Patient
Communication
“The Dance We Do”
Brian E. Wood, D.O.
Associate Professor and Chair,
Department of Neuropsychiatry and Behavioral Sciences
Edward Via Virginia College of Osteopathic Medicine
brwood6@vcom.vt.edu
Communication
• a process by which information is exchanged
between individuals through a common
system of symbols, signs, or behavior
• exchange of information
• personal rapport
Meriam-Webster Online Dictionary
Why Communicate?
• To include someone in
interaction
• To impart to someone
something you want them to
understand.
• To attempt to understand
something about others.
• Innate human drive to seek
others.
– Fascination with the existence
of other life
– Personification in
fantasy/literature, etc.
Biology of Communication
Very complex interplay of physiological functions
controlled by the:
The Missing Link
• Brain functioning and communication are directly linked.
• The brain, when working properly, uses many complex
mechanisms of communication to “connect” with other
organisms.
• One of the predominant mechanisms is language but there
are others.
– Posture, physical presence
– Gestures and mannerisms
– Appearance and expression
Mental Status Exam
• Observation of brain functioning is the goal
• Complications/limitations
– Attempting to derive information about brain functioning
through observation of behavior and responses to tasks,
etc.
– Looking at brain functioning through overlay of learned
responses, behavior, dynamics, etc.
• Examination remains science with art
– Not unlike any other medical examination (ex.
Auscultation)
Characteristics of Patient
Communication
• Mental Status (functioning of the CNS) is
integrally involved
• There are two parties
– You
– The patient
• There is a constant two way street
– Communication to and from the patient
• There is a dynamic interplay
Language
• Language encompasses many complex processes.
• Not just speech
• Expressive language
– Written
– Verbal
– Prosidy
• Receptive language
– Written
– Verbal
– Prosidy
Non-verbal communication
• Patient appearance
– Anxious ?
– Distracted?
• Does the non-verbal communication conflict
with verbal ?
– Often when patients have barriers to verbal
communication (ambivalence, social barriers,
etc.), we see mixed messages from verbal and
non-verbal sources.
Eliciting Information
• Eliciting information from only verbal sources
– Content or fact oriented
– Very limited scope to patient communication
– Close ended factual information gathering
• Eliciting information from multiple sources
– Much more complete view of patient status
– Content (static) plus Process (dynamic)
information
– Open ended
Patient Interview Design
Information In
• Should incorporate
ways of getting both
content and process
information.
• Open ended questions
for sensitivity.
• Close ended questions
for specificity.
Open Ended
Process
Close Ended
Content
Information Out
Patient Interview
• Content
– Factual (ex.)
• History of illnesses
• Current living
arrangements
– Close ended
– Provided directly or
indirectly.
• Process
– Interaction based (ex.)
• Rapoirte
• Openess to examiner
– Open ended
– Based on observation of
patient and
environmental
interactions.
Effects of CNS Abnormalities
• Can abnormalities in brain functioning affect
content of information? What brain functions
might be involved?
– Fairly direct relationships.
• Can abnormalities in brain functioning affect
process information? Which brain functions?
– Much more complex issues
– May be subtle but very significant
Mental Status Abnormalities and
their Effects
• Content
– Factual errors
– Distortion of
information (ex.
Negativistic thinking)
• Process
– Inability to establish
relationship with
examiner.
– Inability to filter
extraneous
environmental cues
– Inability to understand
(capacity)
Factual Errors and Distortions
• May introduce error into elements of history
and thus diagnostic decisions.
• May be dependent on multiple factors
including patient functioning and
environment.
• Usually requires corroborating source of
information.
Inability to Interact with Examiner.
• May result in complete inability to acquire
reliable factual information.
• Be aware of your interactions and how the
patient is interpreting them.
• May require treatment of the patient and/or
adjustment of examiner technique in order to
engage patient in therapeutic interaction.
Capacity
• Ability to engage in some sort of cognitive
process
• Many different types or areas of capacity
– Capacity to understand
– Capacity to manage affairs
– Capacity to give informed consent
• Not an “all or nothing phenomenon”