Transcript How to build a rapport with patients?

Professional skills
part one
2008-2009
By
Dr. Aziza Rajab
Dr. Hashim Fida
Assistant professor
Assistant professor
Head of Nursing dep.
Family & community health
King Abdul Aziz University
king Abdul Aziz University
Professional skills -1
part one contents
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2.
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6.
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8.
9.
What is communication, role of com. theory, types,
components, process, why com. in healthcare and
medicine, principle of effective com.
Principles of accurate perception
Understanding self concept
verbal and non verbal com./ body language
Listening and thinking in communication
Empathy, sympathy & empowerment of patients
Interpersonal relationship and self disclosure.
Doctor –patient relationship and How to build
rapport
Principles of interviewing patients
Lecture 1
What is communication
theory, process, models, types, components
why com. in healthcare and medicine
principle of effective com. Barrier’s to effective
communication
By
Dr. Aziza Rajab
Assistant professor
Head of Nursing department
King Abdul Aziz University
Dr. Hashim Fida
Assistant professor
Family & community health
king Abdul Aziz University
Objectives
What is communication skills
 Communication theory
 Communication essential components
 Communication models
 Steps of communication process
 Communication types
 Communication why
 Principles of effective communication
 Barrier’s to effective communication

What is communication?


The simultaneous sharing and creating of meaning through human
symbolic action.
Is the act by which information is shared between humans. Such
encounters may cover:

Desires

Needs
 Perceptions
 Knowledge
 Affective states.
Communication 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.
It may involve conventional or non-conventional signals.
It may involve conventional or non-conventional signals.
It may take linguistic or non-linguistic forms.
It may occur through spoken or other modes.
COMMUNICATION THEORY
Communication is a learned skill or a series of learned skills
which is based on 3 pillars:
 Accuracy
 Efficiency
 Supportiveness
all combine to contribute to effectiveness of
communication
Experience is a poor teacher: it needs observation with well
intentioned, constructive, detailed and descriptive
feedback plus rehearsal to effect change.
Communication is an art and like other arts it is a learned
skill
What are the essential components
of an effective communication ?
Source / sender of information
 Message ( knowledge, feelings, thoughts)
 Interference / interrupters of com.
 Channel / media in and by which massage
is delivered
 Receiver
 Feedback
 Environment / context com. occurs

What are the models of communication?
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Linear
Interactive
Transactional
Can Communication be intentional or
unintentional?
is communication a process?
Yes, it’s a series of actions that has no beginning
or end and is constantly changing.
Linear
Interactive
Transactional
What is the steps of a communication
process?
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Encoding: process by which the source translates thoughts or feelings in
words, sounds, and physical expressions, which together make up the
actual message.
Interaction: exchange of communications take turns sending& receiving
messages
Message: the stimulus that is produced by the source
Interference: anything that changes the meaning of an intended
message, could be internal & psychological or external & physical
Channel: the rout by which messages flow between senders and
receivers (person or people who analyze and interprets the message)
Decoding: the process of translating a message into the thoughts,
feelings that were communicated
Feed back: the response to a message that the receiver send to the
source or sender ( increase our perception, accuracy and confident, help
in learning about ourselves, adjust to others, maximize connection with
other, serves as monitor of communication process)
Environment: the surrounding in which communication occurs
Context: the circumstances or situation in which communication occurs
What are the types of communication?
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Intrapersonal communication: the process of understanding information
within oneself. includes diverse internal activities, such as critical thinking,
decision making, problem solving, conflict resolution, planning, stress and
time management, developing , maintaining and evaluating relationships.
Interpersonal communication: also called dyadic communication: which is
the informal exchange of information between two or more people such as
Interview : a careful planned and executed question and answer session
designed to exchange desired information between two parties
Group communication: an exchange of information among a relatively
small number of persons, five to seven who share a common purpose or
task such as, solving a problem, making a decision, reviewing a policy or
sharing information.
Public communication:Transmission of a message from one person who
speaks to a number of individuals who listen.
Mediated communication: Any communication transmitted by the use of
technology means, such as radio, television, telephone or the internet ,it
may be one to one communication.
Mass communication: Communicating with or to a large number of people,
such as lectures, election speeches.
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 the
corner stones of modern medicine.
Why communication?
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Communication is essential For all daily life
competent interactions
For better career development
To Increase satisfaction and knowledge
To decrease anxiety and distress
facilitate decision-making and coping
assists in accurate history taking and diagnosis
Effective communication is the basis of mutual
understanding & trust.
Poor communication causes a lot of misunderstanding
& hinders work & productivity.
Do doctors need communication?
Doctors need to learn essentials of good
communication more than other
professionals because patients are humans
with sensitive needs.
Doctors can not practice medicine without
effective communication skills.
Poor communication causes a lot of
medico-legal and ethical problems.
Effective communication does what?
Ensures good working relationship
Increases patients satisfaction
Increases patients understanding of
illness & management
Improves patients compliance with
treatment
Principles of effective communication
Ensures an interaction rather than a direct
transmission process (telling someone what to do or
only listening is not enough).
Reduces uncertainty.
Demonstrates flexibility in relating to different
individuals and contexts).
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.
Barriers to effective communication
Personal ( lack of confidence, shyness, internal conversation, self talk,
lack of objectivity, cultural differences, discomfort in sensitive
situations, values believes, attitudes, feeling tiredness, stress)
Language, Ignorance , Lack of Time management, Inconsistency in
providing information
Working environment (crowded, noisy, music playing, lack of privacy,
telephone call, presence of assistants)
Patient barriers( their negative perception about the desies and
condition, less trust in knowledge and capabilities of health providers,
think you are not interested in them, address them as cases, sense of
inferiority)
Administrative and financial barriers ( management strategies,
economical support, number of staff, availability of recourses, policy and
administrative decisions).
Communication Training why?
to acquire knowledge of the basic features
of verbal and non-verbal communication.
to learn how to take a medical history
from patients & relatives.
to know about illness behavior, physician
and patient roles, and relevant cultural
beliefs.
to learn how to draw up a plan for an
interview, open and close interviews,
explain the purpose and summary.
Communication Training why?
Cont.
to know how to communicate with
patients who have a learning disability.
to gain further experience of doctorpatient communication with different
types of patient (e.g. male, female,
different social and ethnic groups, school
age children & elderly people).
to learn the basic principles of clinical
problem solving.
Lecture 2
Understanding Perception
the nature of perception, perceptual differences,
improving perceptional competencies and
perception checking
By
Dr. Aziza Rajab
Assistant professor
Head of Nursing department
King Abdul Aziz University
Dr. Hashim Fida
Assistant professor
Family & community health
king Abdul Aziz University
Perception and
Communication
Perception
I know that you
believe you understand
what you think I said,
but, I am not sure you
realize that what you
heard is not what I
meant.
Preview
Perception defined 
Influences of perception 
Four stages of perception 
Pitfalls to accurate perception 
The Role of Perception in
Communication
Perception
process through which people select, 
organize, and interpret sensory input to give
meaning and
order to the world around them

