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Communication Skills
Prof Eiad Al- Faris
Chairman,
Department of Family Medicine
Prof. Eiad Al- Faris
Communication Skill
Outline

Definition
Types of communications
Why to learn communication skills?
 Exercise
 Characters of good communicators
 Some specific skills e.g. Eliciting
 How to learn communication skills?
 Conclusions

Prof. Eiad Al- Faris
Communication Skill
Objectives
Today’s session is important.
WHY?
Prof. Eiad Al- Faris
Communication Skill
i
Definition
Prof. Eiad Al- Faris
Communication Skill
‫تعرف االتصاالت بأنها‪:‬‬
‫عملية نقل و تبادل األفكار‬
‫والمشاعر بين شخصين أو أكثر‬
‫عن طريق استخدام رموز‬
‫مشتركة متعارف عليها بهدف‬
‫بين‬
‫التفهم‬
‫خلق‬
‫تتكون عناصر االتصال من‪:‬‬
‫– المرسل‬
‫– المستقبل‬
‫– الرسالة‬
‫– التغذية المرتدة‬
‫إدراك‬
‫مهارات‬
‫خبرة‬
‫ميول ‪ /‬اهتمامات‬
‫قيم‬
‫حاجات‬
‫التغذية المرتدة‬
‫أثبتت إحدى الدراسات أن التعبير في الرسالة‬
‫يكون كما يلي‪:‬‬
‫•‬
‫•‬
‫كلمات‬
‫قالب‬
‫‪%7‬‬
‫‪% 38‬‬
‫– قوة و مستوى الصوت‪ ،‬النغمة‬
‫•‬
‫لغة الجسم ‪%55‬‬
‫– (اإلشارات‪ ،‬الرموز‪،‬تعابير الوجه)‬
Piece of Cake?
38%
visual
verbal
tonal
55%
Prof. Eiad Al- Faris
7%
Communication Skill
Piece of Cake?
38%
visual
verbal
tonal
55%
Prof. Eiad Al- Faris
7%
Communication Skill
%7 ‫كلمات‬
Prof. Eiad Al- Faris
%38‫قالب‬
%55 ‫لغة الجسم‬
Communication Skill
Non verbal communication
❚ Eye contact
❚ Facial
expressions
❚ Body language
❚ Tone of voice
❚
Emphasis
Prof. Eiad Al- Faris
 Deliberate
silence
 Timing
 Appearance
 Touch
 Hand
movements
Communication Skill
‫األشكال المختلفة لالتصاالت‬
‫االتصال الشفوي‬
‫*‬
‫*‬
‫*‬
‫المقابلة الشخصية‬
‫االتصال الهاتفي‬
‫الحلقات التدريبية‬
‫االتصال التحريري‬
‫*‬
‫التقارير‬
‫*‬
‫*‬
‫المذكرات‬
‫الرسائل‬
‫األشكال المختلفة لالتصاالت‬
‫( تابع (‬
‫االتصال التصويري‬
‫*‬
‫*‬
‫اإلشارات االرشادية‬
‫الصور التعبيرية‬
Which is easier to read?
 'The

man gave the ball to the boy‘
'The ball was given to the boy by
a man.'
Prof. Eiad Al- Faris
Communication Skill
it's important to:

Use short sentences:
 They force you to break your ideas into simple
understandable statements.
 Less than 20 words.


Use words readers understand.
Use subject-verb-object constructions
Prof. Eiad Al- Faris
Communication Skill
http://
www.LearnHowToWrite.com
Prof. Eiad Al- Faris
Communication Skill
Outline

Definition
Types of communications
Why to learn communication skills?
 Exercise
 Characters of good communicators
 Some specific skills e.g. Eliciting
 How to learn communication skills?
 Conclusions

Prof. Eiad Al- Faris
Communication Skill
Why do we need to teach
communication skills in
medical schools?
Any suggestion?
Prof. Eiad Al- Faris
Communication Skill
Effect on Health Outcome
Many studies reiterate that effective
communication and relationship-building
are important in the delivery of highquality health care.
(Roter 1987, Betakis 1991, Stewart 1995).
Prof. Eiad Al- Faris
Communication Skill
Effect on Health Outcome


Stewart 1995, in a review of several studies about
effective physician-patient communication and
health outcome concluded that health outcome is
positively affected by:
Probing the thoughts, feelings, and expectations
of patients.
Encouraging them to ask questions, and
allowing patients to share in the decision making.
Prof. Eiad Al- Faris
Communication Skill
Effect on Health Outcome







