Communicating with special
groups
Dr Tabassum Alvi
Assistant Professor Psychiatry/Behavioural
Sciences
Majmaah University
Learning Objective
Analyze the issues surrounding communicating
with special groups
Caring for Children
Be sure to
• Greet the Child and establish rapport.
• Use firm and gentle voice to greet the child by his
name.
• Meet the child and make eye contact at his/her
level.
• Understand child psychology and his/her needs.
• Build trust and confidence of parents as their well wisher.
• Ask parents to verify the present illness.
• Ask parent for additional details.
Be sure to:
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Look for clues by observing child.
Give right and realistic information
Understand multiple agendas of parents
Examine painful parts at the end of examination
Show extreme patience while dealing with crying or
problem child.
• Acknowledge hard work of parenting and praise them.
• Use feedback system to establish best course of
treatment.
• Be supportive and gentle through out.
Avoid
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Showing ‘doctors’ attitude.
Calling him / her a baby.
Confusing parents with attendant.
Engaging in other activities while talking to
the child.
• Making the child embarrassed.
• Being judgmental.
Children care
0-12 months
• Quickly respond to infant communication (e.g.,
comfort a crying baby; smile at a smiling infant; relax
if a baby turns her head to the side)
Toddlers
• Give toddlers one direction at a time and provide
warnings before transitions
• Label toddlers' emotions
Children care
Preschoolers
• Ask preschool children questions about past events
• Probe for details and provide new words to enhance description of
experiences.
• Create opportunities to engage in fantasy and pretend play, either
alone or with friends
School age:
• Use conversation to help school-age children set goals and solve
problems
• Take the time to discuss strategies and solutions and have the
school-age child talk about possible outcomes.
Children care
• When correcting the school age child's behaviour,
provide a calm explanation for your preferences.
• By giving a reason, you help the school-age child
understand the implications of his or her behaviour
for others.
• Encourage school-age children to talk about their
feelings and the possible reasons for their emotions.
Adolescents: 12 to 18 years
• Adolescents are interested in talking in depth about
themselves and about their relationships with others. They
want to understand who they are becoming and what others
think and feel about them.
• Adolescents want to talk about how they are different from
their parents and the rest of the world. They are beginning
to recognize that their parents are imperfect people.
• Use conversation as an opportunity to keep up with
adolescent activities and relationships.
• Stay interested in the adolescent and gently ask questions
and seek explanations for adolescent behaviour.
Caring for Children
• Parents expect that their concerns for child
will be addressed
• Spending sufficient time with the child,
appeared most important to families in their
assessments of overall care
• Parents expect "well child care" attitude.
• Parents expect best course of treatment.
• They rely and trust their physician for best
hope.
CARING FOR AGING PATIENTS
Problems Associated With Aging Patients
• Older people want to be viewed as individuals, not as
stereotypical members of an age group.
• Older patients tend to have multiple chronic
conditions.
• They have fear of diagnoses and treatment.
• They are dishearten because of their aging process.
• They are afraid of surgery or suggested costly
diagnostic tests or medications.
• Depression, and depressive symptoms are common in
older people.
• They tend towards saving money for their spouse.
General Suggestions
• Varying nature and special needs call for flexibility by
physician.
• If feasible, gather preliminary data before the session.
• Try to avoid making the patient tell his or her story
more than once.
• Always look beyond chief complaint.
• Remember that the interview itself can be therapeutic.
What Most Doctors should do:
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Encourage the patient or caregiver to take notes
Provide sufficient information
Encourage the patient to ask questions
Provide the main information and advice yourself,
instead of your staff
Identify and discuss lifestyle factors
Repeat key points
Avoid medical jargon.
Avoid overloading the patient with too much
information
What Most Doctors should do:
• Provide praise and encouragement when appropriate
• Be certain that the patient agrees with the goal or
outcome of the treatment plan
• Keep the treatment plan as simple and straightforward
as possible
• Check feasibility and acceptability of treatment plan
• Resolve all misunderstandings
• If possible, support your treatment plan with literature
• Speak slowly and gently
ANXIOUS PATIENTS
• Remember anxiety is a frequent and normal reaction
to sickness
• Anxious patients may sit tensely fidgeting with their
fingers or clothes.
• Lick their dry lips.
• Sweat more than often.
• Consult more than required.
• Asking multiple questions.
• Show more concern in their sickness than usual.
Best Ways To Provide Care
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Establish rapport.
Encourage them to talk about their feelings.
If needed, recommend psychiatric therapy.
Answer all queries before they ask.
Give detailed information care.
Use of words like ‘don’t worry’.
Provide reassurance.
CRYING PATIENTS
• Crying patients are sensitive by nature.
• Crying maybe due to sadness anger or frustration.
• Usually it is therapeutic for some patients.
Best Ways To Provide Care
• Offer tissue.
• wait for recovery.
• Be gentle.
• Be facilitator and supportive "it’s good to get it
out".
• Try to compose them.
• Help them continue the session.
TALKATIVE PATIENTS
Situations that Call For Special Responses
• Patients are equally difficult as silent patients.
• They have more information to share.
• They might be attention seekers.
• Might be victim of loneliness.
• Some have professional compulsion of speaking
behavior.
• They can act as advertising agency for building
rapport.
Best Ways To Provide Care
• Develop your agenda of session and discuss with
patient.
• Listen to him/her, perhaps they lack good listener.
• Interrupt if you must, but courteously.
• Be directive, and ask close ended questions.
• Repeat and show that you have heard and understood.
• Do not show impatience.
• If needed, arrange next appointment.
• Let them ventilate in the beginning and then control the
session.