Perception Defined
The process by which we become aware of objects and
events in the external world.

The process of making sense of the world around us.

Many people ignore the fact that all of us are different
and that these differences equip us to view the world
from our very own vantage points. Usually we spend
more energy defending our own position than
understanding others.

Where does the triangle begin?
The Role of Perception in
Communication
Biases
systematic tendencies to use information 
about others in ways that can result in
inaccurate perceptions

The Role of Perception in
Communication
Stereotypes
often inaccurate beliefs about the 
characteristics of particular groups of people
can interfere with the encoding and decoding 
of messages

Influences on Perception
Physiological (biological, neurological) Influences
Senses, age, health, fatigue, hunger, biological cycles
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Social Influences
Cultural Differences
Nonverbal behaviors, odors, speech, silence, space
Sex roles, gender roles, occupational roles
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Social Roles
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Self-Concept
Self-esteem, locus of control, attribution (attaching meaning to 
behavior)
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Perception
Perception is the process of making
sense of the world around us
Also called informational or cognitive
processing
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Perception is influenced by two factors:
Biological/Neurological—How we are
hardwired
Universal to all humans
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Social—The different social influences in our
lives
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Differs in all humans (men vs. women; US 
vs. Japan; 12th vs. 21st Century)
It is important we understand this
process if we are to become smart,
competent communicators
It is the “thing” that happens before we
even open our mouths
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There are four stages of perception
Stage 1: Selection
Life is a process of selecting 
information/data
We are confronted with millions of 
pieces of stimuli each day (1,500
advertisements alone)
Factors That Influence Our Selection 
A. Interest (College Basketball, Movies, Music)
B. Need (lectures, traffic lights, buying 1st car)
C. Aesthetics (noise, movement, color)
What advertisers, marketers, & designers do
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D. Biology (sensation seeking, ADHD, circadian
rhythms)
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Stage 2: Organization
We put our “selected” data in cognitive “folders” 
Also called: Schemata's or Cognitive Frameworks

Three Principles of Organization: 
A) Binary Opposition (all things in pairs)

male/female, short/tall, white/black, good/bad 
B) Already formed social categories

101 students, sorority sisters, UK basketball 
players, Italians
C) We also organize by similarities
size (big buildings), color (things that are 
purple), space (things from Hawaii), smell
(things that make us hungry), function
(computer, phone, TV, DVD, VCR, CD player,
pager, palm)