These effects are documented in:
The reduction of anxiety.
The reduction of psychological distress.
Pain relief.
Symptom resolution.
Mood improvement.
Reduction of high blood pressure.
(Stewart 1995).
Prof. Eiad Al- Faris
Communication Skill
Effect on Health Outcome





Improved communication has also been shown
to:
Increase satisfaction of patients.
Decrease in the duration of treatment.
Decrease in the intake of painkillers.
Decrease in hospital stay.
( Van Dalen 2001, Eisenthal 1976, steward 1984, Mumford
1982, Egbert 1962).
Prof. Eiad Al- Faris
Communication Skill
“The Toronto consensus statement
stressed that the main complaint of
patients is related to
“communication problems and not
to clinical competency.”
(Simpson 1991)
Prof. Eiad Al- Faris
Communication Skill
The association between specific
communication patterns and law suits was
found in a study done on primary care
physicians.
( Levinson 1997).
Prof. Eiad Al- Faris
Communication Skill
“The main remarks made by patients in the
primary health care centers in Riyadh was
that “physicians were not listening enough
to their complaints.”
( Saeed 2001)
Prof. Eiad Al- Faris
Communication Skill
The magnitude of the problem of poor
communication is demonstrated by:
The increase in patient’s complaint.
 The increasing number of law suits against
doctors and hospitals.
 The tendency of patients to keep changing
physicians and hospitals.
 Patients non-adherence to medical regimen.
(Meryn 1998, Simpson 1991, Vincent 1994).

Prof. Eiad Al- Faris
Communication Skill
Outline

Definition
Types of communications
Why to learn communication skills?
 Exercise
 Characters of good communicators
 Some specific skills e.g. Eliciting
 How to learn communication skills?
 Conclusions

Prof. Eiad Al- Faris
Communication Skill
Excercise
Prof. Eiad Al- Faris
Communication Skill
Exercise
Q1. Describe each patient in 1-2 words
1
2
3
Prof. Eiad Al- Faris
4
31
Communication Skill
Exercise
Q2. How do you think his doctor may feel about him or
her?
1
2
3
Prof. Eiad Al- Faris
4
32
Communication Skill
Exercise
Q3. What is your first objective in dealing with these patients?
1
2
3
Prof. Eiad Al- Faris
4
33
Communication Skill
Common answers:
1.
This pt is arrogant and he needs control
2.
This pt is angry and may be dangerous, he
needs control
3.
This pt is abusing her doctor and she needs
control
4.
This pt is careless, she needs control
Prof. Eiad Al- Faris
34
Communication Skill
The Tip of The Iceberg
Prof. Eiad Al- Faris
Communication Skill
Illness Behavior
The Tip of The Iceberg

5% of the patients
visiting their physicians

1% of them

5 per 1000 need
need
referral to hospital out
patient
hospital admission
Prof. Eiad Al- Faris
36
Communication Skill
Ratio of Medical
Consultation to Symptoms
Episode
Prof. Eiad Al- Faris
Communication Skill










Headache
Changes in energy, tiredness
nerves, depression, or irritability
Aches or pains in joints,
muscles, legs or arms
Women’s complaint’s like
Period pain
Stomach aches or pain
Backache
Cold, flu, or running nose
Sore throat
Sleeplessness
Others
 Total
Prof. Eiad Al- Faris
1: 60
1 : 74
1: 18
1 : 10
1 : 11
1 : 38
1 : 12
1:9
1 : 31
1:8
1 : 18
38
Communication Skill
The Tip of The
Iceberg
Why?
The Tip of The Iceberg … Why??
One Headache episode
59 Headache episode
It is simple
I can manage
Prof. Eiad Al- Faris
40
Communication Skill
The Real Reason:
Patient’s Ideas :
Prof. Eiad Al- Faris
41
Communication Skill
The Real Reason:
Patient’s Concerns :
Prof. Eiad Al- Faris
42
Communication Skill




I am a patient
I am weak
I am worried
I need help
This is a very basic fact:
Patients
Prof. Eiad AlFaris are
not ordinary customers
Communication Skill 43
Patients use verities of ways to express
their weakness and worries
1
2
3
Prof. Eiad Al- Faris
4
44
Communication Skill
The Real Reason:
Patient’s Needs & Expectations
Understanding
Explanation
Reassurance
Empathy
Prof. Eiad Al- Faris
45
Communication Skill
First Facts:
This answers reflect:

