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The Four Habits Model
10
The Four Habits Model
Presented By:
Ryan Cerny
Siena Bovenkamp
Mikala Gilbert
Andres Almao
Chanarith Sisouthone
Create rapport quickly
Invest In The Beginning
Three tasks should be accomplished at the beginning of the interview: making rapport quickly, eliciting the patient’s issues, and designing the visit.
Invest In The Beginning
The pay-off:
•Establishes a welcoming atmosphere
•Allows faster access to real reason for visit
•Increases diagnostic accuracy •Requires less work •Minimizes "Oh, by the way ... "
at the end of visit
•Facilitates negotiating an agenda •Decreases potential for conflict
Create rapport quickly
•Introduce self to everyone in the room
•Acknowledge wait
•Convey knowledge of patient's history by commenting on prior visit
or problem
•Attend to patient's comfort
Elicit patient's concerns
•Start with open-ended questions:
– "What would you like help with today?"
Or, "I understand that you're here for ... Could you tell me more about that?" – "What else?"
•Speak directly with patient when using an interpreter
Elicit patient's concerns
Plan the visit with the patient
•Repeat concerns back to check understanding
•Let patient know what to expect: "How about if we start with talking
more about ..., then I'll do an exam, and then we'll go over possible
tests/ways to treat this? Sound OK?"
•Prioritize when necessary: "Let's make sure we talk about X and Y. It
sounds like you also want to make sure we cover Z. If we can't get to the other concerns, let's ... "
Elicit the patient's perspective
The Pay-Off:
•Respects diversity •Allows patient to provide
important diagnostic clues •Uncovers hidden concerns •Reveals use of alternative
treatments or requests for tests •Improves diagnosis of
depression and anxiety
Ask for patient's ideas
•Assess patient's point of view:
– "What do you think is causing your symptoms?" – "What worries you most about this problem?"
•Ask about ideas from significant others
Ask for patient's ideas
Elicit specific requests
•Determine patient's goal in seeking care: "When you've been thinking about this visit, how were you hoping I could help?"
Explore the impact on the patient's life
* Check context: "How has the illness affected your daily activities/work/family?"
Explore the impact on the patient's life
Demonstrate Empathy
Demonstrate empathy
In terms of the flow
of the visit, this response usually occurs after gathering data about the full spectrum of patient concerns.
Pay-off:
•Adds depth and meaning to
the visit
•Builds trust, leading to better
diagnostic information,
adherence, and outcomes
Be Open To Patient's Emotions
•Assess changes in body language and voice tone
•Look for opportunities to use brief empathic comments or gestures
Be Open To Patient Emotions
Make At Least One Empathic
Statement
•Name a likely emotion: "That sounds really upsetting."
•Compliment patient on efforts to address problem
Make At Least One Empathic
Statement
Convey Empathy Nonverbally
Convey Empathy Nonverbally
•Use a pause, touch, or facial expression
Be aware of your own
reactions
•Use own emotional response as a clue to what patient might be feeling
•Take a brief break if necessary
Be aware of your own
reactions
Invest In The End
Invest in the end
Habit 4, requires
information sharing. This difference in emphasis is
reflected in the tasks of the end of the encounter.
The Pay-off:
•Increases potential for
collaboration
•Influences health outcomes
•Improves adherence
•Reduces return calls and visits
•Encourages self care
Deliver Diagnostic
Deliver Diagnostic Information
•Frame diagnosis in terms of patient's original concerns
•Test patient's comprehension
Provide Education
•Explain rationale for tests and treatments
•Review possible side effects and expected course of recovery
•Recommend lifestyle changes
•Provide written materials and refer to other resources
Involve Patient In Making Decisions
•Discuss treatment goals
•Explore options, listening for the patient's preferences
•Set limits respectfully: "I can understand how getting that test makes
sense to you. From my point of view, since the results won't help us
diagnose or treat your symptoms, I suggest we consider this instead."
•Assess patient's ability and motivation to carry out plan
Complete The Visit
Complete the visit
•Ask for additional questions: "What questions do you have?"
•Assess satisfaction: "Did you get what you needed?"
•Reassure patient of ongoing care
Speak Up™ materials are intended for the public and have been put into a simplified (i.e., easy-to-read) format to reach a wider audience. They are not meant to be comprehensive statements of standards interpretation or other accreditation requirements, nor are they intended to represent evidence-based clinical practices or clinical practice guidelines. Thus, care should be exercised in using the content of Speak Up™ materials. Speak Up™ materials are available to all health care organizations; their use does not indicate that an organization is accredited by The Joint Commission.
Speak-Up
Model
Speak up if you have questions or concerns. If you still do not understand,
S
Pay attention to the care you get. Always make sure you are getting the right treatments and medicines by the right health care professionals. Do not assume anything.
P
Educate yourself about your illness. Learn about the medical tests you get and your treatment plan.
E
Ask a trusted family member or friend to be your adviser or someone that can support you in your time of need.
A
Know what medicines you take and why you take them. Medicine errors are very common.
K
Use a hospital, clinic, or other types healthcare org. that has been carefully checked out.
U
Participate in all decisions about your treatment. You are the core of the healthcare team.
P
Frankel, Richard M, and Terry Stein. “Getting the Most out of the Clinical Encounter: The Four Habits Model.” Thepermanentejournal, 1999, www.thepermanentejournal.org/files/Fall1999/habits.pdf.
Citation
“14.” Introduction to Human Communication: Perception, Meaning, and Identity, by Susan R. Beauchamp and Stanley J. Baran, Oxford University Press, 2017.