SKILLS IN
MEDICAL COMMUNICATION
Dr.T.V.Rao MD
DR.T.V.RAO MD
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CONSULTATION / COMMUNICATIONS SKILLS
PROBABLY THE MOST IMPORTANT SKILL IN MEDICINE
*HIPPOCRATIC OATH
• I will prescribe regimens for the good of my
patients according to my ability and my judgment
and never do harm to anyone.
• All that come to my knowledge in the exercise of
my profession or in the daily commerce with men,
which ought I not to be spread abroad, I will keep
secret and will never reveal.
• *Practice of ethics reduces litigations it is true
DR.T.V.RAO MD
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COMMUNICATION SKILLS IN
MEDICAL PRACTICE
• Developing strong
communication skills is
integral to becoming an
effective health provider. In
recent years good doctor–
patient communication has
been linked to improved
patient satisfaction, better
patient care and a
decrease in malpractice
lawsuits.
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WHAT DOCTORS NEED
• Knowledge
• Ability to elicit
information from
patients
• Interpersonal skills
to respond to
patients’ feelings
and concerns
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COMMUNICATION SKILLS
• To diagnose and
treat disease
• To establish and
maintain a
therapeutic
relationship
To offer information
and educate
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CREATING SKILLS IN MEDICAL COMMUNICATION
CONTINUES TO BE A CHALLENGE
• Recognised its importance,
medical schools/colleges
have strived to teach
students not only the
science of medicine, but
also the art of
communication.
Unfortunately, creating
methods for teaching
communication skills that
are effective and enjoyed
by most students is
challenging.
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RESPECTING PATIENTS A GREAT SKILL
• Remember that
every patient could
be you, your mother,
your brother or your
sister. How would
he or she feel
waiting for the doctor
to come into the
room
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RESPECTING PATIENTS MAKES YOUR
JOB EASY
• Introduce yourself to the
patient.
Explain your role.
•
Shake hands, but don’t force
physical contact if
• patient is uncomfortable.
Call the adult patient Mr., Mrs.,
or Ms. (do not use first name )
Maintain privacy.
DR.T.V.RAO MD
•
Keep doors and curtains
closed.
•
Acknowledge and greet others
in the room.
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YOUR APPEARANCE INCREASES
CONFIDENCE
Maintain a professional
appearance
Clean, neat,
“conservative,”
See dress code in
syllabus
Goal is to inspire
confidence
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MAKE YOUR PATIENTS COMFORTABLE
• Make sure the patients
comfortable.
• Sit at the patient’s level.
Be aware of the
patient’s personal
space (can vary among
cultures.)
Continue to consider
the patient’s comfort
during the history and
physical.
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CONSULTATION SKILLS
THE MOST IMPORTANT SKILL IN MEDICINE
• To get the most out of the consultation for the patient
foremost and for the doctor.
• To plan the consultation using a framework
• To adapt your style of consulting to meet the needs of the
patient
• To handle difficult situations
• To have “rescue” plans when things go wrong
• To use time efficiently in the consultation
• To be able to assess and improve the consultation
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COMMUNICATION SKILLS PART OF YOUR
MANAGEMENT
• In order to deliver
effective healthcare,
doctors are expected
to communicate
competently both
orally and in writing
with a range of
professionals,
managers, patients,
families and carers
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COMMUNICATION IS THE MAJOR PART
OF MEDICINE
• Good communication skills are integral to medical and
other healthcare practice.
• Communication is important not only to professionalpatient interaction but also within the healthcare team.
The benefits of effective communication include good
working relationships and increased patient
satisfaction. Effective communication may increase
patient understanding of treatment, improve compliance
and, in some cases, lead to improved health
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Task Orientated
Patient centred
Doctor centred
Behaviour Orientated
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COMMUNICATION SKILLS
SOME TECHNIQUES
• Developed fluent dialogue with patient
• Used silence effectively, allowing patient enough time to express
thoughts or feelings
• Actively encouraged patient through use of supportive words or
comments
• Dialogue with patient was enhanced by effective use of non-verbal
behaviour
• Used open, exploratory questions – inviting patient to become
actively involved
• Adjusted language as appropriate, to suit particular needs of the
situation
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KNOWLEDGE CAN UNDERSTAND A PROBLEM
BUT CANNOT SOLVE WITHOUT EMPATHY
• Some people think only
intellect counts:
knowing how to solve
problems, knowing how
to get by, knowing how
to identify an advantage
and seize it. But the
functions of intellect are
insufficient without
courage, love,
friendship, compassion
and empathy.
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MOST IMPORTANT DEMAND FROM PATIENTS
EMPATHY
• Empathy: “The ability
to understand and
share the feelings of
another.” from Greek
empatheia (from em‘in’ + pathos ‘feeling’)
This sums up what
empathy is: I am here
with you, I give you
hope, and accompany
in your feeling
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PRACTICE LITTLE EMPATHY
JUST NOT SYMPATHY
• Is the ability to
understand the patient’s
experiences and
feelings accurately as
well as to demonstrate
that understanding to
the patient. 􀁼 Is an
active process. 􀁼 Is
more than sympathy, or
feeling sorry for
someone.
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START PRACTICING EMPATHY
• Empathy requires
listening. Remain quiet
and let the patient talk.
• Silence can be helpful,
don't be afraid of it.
Use open ended
questions.