How many Fs?
A Duck . . . Or a Rabbit?
Stage 3
Interpretation/Comprehension
Next, we have to Evaluate the data in 
our folders
Larger files (more complete and 
accurate)
Smaller files (simplistic and 
underdeveloped)
Our Comfort Zone: 
Not Comfortable with New or Small 
Folders
We like our old, Big Folders (Basketball) 
and avoid our small, underdeveloped
folders
College Forces Us To Make New Folders 
Young, or old?
Young, or old?
Native American . . . Or Eskimo?
Which line is longer?
A
B
Perfect Circle?
1
2
3
4
5
1
2
3
4
5
Count the black dots . . .
Ladder up… or down?
Which way is water flowing?
Stage 4
Retention and Memory
We Don’t Retain All We Select! 
Photographic Memory & Hypnosis (still 
not perfect)
Factors That Influence Long- 
term Memory
A) Recency of Time (today vs. 10 
years from now)
B) Frequency of Use (628-2254,
names, TV channels)

C) Importance (test information, PIN 
number, anniversary)
D) Emotional Connection (1st
wedding)

Pitfalls to Perception
As much as we wish our minds 
(and the process of perception)
were perfect, they are not
Ask the police at a crime scene
reflecting on “what went wrong”

Some of our mistakes, however, 
are due to our “biological
brain” playing tricks on us
(below the level of consciousness)
If we know what they are, we 
can prevent them!
There are 5 major “biological”
pitfalls:
1) Impressions of Others
A) First Impressions of others
1st impressions overwhelm 2nd & 3rd
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They tend to taint the rest of the interaction (for the 
better or worse)
Start strong is what matters!! 
B) Negative Impressions of others
When people are aware of both positive and
negative qualities, we tend to be more influenced by
the negative
“Bob is handsome, hardworking, intelligent and
honest. He’s also conceited”
Did you keep Bob’s negative quality in perspective? 4 
to 1 ratio!
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2) Halo & Devil Effect
A) We select the first (positive or negative)
“obvious” or “dominant” characteristic of a
person
Physical appearance, weight, personality,
wealth, clothing, regional accent, race, large
nose, glasses, nice shoes, etc.

B) We then assign “accompanying”
positive or negative traits to that person
(that they have not earned)
Halo--Attractive People: smart, happy, rich,
honest
Devil--Unattractive People: dumb, poor,
dishonest
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C) Problem: We unfairly punish some
while rewarding others simply due to one
dominant trait we happen to notice
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3) Selective Processes
The mind likes consistency, simplicity, &
balance. Any information that could “disrupt
the peace” is seen as dangerous. Ergo, the
brain tries to restore balance:
A. Selective Exposure
We attend to messages that are in accord with 
our already-held attitudes (conservative talk
radio)
And avoid dissonance from other ideas 
B. Selective Retention
We remember what is consistent with pre- 
existing attitudes and interests
C. Selective Perception
We mentally recast messages so that they are 
inline with our beliefs and attitudes
Classic Study by Allport and Postman in 1945 
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4) Primary
& Recency
Theory
(first things)
(last things)
The mind privileges things that 
come first and last in a set, list,
or encounter
Job Interviews (never get stuck in 
the middle)
Beauty Pageants & Talent 
Contests e.g. Greek Sing (statistics
show bookends are more likely win)
Spelling Lists (the top & bottom are 
easy)
Movies (intros & conclusions stay with 
us)
Human Encounters (see pitfall #1) 
5) Self-Serving Bias
(AKA Fundamental Attribution Error)
We alter our interpretations to favor
ourselves & to “cheat” others:
Your Test Grade:
When we do well, it is because of internal factors
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I worked hard--I’m smart 
When we do poorly, it is because of external
factors

Your professor hates you 
Others Test Grade:
When others do well, it is because of external
factors

They got lucky--They were given special treatment 
When others do bad, it is because of internal
factors
They are stupid and lazy 


Summary
Perception defined 
Influences of perception 
Four stages of perception 
Pitfalls to accurate perception 
Lecture 3
Self Concept
relation between self concept / needs and
self esteem, theories, definitions, influences
on self concept, factors that enhances self
concepts.
By
Dr. Hashim Fida
Assistant professor
Family & community health
King Abdul Aziz University
Dr. Aziza Rajab
Assistant professor
Head of Nursing department
king Abdul Aziz University
Self-Concept/Self-Esteem
Cause or Effect?
THE SELF
EARLY THEORISTS OF ‘THE SELF’
William James, Charles Cooley
SELF-CONCEPT & SELF-ESTEEM
Pelham & Swann (1989)
Gender differences?
Self-objectification theory
EARLY THEORISTS OF THE ‘SELF’
WILLIAM JAMES (1842--1910)
“Principles of Psychology”
Duality of Self:
• Self as object than can be observed
I have property X
“me”
• Self as agent doing the observing
Self as the perceiver
“I”
Related to consciousness: the “I” does the perceiving, feeling,
CHARLES COOLEY (1864-1929)
“Human Nature and the Social Order”
The Social Self:
• Self can’t be understood in isolation--must be
studied in interaction with others
• Self is not an inherent property of human nature but
rather a socially-constructed entity: our sense of self
is built upon the life-long experience of seeing
ourselves through the eyes of others (“looking-glass
self”)
Self-Concept

