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Building the

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Anne Murphy

on 13 March 2014

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Transcript of Building the

Building the Physician-Patient
Relationship

Sarah Mouton & Anne Murphy
OBJECTIVES:
Using the Calgary-Cambridge Model for Medical Interviewing as a guide, at the end of our presentation, you will be able to apply one skill from each of the three dimensions of "Building the Relationship":
1. Using appropriate non-verbals
2. Developing rapport
3. Involving the patient
Preview
Relevance
Calgary-Cambridge Method
Appropriate Non-Verbals
Developing Rapport
Involving the Patient
Activity #1
Activity #2
"The remarkable scientific advances in medicine have not changed the fact that
physicians' core medical skills are interpersonal
"

Non-verbal behavior has been linked to:
patient satisfaction
adherence
clinical outcome

A lack of compassion and empathy is a
predisposing factor in malpractice suits

Empathic communication has been shown to
increase clinician job satisfaction
and to
reduce burnout

Novack et al., as quoted in Hall, Harrigan, & Rosenthal, 1995, p. 22
Marcinowicz, Konstantynowicz, & Godlewski, 2010, p. 83
Suchman et al., 1997, p. 678
Take
15 seconds
to think about a time when you were either
very sick
or suffered a
painful injury
...
www.gp-training.net/training/communication_skills/calgary/framework/framework.htm
Relationship Dimensions
1. Appropriate non-verbals
2. Rapport
3. Patient Involvement
"
Continuous thread
"
throughout entire interview
Silverman, 2007, p. 91
What are your
goals
for the medical interview or for treating your patients, in general?
Whether or not a patient is satisfied with his or her doctor following a visit usually
has

less to do with
WHAT
was said than
HOW
it was said
.
Hall, Harrigan, & Rosenthal, 1995, p. 21
S

it down
E

ye Contact
T

one of voice
E
ye contact
M
uscles of facial expression
P
osture
A
ffect
T
one of voice
H
earing the whole person
Y
our response
Empathic opportunity

Empathic response

Empathic opportunity terminator

Potential empathetic opportunity

Potential empathetic opportunity continuer

Potential empathic opportunity terminator
Your Response
Use your
word bank
to fill in the blanks on the back of your handout
Riess, 2013
Suchman, et al., 1997, p. 679
Krasner et al., 2009
EMPATHIC OPPORTUNITY

"A direct and explicit description of an emotion by a patient"

Marcinowicz, Konstantynowicz, & Godlewski, 2010, p. 85-86
"A clinician's statement that immediately follows an empathic opportunity and directs the interview away from the stated emotion"
Empathic Response
"A clinician's explicitly expressed recognition of a patient's expressed emotion"
Empathic Opportunity Terminator
Potential Empathic Opportunity
"A patient statement from which a clinician might infer an underlying emotion that has not been explicitly addressed"
Potential Empathic Opportunity Continuer
"A clinician's statement following a potential empathic opportunity that facilitates further exploration and direct expression of an implied emotion"
Potential Empathic Opportunity Terminator
"A clinician's statement that immediately follows a potential empathic opportunity and directs the interview away from the implied emotion"
A communication technique used to help patients remember and understand the important information regarding their diagnosis, treatment, or medication.

The technique involves asking patients to recall and then explain or demonstrate the important information discussed during an interaction with their health care team.
Marck, 2011, p.1
Video Clip
Q.What elements are incorporated from non-verbal and empathy dimensions?

Q.What
new
elements are introduced during the teach back encounter?
Activity #3
1. Each of you will be assigned a role:
patient
,
physician
, or
observer


2.Facilitators will pass out
index cards
with a description of each role’s purpose

3. The
physician
will use the teach-back technique to involve the
patient
. The
observer
is in charge of taking notes.

Teach Back Technique
Teach back promotes a communication understanding or "shared meaning," thereby promoting a
genuine alliance
"Patients are
experts
in what matters most to them and in circumstances that will cause them to embrace one treatment strategy/lifestyle change and reject another."
Why is teach-back important to the patient physician relationship?
"Research suggests that
40-80%
of the medical information patients receive is forgotten and nearly half of the information retained is incorrect."
Teach back best practices
Set the stage
Living room language
Open Ended questions rather than "yes" or "no"
Chunk and check
Think of teach back as a way to check how you are doing-not testing the patient.
Last patient of the day

Opening Discussion
Overview: Building the Patient-Physician Relationship
10 mins
Non-Verbals: SET
Eye Contact Activity
Rapport: EMPATHY
Empathic Opportunities
Involving the Patient
Teach Back Activity
10 mins
10 mins
Review & Closing
10 mins
5 mins
"The
quality
of the physician-patient relationship had the
greatest effect on patient engagement
."
DeBenedette, 2011
Teach back:
Dotson, et al., 2011, p.12
Thuy Ha Dinh, et al., 2013, p.31
Keberly, Alliant GMCF, p. 19
Rees, 2011
Reflect...
Going back to the objectives:
How to use non-verbals appropriately with SET

How to build rapport with patients with EMPATHY

How to better involve the patient with the teach-back method

How all of these skills can benefit you and your patients
Thank you!
Please fill out the evaluations.
Murphy-Mouton
Memorial Hospital
Full transcript