Use “continuers” and
echoing.
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PATIENTOLOGIST
• Patientologists. They are empathetic; and understand
what the patient's fears and worries are, so that they
can help them to manage them.
• How does a doctor become a good patientologist ?
Unfortunately, these skills are never taught formally in
medical college. Some doctors have a great bedside
manner, because they have a high EQ ( emotional
quotient). Others learn how to improve their patient
skills by emulating their teachers who are good
clinicians
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DO YOU KNOW MANY PATIENTS COMPLAIN DOCTORS ARE
NOT LISTENING
JUST START INVESTIGATING
• Enhance empathy by
the way you respond to
what the patient says. 􀁼
Show the patient you
have been listening to
the content of their
problem.
Show the patient you
understand their
perspective on the
problem
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PROVIDING OPPORTUNITIES FOR
BETTER COMMUNICATION
• Education providers
need to ensure that
appropriate and
effective training
opportunities are
available to doctors to
develop and refine such
skills in order to
facilitate interaction with
patients and others.
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YOUR FIRST TASK TO GET HISTORY
NEEDS EFFECTIVE COMMUNICATION
• In all doctor-patient interactions a variety of
communication skills will be required for
different phases of the consultation. During the
start of a consultation, doctors must establish a
rapport and identify the reasons for the
consultation. They must go on to gather
information, structure the consultation, build on
the relationship and provide appropriate
information
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STUDENTS SHOULD BE TRAINED IN
DEALING WITH
• Students must have opportunities to practise communicating in different
ways, including spoken, written and electronic methods. There should also
be guidance about how to cope in difficult circumstances. Some examples
are listed below:
a. breaking bad news
• b. dealing with difficult and violent patients
• c. communicating with people with mental illness, including cases where
patients have special difficulties in sharing how they feel and think with
doctors
• d. communicating with and treating patients with severe
mental or
• physical disabilities
• e. helping vulnerable patients.
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TODAY’S DOCTORS DEPENDENT ON PATIENT
SATISFACTION ………..
• The doctor-patient relationship is improved. The doctor is better
able to seek the relevant information and recognise the
problems of the patient by way of interaction and attentive
listening. As a result, the patient’s problems may be identified
more accurately.
• • Good communication helps the patient to recall information
and comply with treatment instructions thereby improving patient
satisfaction.
• • Good communication may improve patient health and
outcomes. Better communication and dialogue by means of
reiteration and repetition between doctor and patient has a
beneficial effect in terms of promoting better emotional health,
DR.T.V.RAO
MD
resolution
of symptoms and pain control.
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CLINICAL ERRORS ARE COSTLY
COMMUNICATION REDUCES
• The overall quality of care
may be improved by
ensuring that patients’
views and wishes are taken
into account as a mutual
process in decision making.
• Good communication
is likely to reduce the
incidence of clinical
errors.
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EFFECTIVE COMMUNICATION BENEFITS
DOCTORS AND REDUCES LITIGATIONS
• Effective communication skills may relieve doctors of
some of the pressures of dealing with the difficult
situations encountered in this emotionally demanding
profession. Problematic communication with patients is
thought to contribute to emotional burn-out and low
personal accomplishment in doctors as well as high
psychological morbidity. Being able to communicate
competently may also enhance job satisfaction.
• Patients are less likely to complain if doctors
communicate well. There is, therefore, a reduced
likelihood of doctors being sued
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ALL MEDICAL AND PARAMEDICAL STAFF ARE IN
COMMUNICATING THE FACTS TO PATIENTS
• Good communication within the
healthcare team is essential in
order to ensure continuity of care
and effective treatment for
patients. Moreover, poor
communication between
professional staff has been
identified as an underlying factor
for failed communication with
patients. For example, a patient
may be given different
information regarding their
condition by different members of
the healthcare team.
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TO BE A BETTER PRACTITIONER
PRACTICE GOOD COMMUNICATION
• To diagnosis and treat
disease and maintain a
therapeutic relationship:
Data from the patient
must be objective,
precise and reliable.
You must demonstrate
respect, genuineness
and empathy. These
skills can be learned
with practice!
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COMMUNICATION SKILLS TO BE INCLUDED
IN STUDENT APPRAISAL
• Communication skills are
now regarded as a core
competence. Assessment
of communication skills will
be necessary as part of the
doctors appraisal and
personal development
plans. In addition,
revalidation will also take
communication skills into
account
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WHAT OUR MEDICAL STUDENTS
NEED
• Medical schools / Colleges must be encouraged
to provide the best possible communication
skills training as part of the core undergraduate
curriculum. This training should have set
objectives and clear methods of assessment.
• More communication skills training programmes
should be developed at postgraduate level.
Doctors could use the appraisal process as a
vehicle for discussing the success of
communication skills training
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THE INSTITUTE OF MEDICINE’S 2000 REPORT
•
To Err is Human: Building a Safer
Health System” suggested that
close to 90% of medical errors are
a result of failed systems and
procedures. The Joint
Commission, which accredits and
certifies more than 15,000 health
care organizations and programs
in the United States, cites team
training as an essential factor in
reducing risk of medical errors.
• Communication skills too
are very Important
• Professional coordination is
basis of success
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• Programme Created by Dr.T.V.Rao MD for
Medical and Health Care Workers in the
Developing World
• Email
• doctortvrao@gmail.com
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