A Composite of all Self-Definitions
 Cognitions,
Beliefs, Images, Emotions
Explanation of who we are
 In a constant state of CHANGE
 Partitioned into separate identities
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 Sports,
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Academic, Social, etc.
Moderate Correlation to Academic
Achievement
Self-Esteem

An emotional reaction to who you are
A
subsection of the Self-Concept
 Affection/Disaffection of ourselves
Tied to performance in valued activities
 Children have higher Self-Esteem
 Teenage females have moderate-low SelfEsteem
 Moderate Correlation to Achievement

Classroom Techniques
Maintain an atmosphere of TRUST.
 Help to recognize & process emotion

feeling _______.”
 Predict how others might feel
 Be honest with your emotion
 “You’re
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Cultural Awareness (Thai smiles)
Recap
Self-Esteem
Our SelfConcept
Self-Image
Our Self-Concept is made up of our self-esteem and our self-image
Definitions

SELF-CONCEPT
 The
sum total of the ways in which we think
about ourselves
• SELF ESTEEM
- How highly we think about our abilities and
our self.
• SELF IMAGE
- How we view our self based on others
reactions to us.
Self-concept
SC is an organized cognitive set of traits,
opinions, attitudes, notions, beliefs and
other mental contents that an individual
has about him/her-self.
Why study the self in social
psych?
Social factors influence how we think about
ourselves.
 We learn about ourselves by comparing
ourselves with other people.
 Our self-views shift with our social surroundings.
 The way people think and feel about themselves
influences their social behavior.
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Self-concept areas(SDQ III)
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Mathematics
Verbal
Academic
Problem
solving/Creativity
Physical abilities
Physical appearance
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Relations with
opposite sex peers
Relations with parents
Religion/Spirit.
Honesty/Reliability
Emotional
stability/Security
General self-concept
A Positive Self-Concept
A positive self-concept helps us in
life – how we behave and act with
others.
A positive self-concept generally
makes us feel happier.
Influences to Self-Concept
Life
Experiences
Age
Sexual
Orientation
Appearance
Self-Concept
Gender
Relationships
Education
Culture
Emotional
Maturity
Age
Self-concept changes as we get older.
YOUNG
CHILDREN:
OLDER
CHILDREN:
ADOLESCENTS:
ADULTS:
ELDERLY:
Younger children are limited to descriptions of
themselves, like boy/girl, size etc.
Older children can provide much more detailed
descriptions; hair and eye colour, address, shoe size etc.
Self concept can be explained in terms of beliefs,
likes and dislikes, relationships.
Adults can explain themselves in terms of quality of
life and their personality.
Older adults may have developed even more self
knowledge and developed ‘wisdom’.
Appearance
By the age of 10 or 12 we begin to compare ourselves
to others. If we think we look good we have a positive
self-image
The important thing is we feel positive about the way
we look. We can easily develop a negative self image
and this can lead to a lack of confidence or to feel
depressed about our relationships with other people.
How does how we dress affect our selfconcept?
Gender
Very early in life we know if we are a boy or a girl. How
does this affect our self-concept and our lives?
There are different social expectations of men and women
Girls tend to do much better at school than boys, but
boys do better at higher education. Why is this?
Gender affects the type of employment we go for.
Women are more likely to interrupt their careers to look
after children.
Culture
Different people have different customs and different ways
of thinking. Your family or community may have different
beliefs and expectations from other families and
communities.
These influences affect the way we think and are called
‘cultural influences’. Different cultures have different views
of what is normal or right and wrong and these are our
norms.
Cultural Influences and Norms
Most British people wont eat frog’s legs, snails or horse
meat.
Parents who do not smoke will discourage their children
from smoking.
People from ethnic minority groups are more likely to live
in an extended family.
What you think of as important, or right or wrong, will be
influenced by the norms of the people around you.
Your self-esteem will be influenced by cultural beliefs
about what is right or wrong.
Objectives

Recap self-concept and continue on
factors that can influence it.
Affect on Self-Concept
.
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It can be difficult to be positive about yourself if you
receive negative signals about a big part of your life.
Education
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Self-concept is strongly influenced by
school.

