COMMUNICATION SKILLS
&
DOCTOR-PATIENT RELATIONSHIP
DR Tabassum Alvi
Assistant Professor Psychiatry/Behavioura Sciences
Majmaah University
15TH OCTOBER, 2014
What and why
Oh my Sustainer!
Open my heart and
Make my task easy for me
And loosen the knot from my tongue
So that they might understand my Speech
Surah Taha (16:25-29--Al Quran
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OUTLINE
• Objectives
• Definition
• 7 Cs
• Types
• Doctor patient relationship
• Fundamental elements
• Partnership with patient
• Improving communication
OBJECTIVES
At the end of session students should be able to
01. Explain the basic principles of communication skills
02. Discuss the role doctor patient relationship in clinical care
DEFINITION
“The imparting or exchange of information by speaking, writing or
using any other medium”
APT (2002), vol. 8, p. 166
Communication Model
Context
(
Sender
Thought Process
What, When, Why,
Whom, where & How
Encoder
stimuli)
Message
(Medium)
Verbal & Non Verbal
Receiver
Thought process
Taking meaning out
&
Plan to respond
decoder
7 Cs
1.
2.
3.
4.
5.
6.
7.
Clear
Concise
Concrete
Correct
Coherent
Complete
Courteous
TYPES
• Verbal
• Nonverbal
• Written
WHAT IS MORE IMPORTANT?
Types of communication
Verbal
Non verbal
Symbol Based
Gesture Based
Largely Learnt
Largely Innate
Consciously Controlled
Partial Control
Higher Risk of Deception
Relatively Uncontaminated
WHY IN MEDICINE?
Communication error leads to 60% to 70% of preventable
hospital deaths
(The Joint Commission on Accreditation of Healthcare Organizations)
DOCTOR-PATIENT RELATIONSHIP
FUNDAMENTAL ELEMENTS
• Right to receive information
• Right to make decisions
• Right to courtesy, respect, responsiveness, and timely attention
• Right to confidentiality
• Right to continuity of health care
• Right to have available adequate health care
(Issued June 1992 based on the report "Fundamental Elements of the Patient-Physician Relationship)
PARTNERSHIP WITH PATIENT
• Polite and considerate
• Treat patients as individuals(holistic model)
• Treat patients fairly
• Work in partnership with patients regarding:
• Condition, its likely to progression and the options for treatment, including
associated risks and uncertainties
• The progress of their care, and your role and responsibilities in the team
• Who is responsible for each aspect of patient care
PARTNERSHIP WITH PATIENT
• You must support patients in caring for themselves
• Not pursue a sexual or improper emotional relationship with a
current patient
• Be aware of risk involved in social media
(http://www.gmc-uk.org/guidance/good_medical_practice/partnerships.asp)
IMPROVING COMMUNICATION
• Call by name
• Not just the illness!
• Minimize distractions
• Engage in active listening
• Concrete feedback
• Culturally responsive care
ACTIVE LISTENING
• Sit squarely in front of patient
• Attentive posture
• Nodding
• Active questions and answer.
• Use Para linguistics
• Eye contact
• Matching facial expression
• Level of seating
• Environment
IMPROVING COMMUNICATION
• Assessing your own biases
• Expect resistance to change
• Highlight the positives
• Don’t just write an order
• Clarify before you end interview
• Pain is not always physical!
Guidelines to Effective Listening
• Listen for emotions
• Avoid jumping to conclusions
• Observe the congruence between the verbal and non-verbal
• Practice listening
• Limit your own talking
• Be patient
• Concentrate
Information Care
The Essential Questions
• What is wrong with me?
• Is there a risk of the illness spreading to those around me or passing
• it to my off-springs?
• Is there an effective treatment for my problem?
• Is the treatment safe / are there any serious side effects or dangerous
• effects of the treatment (drugs, interventions, surgery etc), effects on sex, appetite, sleep,
weight etc……Alternative treatments
• Alternative treatments available?
• How long will I take to recover?
• Is there any abstinence?
Basic steps in informational care
• Patient’s knowledge and expectations must be assessed prior to and after
the communication of significant information to see what and how much
has been retained.
• Evidence Based Facts should be provided.
• Positive and negative effects of medicine expressed.
• Avoid false hopes.
• Discuss prognosis of disease in range.
• Summarize
• Check for information retained.
Assignment
Write a learning agreement showing how principles of interpersonal
skills can be applied to daily activities
THANK YOU