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Communication skills in clinical practice

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by

Nasser Aljehani

on 30 March 2014

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Transcript of Communication skills in clinical practice

Communication skills
Main objectives
Communication Styles
Road map to build good rapport with the patient
Challenging situations
Challenging questions
BRAINSTORM
ELEMENTS
copy and paste as needed and take advantage of an infinite canvas!
Non-Verbal
Facial expression
Posture
Eye contact
Distance
Tone of voice
Communication skills techniques
5 E's
Engage
Empathize
Educate
Enlist
Expectation
C-L-A-S-S
Context
Listen
Acknowledge
Summarize
Difficult situations
Challenging questions
- Knocked on the door before entering / stood up for patient
- Introduced self by name
- Shake patients hand. Project warmth and confidence
Identified his/her role or position
- Correct posture and setting
- Correctly used patient’s name
- Made eye contact with the patient
History taking
- Start with an open-ended question
- Listen carefully without interruption
- Keep eye contact
- Facial expressions
- Avoid technical medical terms.
- Show empathy and address any patient concerns
- Summarize the history
- Ask if there is anything that was not covered.
- Ask if patient has any concerns or questions
Physical examination
- Washed his/her hands
- Used respectful draping
- Respected privacy
- Asked permission to start the exam
- Explained all the moves
- Kept eye contact during exam (especially painful maneuver during abdominal examination
- Showed compassion for your pain
- Do not repeat painful maneuvers
- Assisted the patient all the time
- Never say good or aww during examination
Conclusion
- Discussed initial diagnostic impressions.
- Discussed initial management plans
- Diagnostic tests.
- Discussed alternative living options such as assisted living.
- Offered social work assistance.
- Offered a statement of support: “Your safety is my primary concern, and I am here for help and support when you need it.”
asked if the patient has any other questions or concerns.
Patient entering the room
Children
- Always bring parents
- Have an idea about child's understanding
- Repeat things
- Magical thinking
Breaking bad new
Crying patient
patient
refuses to answer
Hidden
agenda
Allow the crying patient to express his feelings.
Wait in silence for him to finish.
Offer him a tissue.
Get closer.
Show him empathy in your facial expressions.
Ask an open ended question of what is the cause. You may also place your hand lightly on the patient’s shoulder or arm and say something like “I know that you feel sad. Would you like to tell me about it?” Don’t worry about time constraints in such cases.
Patient in pain
Show compassion for the patient’s pain.
Say something like “I know that you are in pain.”
Offer help by asking, “Is there anything I can do for you to help you feel more comfortable?”
Do not repeat painful maneuvers. If the patient does not allow you to touch his abdomen because of the severe pain he is experiencing, tell him, “I know that you are in pain, and I want to help you. I need to examine you, though, to be able to locate the source of pain and give you the right treatment.”
Reassure the patient by saying, “I will be as quick and gentle as possible.”
Explain to the patient why the question or the physical exam is important.
Tell him that they are necessary to allow you to understand the problem and arrive at a diagnosis.
If the patient still refuses to cooperate, skip the question or the maneuver and document his refusal and your counseling in your PN.
Patient has mismatch between how they response to your news.
Difference between body language and real response
Verbal
Call a person by name
Use respectful words
Don't use slang
Avoid medical terminology
Be concise and clear
Try to add humor
Do not speak in hurry
Join the patient - welcome and introduction
Elicit Agenda - Talk without interruption Use open ended questions
Facilitation
Set Agenda
Assess understanding
Deliver in small chunks
Assume questions
Strategy
Why?!
Increased patient satisfaction
Increased adherence to treatment
Better health outcomes
I know that this is very upsetting to you.
You have to acknowledge the emotion even if you don’t fully understand it.
Physical space - Relatives or friends - Body language
Empathic response - Touching - Normalizing
S
etting
P
erception
I
nvitation
K
nowledge
E
xplore emotions and Empathize
S
trategy and summarize
Listen to level of comprehension - body language
know what level of information to start with
What does the patient want to know?
Give information in small chunks
Make sure patient understands what you are saying
Straight but sensitive
- Empathic response
- Identify emotions
- Identify cause/source of emotions
- Summarize
- Propose strategy
- Ask if patient has questions
Engage the patient in treatment plan
- Be honest and diplomatic.
- Before addressing the patient’s issue, you might restate the issue back to the patient to let him know that you understand.
- Don’t give the patient a final diagnosis. Instead, tell the patient about your initial impressions and about the workup you have in mind to reach a conclusive diagnosis.
_ Do not give false reassurances.
_ If you do not know the answer to the patient’s question, just tell him so.
Herbal medicines have been suggested for many diseases. However, compounds.” their safety and efficacy may not always be clear-cut. Let me know the name of the herbal medicine and I will check into its potential treatment role for this disease.”
“I understand your feelings. It is
normal and very common to have
these feelings before surgery. Is there
anything specific that you are
concerned about?”
“I read in a journal that the treatment of this disease is herbal “
“I am afraid of surgery.”
Consultation
- Take history
- Ask pt what they think
- Explain principles of risk assessment
- Give information about this test
- Respond to pts reaction
- Close with summary and strategy
Angry patient
Stay calm and don’t be scared.
Let him express his feelings,
Ask about the reason for his anger.
You should also address the patient’s anger in a reasonable way.
For example, if the patient is complaining that he has been waiting for a long time, tell him you understand.
Explain that the clinic is crowded, and there were many patients who had appointments prior to his. Reassure the patient that now that it is his turn, you will focus on his case and take care of him
Examples
By: Nasser Aljehani
Full transcript