You spend more than half your waking
time at school, doing homework or doing
school things.
AGREE OR DISAGREE?
You mix with
other people
and compare
yourself to them
The expectations
of teachers
influence your
success or failure.
Students
expected to do
well often perform
better than those
not. This is a self
fulfilling prophecy.
Friendships
boost self
esteem as it
shows people
want to be your
friend
Education
influences
our selfconcept
Success or
failure at school
has an affect on
self esteem
Learn theories
and ideas that
help you to
understand your
life and that of
others
Relationships with others
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Write the following list of people on the back of
the handout.
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Mother or step-mother
Father or step-father
Brothers and sisters
Best friend
Teacher
Relationships’ Effects

Write one way in which each of these
people have affected you or taught you
something.

Which relationship affected you the
most?
Forms of relationships
Family relationships
Work relationships
Friendly relationships
Depending on the amount of time we spend
with these people and the value we place on
their opinions determines the extent that they
affect our self-concept.
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Group Task

In groups of no more than 4 choose one
of the factors that influence our selfconcept and produce an A3 poster that
contains the following information:
A
title of the influencing factor (i.e. AGE)
 A definition of self-concept, self-esteem and
self-image
 An outline of how the factor influences our
self-concept.
 Choose
from: Age, Appearance, Gender,
Culture, Education, Relationships,.
Example
Self-Concept: xxxx
Self Esteem: xxxx
Childhood
Self Image: xxxx
AGE
Older
Children
Elderly
Adults
Adolescence
Extension Questions

When you have completed your poster
and are fully prepared to present it to the
class answer the following questions:
 1.
How might a very young child describe
their self-concept?
 2. How can the way we dress affect our selfconcept?
 3. Write about a time when your own self
image was affected. Why did this happen?
lecture 4
Verbal and non verbal communication,
and body language
the importance of elements of language, how to use
language effectively, assertiveness, definitions, types,
functions and techniques of using non verbal
communication and body language In medicine
By
Dr. Aziza Rajab
Assistant professor
Head of Nursing dep.
King Abdul Aziz University
health
Dr. Hashim Fida
Assistant professor
Family & community
king Abdul Aziz University
What is verbal communication ?
what are the different Types of
possible Reponses in the health field?
Assertive response:
- initiate com. In trust, confident atmosphere
- direct expression of ideas, opinions, desires
- Stand up for oneself yet respect others
Non assertive response:
-
Fear for rejection, need for approval, every body should like me and
approve of what I do
Over concern to others needs & rights I should please all
Passive response:
wait other to start, avoid conflict, low self esteem,
victimize themselves,
Aggressive response:
win in short term – lose on long run, always in
conflict, hostile, say their feelings and thoughts
How to be assertive?
What is assertiveness?
Clearly communicating your needs and expectation with
respect to others and with no or minimal compromises
or damaging relationship.
What are assertive techniques?
 Provide and invite feed back
 Setting limits
 Making request
 Being persistent
 Ignoring provocation and focussing on problem in
hand
 Responding to criticism without losing temper,
objectivity, and mutual respect
What is non verbal communication ?
1.
2.
3.
Body language ( includes all behaviors that
used to communicate messages such as
facial expression, posture, appearance( skin
color, body size, shape,, space , time, touch
distance, furniture lay out, grooming,
makeup, clothing, eye glasses, eye contact,
smile..
Tone of voice, volume, silence.
Written communications
What are the Characteristics of non
verbal com.
Occurs constantly
 More believable than verbal & powerful & interdependent with
verbal com.
 It is a primary mean of communication
 Depend and relate to culture and context greatly
 Ambiguous, and ever changing
 Carries most of the meaning of the message 93% specially
the feeling and attitude
 Frequent source of misunderstandings
 Do not follow a universal rules, not a language
 Spontaneous and unintentional
 Can be learned
 Critical in building trust relationship

What are the Functions of non verbal
com.
Complements the verbal communication
 Regulating and controlling the information
in verbal communication
 Deceiving the verbal incorrect information
 Substituting the verbal communication
 Interpreting the verbal communication
 Improving the message of verbal
communication

Lecture 5
connecting listening and thinking
in communicating with patient
By
Dr. Aziza Rajab
Assistant professor
Head of Nursing dep.
King Abdul Aziz University
Dr. Hashim Fida
Assistant professor
Family & community health
king Abdul Aziz University
What is listening ?

The process of receiving, constructing
meaning from and responding to spoken
or nonverbal messages.

Giving feedback is an important part of
being an effective listener.
Stages of effective listening
Hearing
 Understanding.
 Remembering.
 Interpreting.
 Evaluating.
 Responding.

The functions of listening
Obtain information.
 Evaluate.
 Empathy.
 Enjoyment.

