changes in their diet, lifestyle or daily routine on a short term
or long term basis.
Providing a rationale for behavior change
Providing examples of role models
Allowing opportunities for verbal rehearsal of the details of the
treatment
Feedback (positive reinforcement of constructive behaviour changes
already achieved since earlier consultations)
Finally, pharmacists should be aware about the clincial,
communication and interpersonal skills that are required when dealing
with difficult patients,(e.g., overdependent, dramatizing and
exaggerating, aggressive, and antisocoial personalit.
Interpersonal skills
Appropriate physical environment
The need to establish an appropriate
physical environment to enhance privacy
and attentiveness. Small things like
arranging seating in a manner which neither
threatening nor distant, or having a curtain to
create a sense of privacy will in outcome of
the interview.
Interpersonal skills
Greeting patients in a manner acceptable within
the cultural norms in relation to age, sex. etc. will
help maintain their dignity and encourage their
participation.
Active listening involves using both verbal and
non-verbal communication techniques. The
pharmacist should clearly signal that the patient
has his/her full attention by look, by offering
acceptance and continuation signals such as
nods, phrases such as “right”/”I see” etc. A
willingness to listen actively is however best
signaled by use of open questions to promote
fuller answer.
Empathy, respect, interest,
warmth and support
These issues are at the heart of interpersonal
skills. They cannot easily be faked, and if
pharmacist do not have them, they cannot easily
be taught things to do by way of them. Success
in this area is not a matter of skills but of
attitude.
However, health practitioners should clearly
signal their interest in how the patient’s problem
is perceived, whether it concerns them, what
their hopes and expectations are.
Empathy, respect, interest,
warmth and support
Pharmacist should ask questions to discover
patient perception “Does the thought of the
operation worry you?”.
The pharmacist should also learn to show
respect, interest, warmth and support. This
will also involve being non-judgmental in
attitude.
THESE ARE THE CORE FACTORS IN
RAPPORT BUILDING.
Ethics are rules for behavior,
based on beliefs about how things
should be. Ethical statements
involve:
1) assumptions about humans
and their capacities;
2) logical rules extending from
these assumptions;
3) notions of what is good and
desirable.
Ethical systems (sets of rules for
acceptable behavior) concern the
“shoulds” and “should nots” of life,
the principles and values on
which human relations are based.
Ethics
The assessment of whether a
behavior is ethical
The assessment of whether a behavior is ethical is
divided into four categories, or domains: consequences,
actions, character, and motive.
In the domain of consequences, a behavior is
determined to be “right” or “wrong” based on the results
of the action, whereas the domain of actions looks only
at the act itself.
The domain of character looks at whether a person’s
overall character is ethical; a person who is deemed as
“virtuous” has consistently ethical behavior.
The motive domain evaluates a person’s intentions,
regardless of the consequences.
Language
Avoid medical jargon. You should
consider the educational cultural and
developmental level of the patient e.g.,
“ You have got appendicitis” is
appropriate for most adults but not
young children etc),. It is also
important for pharmacists to monitor
their use of potentially frightening
words “Cancer”/”lump” etc.
Non-verbal communication
Skills in non-verbal communication like
eye contact, physical proximity, and
facial expression need to be improved
to enhance patient’s satisfaction and
adherence to treatment. This should
convey to the patient that the Health
practitioner is attentive and interested.
Avoid Overreacting
Some patients may appear
demanding, dependent or even
at times, adversarial. It is the
physician's responsibility to not
overreact to these situations.
This can be achieved by
establishing limitations
(boundaries) on what can be
provided and suggesting
appropriate ways for the
patients to contact them.
Establishing Boundaries
Frequent phone calls, unscheduled visits,
and unrealistic expectations, are ways in
which some patients lose perspective of
the shared responsibility of their care.
Pharmacists need to establish boundaries
for patients in a way that doesn't belittle
them.
Closing the interview
In addition to the skills of setting up, beginning
and continuing an interview, the way of closing
the interview is also important. The pharmacist
should clearly signal that the interview is
drawing to a close, usually by summarizing what
has been said and what has been negotiated.
Basic to interpersonal skills is to consider the
importance of such factors as gender, cultural
and socioeconomic factors, which could greatly
affect perceptions of norms and standards of
appropriate communication.
Closing the interview
It is also essential for all practitioners to realize
that what is needed is not only to know how to
recognize a disease, but also how to recognize
and to respond to a patient’s emotional
response to their disease.
In their interactions with patients, it is important
for the clinicians to be aware of patients’
emotional responses to their situation and at the
same -aware of their own emotional reactions
toward the patients.