Judgmental attitude

Lack of empathy

Very little consideration for patient’s behavior
The majority of doctors think & feel this way
Prof. Eiad Al- Faris
46
Communication Skill
Second Facts:

If doctors think & feel negative

They communicate according to their feelings
Let us deal with our thinking &
feelings first
Prof. Eiad Al- Faris
47
Communication Skill
Summary:


Symptoms (presenting complaint) are
not the only reason for patient seeking
medical help;
The real reasons are:
Patient’s believes & worries
Needs & expectations

Patients are not ordinary customers, they
need very special communication
skills
Prof. Eiad Al- Faris
48
Communication Skill
Illness Behavior
How are you going to apply this
exercise in your practice?
Try to exercise seeing the full
picture of your patient:
1. Presenting complaint
2. Believes & worries
3. Needs & expectations
Prof. Eiad Al- Faris
50
Communication Skill




Prof. Eiad Al- Faris
I am a patient
I am weak
I am worried
I need help
51
Communication Skill
Without considering
illness behavior
Patient’s action
Arrogant
Doctor’s reaction
Control the situation
Angry
Control the situation
Abusing
Control the situation
Aggressive
Control the situation
Prof. Eiad Al- Faris
52
Communication Skill
When you see the full
picture
Patient’s action
Patient
Doctor’s reaction
Understanding & empathy
Patient
Understanding & empathy
Patient
Understanding & empathy
Patient
Prof. Eiad Al- Faris
Understanding & empathy
53
Communication Skill
HOUSE KEEPING
 The mood to consult.
 Enthusiasm and curiosity.
 The desk .
 A cup of tea.
 Stretch your legs.
 Take a deep breath.
Prof. Eiad Al- Faris
Communication Skill
Outline

Definition
Types of communications
Why to learn communication skills?
 Exercise
 Characters of good communicators
 Some specific skills e.g. Eliciting
 How to learn communication skills?
 Conclusions

Prof. Eiad Al- Faris
Communication Skill
Characters of good
communicators
❚ Know what they want to say
❚ Establish and maintain
relationships
❚ Understand others perspective
❚ Active listeners
❚ Understand and clarify
messages
Prof. Eiad Al- Faris
Communication Skill
Why Dr A sees only 20 pts,
while Dr B comfortably sees
30?
Prof. Eiad Al- Faris
Communication Skill
SOFTEN
S
O
F
T
E
N
Smile
Open Posture
Forward Lean
Touch
Eye Contact
Nod
Prof. Eiad Al- Faris
Communication Skill
‫قال جابر رضى هللا عنه ‪:‬‬
‫ما رأيت الرسول صلى هللا عليه وسلم مرة إال‬
‫تبسم في وجهي‬
‫‪Communication Skill‬‬
‫‪Prof. Eiad Al- Faris‬‬
Prof. Eiad Al- Faris
Communication Skill
Examples of good
communication skills
The three skills that improved patients’
disclosure of sensitive information were.
Asking questions about psychological issues.
Making supportive statements.
Listening attentively .
 (Am J Ped 1994).
Prof. Eiad Al- Faris
Communication Skill
Outline

Definition
Types of communications
Why to learn communication skills?
 Exercise
 Characters of good communicators
 Some specific skills e.g. Eliciting
 How to learn communication skills?
 Conclusions

Prof. Eiad Al- Faris
Communication Skill
1.Initiating the session
 2- Skills for Eliciting
 3- Nonverbal Cues
 (4) Influencing Skills
 5- Explaining Skills
 6- Skills for Sharing Understanding
 7- Relationship building
 8.

Prof. Eiad Al- Faris
Communication Skill
Conclusion (Cont’d)
FIVE SIMPLE STEPS TO
EFFECTIVE COMMUNICATION
 Active listening.

Explain your findings.

Discuss prognosis.

Outline the plan.

Involve the patient in the plan.

Educate the patient.
Prof. Eiad Al- Faris
Communication Skill
1.Initiating the session


Greet him with
appropriate
warmth.
General Questions
e.g
Prof. Eiad Al- Faris
Communication Skill
1.Initiating the session (cont)
‘What can I do for
you?
A-
‘What do you want to
talk about/discuss today?’
B-
Prof. Eiad Al- Faris
Communication Skill
1.Initiating the session (cont)
‘What do you want
 C-
us to
talk about/discuss today?’
 D-
Salamat
 E-
How can I help you
Prof. Eiad Al- Faris
Communication Skill
1. Initiating the session (cont)
A hypertensive patient coming for followup appointment,

‘Hello, well now?’ with a smile and a
raised eyebrow.