HURIER model
Developed by listening scholar Judi
Brownell.
Barriers to effective listening
The topic or the speaker is uninteresting.
 Criticizing the speaker instead of the
message.
 Concentrating on details ,not main ideas.
 Avoiding difficult listening situations.
 Tolerating or failing to adjust to
distractions.
 Faking attention.

Competent Listeners
Be prepared to listen.
 Behave like a good listener.
 Take good notes.
 Ask question to clarify information.

Lecture 6
interpersonal communication
and self disclosure
By
Dr. Aziza Rajab
Assistant professor
Head of Nursing dep.
King Abdul Aziz University
Dr. Hashim Fida
Assistant professor
Family & community health
king Abdul Aziz University
What do we mean by interpersonal
communication ?
It is the process of sending and receiving
information or communication with
another person
What is the function of interpersonal
communication ?
Gaining information
 Learn to interact with others
 Assess personal needs
 Help us better learn and understand
others

Phases of interpersonal relationship
Entry phase.
 Personal phase.
 Exit phase.

Interpersonal communication needs
are based on the following theories:
Uncertainty Reduction Theory (A theory suggesting
that when we meet others to whom we are
attracted, our need to know about them tends to
make us draw inferences from observable physical
data.
2. Predicted Outcome Value Theory (A theory that
suggests that people connect with others because
they believe that rewards or positive outcomes will
result.
3. Social Exchange Theory (A theory based on the
assumption that people consciously & deliberately
weigh the costs & rewards associated with a
relationship or interaction .
1.
4.Reward (Anything that we
perceive as beneficial to our selfinterest.
5.Costs (Negative rewards ,things
that we perceive to be not
beneficial to our self-interests.
6. Orientation Theory (A theory that
provides insight into our
motivation to communicate.
7. Schutz’s theory of need for
- affection (lovable) referred as personal, under personal, or
over personal)
- inclusion referred as social, under social, or over social.
- Controlreferred as abdicrats, autocrats, or democrats.
What is self disclosure
Voluntary sharing of information about the
self that another person is not likely to
know.
Benefits of self disclosure

The principal benefit of self-disclosure
should be personal growth (selfunderstanding and self-improvement).
 Encourages
development of
interpersonal relationships.
Stages of self -disclosure



Self –presentation.
Relationship building.
Catharsis.
Johari Window Model
A graphic model
describing human
interaction during
relationships
in four different levels
of knowledge.
Social Penetration Model
Core believes and feeling
Depth
Surface believes and feeling
Breadth
Facts about self-disclosure
1.
2.
3.
4.
5.
Increases with intimacy.
Increases with reward.
Increases to reduce uncertainty.
Is a reciprocal.
Gender:
-women disclose more than men.
-women disclose more with the close person,
while men disclose more with the person they
trust.
Effective self-disclosure





The situation and factors about the other
person should be considered before
communication.
Accept personal complexity.
Be flexible and sense when to
communicate.
Do not change values ,but change the
ways of communicating them.
Choose the language.
Appropriate self-disclosure





Reasoned.
Two way process.
Appropriate to the person and the
situation.
Consider diversity: individual, group and
culture.
Be positive.
Lecture 7
empathy, sympathy and
empowerment
By
Dr. Aziza Rajab
Assistant professor
Head of Nursing dep.
King Abdul Aziz University
Dr. Hashim Fida
Assistant professor
Family & community health
king Abdul Aziz University
What are the importance of empathy
and sympathy?
Can not build rapport or gain trust without
showing those feelings
 Back bone for establishing and solidifying
helping relationship
 Help in developing mutual understanding
 Guide us to build appropriate perceptions
 Help us to understand the message

how to differentiate between
empathy and sympathy?
Sympathy is to identify and communicate
that you understand the patients feelings.
( e.g. I understand what you are saying, I
know how you are feeling)
 Empathy is to share his/her feelings ( e.g.
I do feel exactly what you feel )

What is empowerment?
Empowerment is helping others to trust
themselves, to identify, know, and believe
in them selves and their abilities
 Enable others to act independently for
him/her self, choose and decide for them
selves.
 Enhancing people’s creativity, cooperation,
inspiration, and productivity.

How to be sympathetic ?









