13th international Course, Slovenia
Introduction to
communication patterns
Amanda Howe
MA MEd MD FRCGP
Professor of Primary Care
University of East Anglia, Norwich, U.K.
EURACT
13th international Course, Slovenia
EURACT
Objectives
By end of keynote:
Be able to identify your ‘taken for granted assumptions’ about
doctor – patient communication in family medicine
Have reconsidered some established models for analysis
Become aware of contribution of different disciplines to this field
of learning and research
Be able to apply some simple tools to your consultations
Have begun to think of some areas for study in practice
Be able to identify issues in consultation where communication
patterns may mislead us
13th international Course, Slovenia
EURACT
Definitions1
To communicate
– impart, reveal, bestow
- succeed in conveying one’s meaning
- have something in common with another
A pattern
- something to be copied, a model
- a design or guide when something is to be made
- recognisable repetitive structure
thus, Communication patterns
- A set of behaviours by which people habitually seek to convey
meaning to another
NB – may not be ‘successful’ or ‘model’
1Chambers
English Dictionary, 1998
13th international Course, Slovenia
EURACT
Assumptions
• What do you ‘take for granted’ in your communication
with patients?
 Discuss
 Consider further after the workshop
Your own learned styles(s)?
Need to modify this to patients?
Time limits?
Tasks to be achieved?
Language and cultural barriers?
13th international Course, Slovenia
EURACT
Models of communication
in family medicine
Doctor centred versus patient centred
Calgary – Cambridge ‘OLOBA’
Objective Led Outcome Based Analysis
Broader consultation analysis models
 Leicester Assessment Package
 LIV-MAAS
 MRCGP video rating scale
 Consultation Quality Index
 >>>>
(NB. these look at communication and clinical care)
13th international Course, Slovenia
EURACT
Evidence based assumptions in these models
• How we communicate is essential to successful
outcomes – both diagnostic and relational
• There are recognisable components to the
consultation (not necessarily sequential in time)
> initiating, building rapport, gathering information, providing
structure, effective explanation, shared decision making
• The opening component of the consultation must
give scope to the patient to communicate ‘reveal’
• Some parts of the consultation must be doctor – led
• Behaviours can be observed and evaluated
• but meaning cannot be interpreted by an ‘outsider’
13th international Course, Slovenia
EURACT
Disciplines which contribute to
studies of communication
•
•
•
•
•
•
•
•
Family medicine (core clinical skill)
Psychology
Sociology (influence of power & culture)
Linguistics (meaning, communication styles)
Ethics and law (constraints, confidentiality)
Education (learning, research into impacts)
Humanities (indirectly but effectively)
Philosophy (epistemology)
13th international Course, Slovenia
EURACT
Practical Approaches
• Use an accredited evidence based checklist
• CPD opportunity to look at one’s consultations
(video, observer, simulated patients)
• Audit patient feedback – CQI, LIV-MAAS
• Audit diagnoses – especially any ‘mishaps’ - for
contribution of communication problems
• Reflect on ‘difficult consultations’ – especially
cultural barriers, anger, somatisation – consider
further training if needed
• Read and think!
13th international Course, Slovenia
EURACT
Communication patterns recommendations
• Consultations should include recognisable
components
> initiating, building rapport, gathering information, providing
structure, effective explanation, shared decision making
• The opening component of the consultation must
give scope to the patient to communicate ‘reveal’
• ‘Microbehaviours’ e.g. clarification, checking, and
safety netting are crucial to effective communication
• Nonverbal behaviours may be as important as verbal
• Continuous reflection on this aspect of professional
behaviours is essential for all FMPs
13th international Course, Slovenia
EURACT
Communication - can be misleading
• PSYCHOLOGICAL IMPAIRMENT – drugs,
depression, damage, disability
• DISTRUST – vulnerability, power, abuse
• LANGUAGE BARRIERS
• ‘CHARACTER’ – introversion / extroversion,
emotional literacy / expressiveness
• ‘IMITATING’ vs genuine EMPATHY/RESPECT
>> looking behind the message
• SYSTEMS CONSTRAINTS – time, design
>> need for underlying attitudinal development,
organisational facilitation and self management
13th international Course, Slovenia
Introduction to
communication patterns
Amanda Howe
MA MEd MD FRCGP
Professor of Primary Care
University of East Anglia, Norwich, U.K.
EURACT