• Remember, there is a long cue outside
PATIENTS WITH LIMITED INTELLIGENT
Such patients maybe
• Mentally retarded.
• Illiterate.
• With limited knowledge about facts of life.
• Unaware that they are sick.
Best Ways To Provide Care
• Pay special attention.
• Gently assess and analyze their mental status.
• Obtain complete social and family history from family or
friends.
• Show concern, establish rapport and engage in simple
conversation.
DEPRESSED PATIENTS
Identifying features
• Feeling sad or crying a lot.
• Losing interest or pleasure in things they used to
enjoy.
• Feeling guilty, helplessness, hopeless or
worthlessness.
• Thinking about death or suicide.
• Feeling very tired or slowed down.
• Having trouble paying attention and making decisions.
Best Ways to Provide Care
• Try to distinguish among the various depressive
disorder.
• Listen to them attentively.
• Show acceptance and respect to the patient.
• Counseling helps them recover quickly from depression.
• Skilled interview and gaining confidence will help gain
insight.
• Encourage the patient to ask questions.
• Build up motivation.
PATIENTS WITH LANGUAGE BARRIERS
Identifying features
• Illiterate patient.
• Low educational level.
• Patient speaking a different language.
Best Ways To Provide Care
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If possible, try conversing in their native language.
Use simple language which is understandable.
Use nonverbal signs to support your conversation.
Come down to the comfortable level for low educated
patients.
Be patient.
If nothing works, use interpreter.
When using Interpreter, set agenda with interpreter that
he/she is the custodian and responsible for right
information.
Speak directly to the patient and do not face towards
interpreter.
DEAF AND HARD -OF- HEARING PATIENTS
Best Ways To Provide Care
• Ask patient whether he or she can hear you clearly.
• If the patient has a hearing aid, make sure that it
works.
• Face the patient.
• Ensure good lighting.
• Speak clearly and slowly.
• Let them lip read and pick up visual cues; do not cover
your mouth.
• Speak in low pitch tone and avoid shouting.
• Do not trail off at the end of sentences.
BLIND PATIENTS
Best Ways To Provide Care
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Shake hand with patient to establish contact.
Explain who you are and why you are there.
Orient the patient to the room.
Explain what all is there, and who all are present
in the room.
• Remember to respond vocally.
Communication with Media
Media Enquiries About Cases and Patients
What should you say?
• What's your name?
• What is the name of your publication/programme?
• What, exactly, did you want me to comment on?
• What is your deadline?
• Who else have you spoken to?
• Give me your number, and I'll ring you back
Top tips
Buy time and prepare
• Always bear patient confidentiality in mind.
• Stay calm and professional.
• Write down the name and contact details of
the journalist and publication.
• Find out the deadline for a response.
• Avoid saying “no comment”.
• Contact the press office for advice.
The media on your doorstep
Top tips
• Behave calmly and professionally – you do
not want to be
• seen as defensive or hostile.
• Ask the journalist for their contact details so
you can get back to them.
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Photographers and camera operators
Top tips
• Do not run away from cameras or try to hide
– this will create a negative image. Instead, let
the photographer take a full shot of you.
• Let your staff know that there is/has been
media attention; advise them to follow the
same guidance.
TV and broadcast interviews
Things to find out:
• What is the storyline or angle?
• Who is producing it?
• Who is the audience?
• When and where will it be broadcast?
• What are the questions they will be asking
you?
• Who else will be contributing?
Top tips
• Make sure you are fully prepared before you
speak and are clear on your key messages.
• Be concise and clear.
• Body language and good eye contact is as
important as what
• you say in a filmed interview
Breaking Bad News
‘Any news that adversely and seriously affects an
individual’s view of his or her own future is considered
as bed news’
Communicating Bad News
• · Getting started
• · What does the patient know?
• · How much does the patient want to know?
• · Sharing the information
• · Responding to patient and family feelings
• · Planning and follow-up
STEP – 1: SEATING AND SETTING: ENVIRONMENT
• Exclusivity
• Involvement of significant others
• Seating arrangements
• Appear attentive and calm
• Listening mode
• Availability
STEP 2: PERCEPTION
• The principle involved in this step is “before you tell,
ask". What does he or she thinks about his medical
condition.
Example
1) What did you think was going on with you when
you felt lump?
2) What have doctors told you about all this so far?
STEP 2: PERCEPTION
• Note the language and vocabulary of the patient.
• If the patient is in denial, try not to confront him in
the first interview.
STEP 3: INVITATION
• Most patients want to know all about their illness
but assumption towards that should be avoided.
• Obtaining overt permission respects the patient’s
right to know or not to know.
STEP 3: INVITATION
• Would you like me to give you details about what
is going on ?
or
• Would you prefer I tell you about the treatment I
am prescribing to you?
STEP 4: KNOWLEDGE
• Before you break bad news, give your patient a
warning to prepare him.
• Use same language as it maintain a therapeutic
relationship with the patient.
STEP 4: KNOWLEDGE
• Avoid scientific and technical language.
• Give information in small bits and clarify whether he
understands
• Emotions and reactions arise during the interview,
acknowledge them and respond to them.
STEP 5: EMPATHY
It comprise of 3 components.
1) One needs to listen and identify the emotion and
acknowledge them.
2) Identify the source of that particular emotion.
3) Respond by showing that you understand the
emotional expression of the patient.
STEP 6: SUMMARIZE
• Recapitulate the information of all that has
been discussed and give your patient an
opportunity to voice any major concerns or
questions.
STEP 7: PLAN OF ACTION
• Clear plan for the next steps that need to be
taken regarding management of the issues.
Assignment
• Write a learning agreement showing how
principles of interpersonal skills can be
applied to daily activities
Thank you