Try to listen effectively,
try to understand and perceive things as they are
Try to accept the feelings and point of views
without changing them, stop them, or judge them,
try to pay attention
Try to be consistent
Try to reflect on the patients feeling verbally by
summarizing, paraphrasing to show your caring
attitude to patient
Try to be genuine and sincere in your relation with
patient
Try to Respect and accept patient feelings
Try to set limits ( I don’t have time now but we will
talk next visit)
What are the type of empathic
responses that we should avoid?
Judging response: to evaluate another’s
feelings:
Tell patients in various ways that they should not
feel discouraged or frustrated, they shouldn’t
worry ,they shouldn’t question their treatment
by other health professionals.
Any message from you that indicate you think
patient is wrong or bad, will make patient think
and feel that you are not worth his trust and
he cant build confidence for a helping
relationship.
1.
2. Advising response: we can offer quick solution
to another person’s concern with or without correct
perception to his exact needs
The best source of solution to the problem is
always within the patient him/her self.
Rely on other for advise may keep patients
dependent this is against the empowerment idea
we talked earlier
When there are times when patients are not
capable of coping or understanding or deciding for
a solution to their problem, you should walk them
and direct them to the solution without dictating it
to them. It has to be and show that it is coming
from them not you.
3. Reassuring response: telling patients who is
facing surgery do not worry, every thing will be fine,
you will turn out just fine.
It may seems to be helpful but it is conveying that
the person should not feel upset , scared of the
procedure, and concerned about the outcomes.
You should tell the patient with exact words what is
the procedure steps briefly in understood words,
explain the risk in an honest words, state the
expected outcomes, and the assurance part has to be
in the part how practices, competent you are, how
careful you will be, and how common this procedure
is, and that his fear is very normal to feel.
4. Distracting response: changing
the subject, or cutting off patient’s talk
or feeling just because we don’t know
how to response to them
We might direct the communication to
topics we feel comfortable with such as
medication regimens and so forth
These responses tend to convey to
patients that we are not listening, or we
don’t want to listen.
Lecture 8
Doctor-patient Relationship
building a rapport with patients ?
By
Dr. Aziza Rajab
Assistant professor
Head of Nursing department
King Abdul Aziz University
Dr. Hashim Fida
Assistant professor
Family & community health
king Abdul Aziz University
Doctors’ Mission
Doctors’ primary goals are:
 To treat and cure where possible
 To bring relief in suffering
 To help the patient cope with illness,
disability and death.
Doctor- patient relationship

1.
2.
3.
The doctor – patient relationship is built
on :
Honesty
Confidentiality
Trust and reliability
How to enhance doctor- patient
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.
Using the verbal responses and non verbal behaviors appropriately
Involving the patient so that he/she understands and is
comfortable with the process of interview and the consultation.
Increasing both the physician’s and the patients’ satisfaction with
the communication.
Developing and maintaining a continuing relationship of trust &
respect over time.
Why doctors Communicate?
Gain Mutual trust & respect
Exchange information
Ask your seniors
Do your share of work
Interview and consult patients
Conduct Seminar & workshops
with whom doctors
Ccommunicate?

patient

psychologist

family

nurse

physician

social worker

health care
administrators

Dietician

Pharmacist

others

Media
Communication & Medical care
 Good communication should be
established on admission between clients,
family and the treating multidisciplinary
team.
 Client & family are 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 clients 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.
We need to communicate to build a
trust relationship with whom ?
Patients & care-givers
Nurses & auxiliary staff
Colleagues
Administrators
Evidence in court
Reporting research findings
Talking to the media
Public at large
How can doctors build a
positive rapport with their
patients ?
What is rapport?
Rapport is the ability to connect, the ability
to trust, the ability to express feeling and
thoughts, the ability to understand, the
ability to accept the other as is without
judgment, and the ability to exchange
information honestly and freely during
formal or informal interviews. It is the
process of creating a goodwill between
the interviewer and the interviewee.
How can we build a rapport?





Using therapeutic communication techniques
Use the non verbal body language ( time, space,
touch, smile, eye contact, dress, distance, location,
expressions, grooming), and the verbal ( the way
we talk and address each other, the tone, voice,
words used), and the formality levels should be
used appropriately as needed to enhance
connectivity.
Avoid being judgmental, labeling, and criticizing
Empower patients and lower their feeling of
powerlessness, helplessness, dependability.
Show sympathy and empathy as needed.
How do I know that there is a
positive rapport between me and
the other party?
When the interviewer and the interviewee
share a similar world view or situational view
 When we are not jugging the person but rather
trying to understand them more
 When we are able to express and communicate
our thoughts and feeling without fear or
criticism to the other person
 When we mutually are understood correctly.