‘It’s your blood pressure, isn’t it”
Prof. Eiad Al- Faris
Communication Skill
Prof. Eiad Al- Faris
Communication Skill
2- Skills for Eliciting

At the start, the patient has the lead

Delay making your hypothesis.

Say as little as possible.

Avoid stopping the flow.

Try to generate several possible hypotheses.

Do not judge too quickly and by appearances.

Do not reassure the patient too soon
Prof. Eiad Al- Faris
Communication Skill
2- Skills for Eliciting (Cont’d)
A. Active Listening
(with genuine interest)
Prof. Eiad Al- Faris
Communication Skill
Prof. Eiad Al- Faris
Communication Skill
2- Skills for Eliciting (Cont’d)
i. Reflection
‘You look sad today’.
‘That must have been very frightening’, ‘
How did that make you feel?).
Prof. Eiad Al- Faris
Communication Skill
2- Skills for Eliciting (Cont’d)
ii. Show understanding, empathy and
sensitivity:

‘I know’, ‘I feel like that sometimes, it’s
terrible’

‘I know, I hate blood tests, too, etc.).
Prof. Eiad Al- Faris
Communication Skill
Prof. Eiad Al- Faris
Communication Skill
2- Skills for Eliciting (Cont’d)

iii. Actively encourage the
other person to talk by
nodding,
smiling
and
echoing significant words.
Prof. Eiad Al- Faris
Communication Skill
Prof. Eiad Al- Faris
Communication Skill
2-Skills for Eliciting (Cont’d)
 iv-Repeat
tentively, in your own words,
your understanding of their story.
 v-Give
 vi-
encouragement such as ‘
Check what the patient has said.
Prof. Eiad Al- Faris
Communication Skill
 2-Let the
patient answer a
question before
you ask another
question.
Prof. Eiad Al- Faris
Communication Skill
2-Skills for Eliciting (Cont’d)

(B) Make good questions.

Ask open questions,…..

Ask closed questions,…..

Example:

I was wondering, whether …’,

‘Sometimes I find, occurred to me that some people

‘I’ve known cases where …’, ‘I had a patient once
…’.
Prof. Eiad Al- Faris
Communication Skill

2- Skills for Eliciting (Cont’d)

C. Actively search for the patient’s
beliefs, ideas, concerns, expectations
and feelings and the effects of these.
Prof. Eiad Al- Faris
Communication Skill
2-Skills for Eliciting (Cont’d)
D( Explain why you are asking a question.
 ‘The reason I asked about wind and bloating
was that I was …………

E) Use silence.
Prof. Eiad Al- Faris
Communication Skill
Prof. Eiad Al- Faris
Communication Skill
3- Nonverbal Cues

Assessing the patient’s mental state.

Look for the minimal cues.

Watch the patient’s facial expression.

We obtain further clues by listening to
their vocabulary, figures of speech,
metaphors and imagery.

Dr. Desmond video
Prof. Eiad Al- Faris
Communication Skill
(4) Influencing Skills (Cont’d)
i.
ii.
Use presuppositions Ex: ‘Do you think you
will find it easier to stop smoking all at
once, or gradually cut down over a
fortnight?’
Use the ‘My friend technique’. For
example, ‘I remember someone else who
did what you are thinking of and found out
…..
Prof. Eiad Al- Faris
Communication Skill
(4) Influencing Skills (Cont’d)
Iv- Reframe statements/questions.
e.g‘attention-seeking.’
What if he were
‘attention-needing’?
Prof. Eiad Al- Faris
labeled
Communication Skill
v.

Compliance:
When patients are more likely take
a treatment such as simvastatin?
A.
It reduces their risk of
heart attack by a third
B.
It reduces their risk from 12% to
8%.
C.
The NNT to prevent 1 attack is 25.
Prof. Eiad Al- Faris
another
Communication Skill
5- Explaining Skills
iii.
One way vs Two ways processes
Use short words / sentences specific).
The order of information .
Repeat imp pieces.
iv.
The patient’s language.

i.
ii.
Prof. Eiad Al- Faris
Communication Skill
5- Explaining Skills
v. Provide ‘explicit categorization:
vi. Use leaflets, tapes, websites, ….
Prof. Eiad Al- Faris
Communication Skill
5- Explaining Skills
 Feedback
 Too

and patient’s understanding.
much information.
Patient staring out of the window is a
sign of ?
Prof. Eiad Al- Faris
Communication Skill
 iii-Break
information
down into
manageable
segments.
Prof. Eiad Al- Faris
Communication Skill
6- Skills for Sharing Understanding.

