Transcript Lecture 6- communication concept in medicine

The Concept of Communication
Skills in Medicine
DR. SALAH R EL-FAQIH
What is Communication
● Is the act by which information is shared between
humans
● It is the process by which we relate and interact with
other people.
● It is a mutual process between 2 sides (Dialogue) not a
one sided monologue.
● It includes listening & understanding with passion &
respect as well as expressing views & ideas and passing
information to others in a clear manner.
COMMUNICATION THEORY
● Communication is a learned skill or a series of learned
skills which is based on 3 pillars:
Accuracy
Efficiency
Supportiveness
All combined contribute to effective communication
Communication: Why?
● Effective communication is the basis of mutual
understanding & trust.
● Poor communication causes a lot of misunderstanding
& hinders work & productivity.
Types of communication
Verbal Communication
 Speaking to the person
Look straight in the eye
 make eye-ball contact
 Show respect
 Clear message
 Relevant
 Use understandable language
 Support by illustrations if needed
 Good listener
 Allow them to understand the message and reply
 Listen carefully
 Make a dialogue ant not one way instruction

Communication & Medicine
● Historically the emphasis was on the biomedical model in
medical training which places more value on technical
proficiency than on communication skills.
● Recently learning communication skills & evidence based
practice become integral part of modern medicine training.
● In healthcare institutions ,effective communication is
essential for patient safety
What is required From the doctors
● Support patients in caring for
●
●
●
●
●
themselves to improve and
maintain their health
Work in partnership with
patients
Listen to patients and respond
to their concerns and
preferences.
Give patients information in
way they can understand
Taking patient’s views into
consideration when assessing
their condition
Respond to patients questions ,
keep them informed & share
information .
● Support patients to self care
● Treat patients politely and
considerately
● You must make sure, wherever
practical, that arrangements
are made to meet patient’s
language and communication
needs.
● Respect patients rights to
confidentiality
● You must be considerate to
relatives, carers and partners
be sensitive and provide
information and support.
What is required From the doctors-continue
● Communicate effectively with colleagues within and outside
the team
● Make sure your patients and colleagues understand your
role and responsibilities in the team and who is responsible
for each aspect of patient care
● You must treat your colleagues fairly and with respect
● When referring a patient you must provide all relevant
information about the patient.
Do doctors need communication?
● Doctors need to learn essentials of good communication
more than other professionals because patients are
humans with sensitive needs.
● Doctors cannot practice medicine without effective
communication skills.
● Poor communication causes a lot of medico-legal and
ethical problems.
Communication: With whom?
● Patients & care-givers
● Nurses & auxiliary staff
● Colleagues
● Administrators
● Evidence in court
● Reporting research findings
● Talking to the media
● Public & legislature
Communication: How?
 The medical interview is the usual communication
encounter between the doctor and the patient.
 It can be classified according to the purpose of the
interview into 4 types:
History taking
Breaking bad news
Consultations
Obtaining informed consent
Effective communication
● Ensures good working relationship
● Increases patients satisfaction
● Increases patients understanding of illness &
management
● Improves patients compliance with treatment
● Reduce medico-legal problems
● Reduce uncertainty
Principles of effective communication
● Ensures an interaction rather than a direct
transmission process (telling someone what to do
or only listening is not enough).
● Demonstrates involvement as well as flexibility in
relation to different individuals and contexts.
Principles of effective communication
● Requires planning and thinking in terms of outcomes.
● Follows the helical model ( i.e. what I say influences
what you say in a spiral fashion and coming back
around the spiral of communication at a little different
level each time is essential).
● Shows empathy & learn how to handle emotional
outbreaks.
COMMUNICATE AS A TEAM
● patient
● psychologist
● family
● nurse
● physician
● social worker
● other health care
● dietician
providers
Communication with peers
● Mutual trust & respect
● Exchange information
● Ask your seniors
● Do your share of work
Communication & Medical care
● Good communication should be established between
the patient , the family and the treating multidisciplinary
team.
● patient & family should be encouraged to participate
and verbalize in the ward round discussion about:
 Offered medical care & treatment
 Rehabilitation
 Follow- up/re-admission plans
 Doubts & worries.
Communication & Medical care
● Proper information to patient and family regarding services
available and how they can utilize them.
● Information should be made available on:
 Health Education/ Counseling & Psychiatry.
 Endocrine, Metabolic, Neurology & nephrology.
 Cardiology, Respiratory, GIT & hematology.
 Nutrition, Immunization & ambulatory care.
 Infections & infection control.
 Clinical pharmacy & therapeutics.
 Hygiene and Safety.
Communication skills: Some techniques
● Develope fluent dialogue with the patient
● Use silence effectively, allowing patients enough time to express
●
●
●
●
thoughts or feelings
Actively encourage the patient through use of supportive words
or comments
Dialogue with patients is enhanced by effective use of non-verbal
behaviour
Use open, exploratory questions – inviting patient to become
actively involved
Adjusted language as appropriate, to suit particular needs of the
situation
Listening vs Hearing
● Hearing - a passive activity; no effort
● Listening - requires