What are the doctors attitude and
behaviors that can damage a helping
relationship and obstruct you from
building rapport?
Stereotyping: seeing a patient as a person
with stereotype behavior, then ,most
probably you as a doctor will fail to listen
without judgment, and your judgmental
thoughts will reflect in your behavior & words
, and patient will not build trust, there won’t
be no rapport.
we must see patient as an individual and accept
him/her as is
1.
2. . Depersonalizing :if we focus our
communication on specific problems and
cases only, without taking the patient
and his culture, background, thoughts&
feeling in account, then we are really not
understanding the person as a whole,
and trying to implement solutions that
are inapplicable because we don’t have
enough connectivity with patient to
comprehend the big picture about
his/her circumstances.
3.Controling : doctors usually try to run the show
when it comes to diagnose and treat patients,
they rely on what they know more to decide
for care, rather than trying to understand more
from the patient about his feelings and
thoughts about the disease it self and their
preferences of the treatment.
Increased levels of patients participation and
control over the health care interventions,
usually empowers patients, and gives positive
results that includes improved health, less
complications & general quality of life positive
outcomes.
Lack of communication and poor
doctor- patient relationship : why?
Clinicians focus often on relieving patients'
bodily pain, less often on their emotional
distress, seldom on their suffering.
Some of them view suffering as beyond their
professional responsibilities.
If clinicians feel unable to, or simply do not
want to, address the powerful issue of patient
suffering, it is appropriate to refer the patient
to another professional on the healthcare
team who is more comfortable in this area.
Lecture 9
How to Interview Patient
By
Dr. Aziza Rajab
Assistant professor
Head of Nursing dep.
King Abdul Aziz University
Dr. Hashim Fida
Assistant professor
Family & community health
king Abdul Aziz University
What is an interview?
Professional Interview in the medical field is
an interpersonal communication method
and process to gather or/ and exchange
information by using therapeutic
communication techniques.
It is one of the most common methods used
in patients assessment
with whom and why to do Interview ?
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
What are the steps of the interview?
Determine the purpose of the interview
( job interview, patient assessment, …)
1. Determine the objectives of the interview
2. Pre- research the topic and the person
3. Prepare the questions and the context
4. Organize the interview (opening, body,
and closing)
5. Record and document the interview
1.
What are the differences between
formal and informal interview?
In the Informal interview: there is small
social talks at the beginning to get self
comfortable, oriented, and prepare to be
ready for the real sensitive issues.
 In the formal interview: the interviewer
takes more direct, focused, serious, and
in-depth elaborative approach to patients
concerns and complains.

What are the Components of
effective interview?
1.
2.
3.
4.
5.
6.
Differentiate between therapeutic and
non therapeutic communications
Establish rapport
Prepare the environment, choose right
time, get client comfortably situated
Listen instead of just hearing
Differentiate between empathy sympathy
Avoid being superficial and routines, Get
to the sensitive issues
How therapeutic comm. Is different
than social comm.
Therapeutic communication characteristics
unlike the social interactions, must be :
1. Goal oriented, planned, and focused on
specific objectives.
2. Leagal accountability and responsibility for
the given information.
3. Credibility of information and good
reputation of the informer.
4. Mutual understanding between all parties
involved in the communication.
Strategies to conduct an interview?
1-Use open ended questions always that makes the
person think and elaborate on the question, and
encourage the patient to tell their own story,
specially in the start, such as:
What exactly happened, how do you feel about it ,
why do you think this is the problem, can you
explain to me this, can you talk more on this…
(this will be time consuming at the beginning of the
interview and hard to control, but that is ok
because you want to build trust and understand
your patient well(
Strategies to conduct an interview?
Cont.
2. Lower patients defensiveness by:
Asking proper type of questions such as the
what? and how?
Minimize the why question, it makes patients
feel that they need to give justifications always
and that might intimidate them, and make
them feel guilt and responsible for what ever
situation they are facing
- Use silence to allow patient to finish answering
before asking next question and to avoid
feeling of being interrogated
Strategies to conduct an interview?
Cont.
3. Use closed ended questions appropriately
only when you need to establish factual
details quickly such as :does it hurt you
when you cough? The yes and no answer
gives you the exact information that you
need for understanding the problem , but
they often will not allow patients concerns
and anxieties to be expressed.
Strategies to conduct an interview?
Cont.
4- use probing questions for clarification and
verification of information:
( e.g. for clarification: exactly what do you
mean by that? )
( e.g. for verification : did I hear you say
that you do not take your medication at
all?)
Strategies to conduct an interview?
Cont.
5. Do not Use and avoid leading questions such as
( e.g. I think your pain increases at night ?)
They specify the answer you expect to get, there
is no advantage of using it.
6- always listen and use silence and touch
whenever needed to express sympathy and keep
building trust
7- accept and respect patients
Strategies to conduct an interview?
Cont.
8- summarize : always summarize to
patients what has been discussed in brief
and points ( e.g. so we can conclude from
our session today that you agreed to
control your diabetes by measuring blood
sugar twice a day, eat seven small meals
instead of three big ones, and walk at
least half an hour daily, right? Is there
something else?)
Critical thinking questions
1.
2.
What are the most important concepts
doctors need to take in consideration in
building a helping relationship with
patients?
What are the main obstacles in building
a rapport in any interpersonal
relationship?