Similar phrases to the pt.

Share a little of yourself e.g ‘I had an
operation once’ or ‘Migraines are bloody
awful, aren’t they?’

Show understanding and empathy.
Prof. Eiad Al- Faris
Communication Skill
7- Relationship building.

Environment: SOFTEN

Be friendly and attentive,

An informal style.

Plueral pronouns to indicate partnership.
Prof. Eiad Al- Faris
Communication Skill
7- Relationship building.

‘I hope you agree. Shall we meet again in two
weeks to see how you are getting on?’

Use self-disclosure to establish trust and
common ground.

‘Yes, I know you must be frightened. I am
terrified of the dentist.’
Prof. Eiad Al- Faris
Communication Skill
7- Relationship building.
 Make
comments that are provisional
 Respond
Prof. Eiad Al- Faris
descriptively.
Communication Skill
7- Relationship building.

A.
B.
‘What about my knees, doctor?’ Which?
‘I think you have some wear and tear,
possibly a little early arthritis’ or
‘You’re too fat and that’s why you have
knee pain’.
Prof. Eiad Al- Faris
Communication Skill
Which is better from the following two:
A- I think that since your heart
attack, your heart has been under a
little strain. You will feel better
with some fluid tablets, but you will
need some time off work so that
your heart can recover.
Prof. Eiad Al- Faris
Communication Skill
Which is better for the
following two:
I will make you an appoint for some
rehab which will help you and get you
back to work quicker. Here is a
leaflet about what I mean.
Prof. Eiad Al- Faris
Communication Skill
B. You must stay off work until I tell
you. Go for rehabilitation treatment,
this will be good for you, and here are
some water tablets to take every
morning.
•
So make comments that are related to
the problem (s) rather than to
controlling the patient.
Prof. Eiad Al- Faris
Communication Skill
7- Relationship building.

Learn to recognize the effect of your own
behaviour on your patient.

Learn to recognize, interpret and use your
feelings.

Learn to deal with your own stress.

Most patients don’t mind waiting if…..
Prof. Eiad Al- Faris
Communication Skill
Can Communication Skills Be
Taught?
Communication skills of physicians can be
changed and this change can endure
(Maguire 1990, Roter 1993).
 Important changes in physician’s behavior
and in their communication skills have
been demonstrated
( Levinson 1993).

Prof. Eiad Al- Faris
Communication Skill
Many medical colleges in the world and an
increasing number of nursing schools have
included communication skills courses in
their undergraduate as well as
postgraduate curriculum.
Prof. Eiad Al- Faris
Communication Skill
The general medical council in the UK
and the association of American medical
colleges recommended that
communication skills training should be an
integral part of any medical curriculum
(GMC 1993, AAMC 1999).
Prof. Eiad Al- Faris
Communication Skill
Outline

Definition
Types of communications
Why to learn communication skills?
 Exercise
 Characters of good communicators
 Some specific skills e.g. Eliciting
 How to learn communication skills?
 Conclusions

Prof. Eiad Al- Faris
Communication Skill
How to learn communication
skills?
Unconscious knowledge
Conscious knowledge
Prof. Eiad Al- Faris
Unconscious ignorance
Conscious ignorance
Communication Skill
How to learn communication
skills?
Feedback is essential
 Experiential learning is the way to learn

Prof. Eiad Al- Faris
Communication Skill
Feedback methods
Self assessment of a videotape or
audiotape
 By colleagues
 By tutors

Prof. Eiad Al- Faris
Communication Skill
Outline

Definition
Types of communications
Why to learn communication skills?
 Exercise
 Characters of good communicators
 Some specific skills e.g. Eliciting
 How to learn communication skills?
 Conclusions

Prof. Eiad Al- Faris
Communication Skill
Prof. Eiad Al- Faris
Communication Skill
Prof. Eiad Al- Faris
Communication Skill
SUMMARY
Prof. Eiad Al- Faris
Communication Skill
Conclusions
Prof. Eiad Al- Faris
Communication Skill
Communication skills are not
an optional extra; without
appropriate communication
skills our knowledge and
intellectual efforts are easily
wasted
Sliverman, Kurtz & Droper 1998
Prof. Eiad Al- Faris
Communication Skill
THANK YOU
Prof. Eiad Al- Faris
Communication Skill
Prof. Eiad Al- Faris
Communication Skill