active involvement, attention
interpretation of message
understanding
takes time and effort
Listen with Attention
focus on patient or relative and give physical
attention
● suitable environment - remove distractions and
interruptions, make speaker feel comfortable
● eye contact
● use positive body language
●
Barriers to effective communication
● Personal attitudes
● Language
● Time management
● Working environment
● Ignorance
● Human failings (tiredness, stress)
● Inconsistency in providing information
The Art of Consultation
● Gauging the correct amount and type of information to
give to each individual patient.
● Providing explanations that the patient can remember and
understand & which relate to the patient’s illness
framework.
● Using an interactive approach to ensure a shared
understanding of the problem with the patient.
● Involving the patient and collaborative planning increase
the patient’s commitment and adherence to plans made.
● Continuing to build a relationship and provide a supportive
attitude.
Initiating the Consultation
●
●
●
●
●
Establishing a supportive environment.
Developing an awareness of the patient’s emotional
state.
Identifying as far as possible all the problems or issues
that the patient has come to discuss.
Establishing an agreed agenda or plan for the
consultation.
Enabling the patient to become part of a collaborative
process.
Closing the interview
● Confirming the established plan of care.
● Clarifying next steps for both doctor and patient.
● Establishing contingency plans.
● Maximizing patient adherence and health outcomes.
● Making efficient use of time in the consultation.
● Continuing to allow the patient to feel part of a
collaborative process and to build the doctor-patient
relationship for the future.
Consultation Framwork
Initiating the Session
• preparation
• establishing initial rapport
• identifying the reason(s) for the consultation
Gathering information
Providing
• exploration of the patient’s problems to discover the:
Structure
 biomedical perspective
• making
organisation
overt
Building the
relationship
 the patient’s perspective
 background information - context
•
using
appropriate
non-verbal
behaviour
•
developing
rapport
•
involving
the patient
Physical examination
• attending to
flow
Explanation and planning
• providing the correct amount and type of information
• aiding accurate recall and understanding
• achieving a shared understanding: incorporating the patient’s
illness framework
• planning: shared decision making
Closing the Session
• ensuring appropriate point of closure
• forward planning
Doctors-Patients Relationship
● Developing rapport to enable the patient to feel
understood, valued and supported.
● Encouraging an environment that maximizes accurate and
efficient information gathering, planning & and
explanation.
● Enabling supportive counseling as an end in itself.

Doctors-Patients Relationship/2
● Involving the patient so that he/she understands and is
comfortable with the process of the consultation.
● Increasing both the physician’s and the patients’
satisfaction with the consultation.
● Developing and maintaining a continuing relationship of
trust & respect over time.
Conclusion
● Communication between the patients, family and heath
team play a vital role in the compliance to outpatient
clinic visits and in-patient care programs.
● Good communication is essential for proper doctorpatient relationship and help avoids problems of
misunderstanding.
● Effective communication is the key to success in
professional career.
● Effective communication is essential to the practice of
high quality medicine