Basic Concepts of Communication With Patient and Family

 

BASIC CONCEPTS OF MEDICAL COMMUNICATION

PUTU SUTISNA

 

  Lecture’s main objectives:   To describe the importance of good communication with patients  To describe the factors that may influence the outcome of communication between the doctor and patient  To explain the technique of conducting effective communication with patients that effective involves involv es questioning, listening and facilitating

 

 Communication

imparting, conv conveying eying or exchanging exchanging of ideas, news, knowledge etc.

 

Sever Several al methods of communication:  Two friends talking  Radio/ TV  Newspaper/book  Wrting a letter  Telephoning/fax  Teaching/lecturing  Doctor or nurse with patient

 

Purposes of Communica Communication tion are to:  form & maintain relationship  give information  convey feelings  persuade  solve problems  alleviate distress make e decisions decis ions  mak  give reassurance

 

Aim of a physician (since ancient time):  “To cure sometimes,

relieve often, comfort always……” 

 

Communication in Medicine •

Doctor – patient/f patient/family amily

•

Doctor – doctor

•

Doctor – community

 

Main areas covered in Block MC 1.

A.Tak A.T akin ing g medi medica call his histor ory y and and rev revie iew w of bo body dy systems B. Giving informat information ion to patient C. Special approach to specific s pecific patient/situation patient/situation 2. Paper presentation and discussion 3. Writing medical letters letters & notes, and CV 4. Scientific writing (5. Health education & health promotion for community at large)

 

  Good communication skills can be learned. Prerequisites:  Written instructions (references)  Opportunities to practice  Feedbacks (SGD)  Discussion on performance (SGD)

 

Doctor-Patient Communication

Influencing Factors

Patient-related factors

- Physical symptoms - Pathological factors related to illness - Previous experience of medical m edical care - Current experience of med care

 

 Doctor-related factors

-Training in communication skills - Self-confidence in ability to communicate communicate - Per Personality sonality - Physical factors factors (e.g. (e. g. tiredness) - Ps Psychological ychological factors factors (e.g. anxiety)

 

requirements ts  Interview setting requiremen - Privacy - Comfortable surroundings - Appropriate seating arrangement

 

Guidelines for conducting interview with patient

A. Beginning

1. Gr Gree eett pa pati tien entt by by nam name, e, sh shak ake e han hand d (?) (?) 2. Ask patient to sit do down 3. Introduce yourself 4. Expl Explai ain n pu purp rpos ose e of in intter ervi vie ew 5. Say h ho ow mu much tim time e av available 6. Explain ne nee ed to to ta take no notes

 

B. Main part of interview 1. Ma Main inta tain in +v +ve e at atmo mosp spher here, e, wa warm rm ma mann nner er,, eye contact 2. Use Use ope open n que quessti tion ons, s, esp esp at beg begin inni ning ng 3. Listen carefully 4. Be al aler ertt and and res espo pons nsiv ive e to to ver verba ball & no non n verbal cues 5. Fac acil ilit itat ate e pa pati tien entt ver verbal bally ly & non non-v -ver erbal bally ly 6. Us Use e clo close sed d que quessti tion onss whe when n app apprrop opri ria ate

 

Clariify wh wha at pa pati tie ent has has tol old d you you 7. Clar 8. En Enccou ourrag age e pa pati tien entt to be rel elev evan antt C. Ending 1. Su Summ mmar ariz ize e wh wha at pa pati tien entt ha hass tol old d you you 2. As Ask k if if pa pati tien entt wan wants ts to ad add d an anyt ythi hing ng 3. Thank patient

 

•

Key skills for communicating effectively with patient

  Questioning   Listening   Facilitating

 

1. Questioning  Main purpose of interviewing patient:

to obtain information about patient’s condition  accurate, complete and relevant  Good communication with patient alone

contributes to correct correct diagnosis in 80% of cases

 

•

Open questions  –

should be used as much as possible

 –

to obtain great deal of informa information tion from patient

“Would you please tell me how you have been  feeling in the past few days?”  days?”   “I understand that you have had pain. Would you  please tell me more about it ?”  ?”   “Can you tell me what brings it on?”…etc on?”…etc  

 

•

Closed questions  –

 –

Give patient little choice in the way to answer

Usually elicits little information, only “yes” or “no”.   “no”.

“Have you been feeling been feeling unwell today?”  

“I see from your GP’s notes that you have had chest  pain. Do you still have the pain?”  pain?”   “Was it tight or dull pain?”  pain?”   “Did it go down your arm?”  arm?”   “Did it get worse when you exercised ?”  ?”  

 

Advant Advantages ages of open questions  More relevant relevant information information in given time  Patient feels more involved 

Pa Patient tientproblems can express all concerns and anxieties about

When to use close questions?  To obtain specific information not yet given by

patient

 In emergency cases

 

2. Listening Features of active and effective listening:  Gathering and ret retaining aining information accurately Understanding tanding implications i mplications for patient of  Unders what is being said

 Responding verbal & non-verbal signals or

cues  Demonstrating you are paying attention and trying to understand understand

 

Non-verbal cues:  Eye contact  Posture  Gestures  Facial expressions  Way voice is used

 

3. Facilitating effective listening. Aim to help patient  Related with effective to talk fully about problems.  Verbal way

“Please go on and tell me more about your pain”. pain”.  “Yes, I understand—please continue”.  continue”.   Non verbal ways:

forward d toward patient  Leaning slightly forwar  Making eye contact  Nodding head at appropriate time

 

Communication with Family How family can help?  Provide emotional & social support  Provide practical practical support s upport  Provide understanding understanding of beliefs about illness

& treatment

 

information about ab out family history  Provide information  Help avoid/overcome avoid/overcome bad p patient atient compliance

Overcome ome difficulties arising from secrets  Overc  Anticipate/address problems that may affect

other family members

 

NO’S 

 Too many or complicated questions

ow n  Not allowing patients to tell story in their own words  Unnecessary interruption  Failing to pick up verbal & non-verbal cues

 

  Patients Patients respect doctor doctorss who  are warm and sympathetic  are easy to talk to  introduced themselves  appear self-confident 

 listen to the patients and respond to their verbal cues

 ask easy-to-under easy-to-understand stand questions

 

  Summary effectively and  The ability to communicate effectively sensitively is essential in medicine   Communicating effectively with patients involves the

core skills of questioning, listening and facilitating facilitating   Good communication leads to: accurate history history taking and diagnosis, patients’ compliance with treatmentt plan, patients’ satisfaction treatmen satisfaction with the care given   The skills of good communication can be learnt and retained

 

  THANK YOU