Communication Skills

2. Communication Skills Dr. YE Elgezouli; MRCGP (UK); JMHPE Consultant & Assistant Trainer in General Practice

3. Task 1: • Think about any 2 conversations; communication with your family, friend or anyone else: - One that worked well, - Another that didn’t work well. • What is the difference between the two events? • What are the characteristics of good communication?

4. Task 2: • Think about a visit to the doctor recently: - What happened? - What did you like when you talk to the doctor? - What you didn’t like in that communication? - And why?

5. Communication Skills قال جابر رضى الله عنه : ما رأيت الرسول صلى الله عليه وسلم مرة إلا تبسم في وجهي

6. Objectives: • Students will: • List different components of communication • List different types of communication • Identify Importance of communication skills. • List methods of learning communication. • Demonstrate these skills in communication with patients.

7. What is Communication? COMMUNICATION IS THE ART OF TRANSMITTING INFORMATION, IDEAS AND ATTITUDES FROM ONE PERSON TO ANOTHER.COMMUNICATION IS THE PROCESS OF MEANINGFUL INTERACTION AMONG HUMAN BEINGS.

8. Communication • Communication is the activity of conveyinginformation. Communication has been derived from the Latin word "communis", meaning to share. • Communication requires a sender, a message, and an intended recipient.

9. Most common ways to communicate Visual Images Speaking Writing Body Language

10. Purposes of Communication To solve problems Reassurance To form and maintain relationship alleviate distress COMMUNICATION convey feelings give information make decisions persuade

11. Contents: • Benefits • Components of communication skills • How to learn communication skills • Summary

12. Think, Pair & Share • Benefits??

13. Benefits • identify patients' problems more accurately: • Improve Pts understanding & Information retention • Increase adherence to treatment • Their patients adjust better psychologically and are • Pts more satisfied with their care

14. Benefits • Doctors with good communication skills have greater job satisfaction and less work stress, • Delivery of high-quality health care. (Roter 1987, Betakis 1991, Stewart 1995)

15. Communication skills - why bother? • Why learn communication skills? • Can you learn communication skills? • What is there to learn? • How is it taught? • Where next?

16. Why learn communication skills? • Are there problems in communication between doctors and patients? • Is there evidence that communication skills can overcome these problems? • Can these communication skills be taught?

17. Why learn communication skills? l Reasons for the patient's attendance l Gathering information l Explanation and planning l Adherence to plans l Medico-legal • Enables us to become better doctors clinically • Improves patient care and disease outcomes

18. Can communication skills be taught? • Communication is a clinical skill • It is a series of learnt skills • Experience is a poor teacher • There is conclusive evidence that communication skills can be taught & • That communication skills teaching is retained

19. How to teach communication skills? • Observation • Video or audio playback • Well-intentioned feedback • Rehearsal • Active small group or 1:1 learning

20. Effective communication is essential to the practice of high quality medicine

21. Effect on Health Outcomes • Reduction of anxiety. • Reduction of psychological distress. • Pain relief. • Symptom resolution. • Mood improvement. • Reduction of high blood pressure. (Stewart 1995).

22. The Toronto consensus statement “stressed that the main complaint of patients is related to “communication problems and not to clinical competency.” (Simpson 1991)

23. core communication skills? (1) build the doctor–patient relationship (2) open the discussion (3) gather information (4) understand the patient’s perspective (5) share information (6) reach agreement on problems and plans (7) provide closure Kalamazoo Consensus

24. “The main remarks made by patients in the PHC centers in Riyadh was that: “physicians were not listening enough to their complaints.” ( Saeed 2001)

25. Components:

26. THINK ARTICULATE COMMUNICATE INFLUENCE

27. FEEDBACK

28. DESIRED ACTION

29. Sender Receiver Message

30. Setting:- • Privacy, • Avoid interruptions, • Comfortable lighting & temperature, • Arrangement of seats, • Distance, • Level.

31. Co-operation Confrontation Conversation Seating arrangements of doctor and patient

32. Two basic types of questions • Closed questions: • Get a one-word response and inhibit thought. • Questions begin with who, when and which • Open-ended questions: • Invite unique thought, reflection or an explanation. • Questions begin with how, what and how (not why!).

33. Probing Questions • Use to:- • Clarify: What do you mean by that? • Justify: What makes you think that? • Check accuracy: You definitely took 3 tablets a day?

34. Questions to be avoided • Complex Questions: “Did your vomiting start yesterday or today & have you had diarrhoea?” • Leading Questions: “ you don’t sleep well, do you?”

35. Important of Listening:- • 80 % TOP EXECUTIVES BELIVES IT AS MOST IMPORTANT SKILL • STRENGTHENS ORGANIZATIONAL RELATIONSHIPS • CREATES OPPORTUNITIES OF INNOVATION

36. TYPES OF LISTENING

37. EMPATHIC LISTENING • UNDERSTAND FEELINGS,NEEDS, WANTS • AVOID JUMPING WITH ADVICE UNTILL NOT ASKED FOR. • APPREACIATE HIS/HER FEELINGS & UNDERSTAND THE SITUATION

38. ACTIVE LISTENING • AVOID OR TURN OFF ANY BIASES OR FILTERS TO TRUALY HEAR & UNDERSTAND THE SPEAKERS MESSAGE • ENCOURAGE SPEAKERS WITH POSITIVE BODY LAUNGUAGE • Passive Listening??

39. ACTIVE LISTENING • LISTENING/RECEIVING / RESPONDING • PHYSICALLY HEARING THE MESSAGE & ACKNOWLEDGING IT

40. ACTIVE LISTENING…(cntd…) 3. Use Non-verbal Communication: • Smile, • Gestures, • Eye contact, • Your posture.

41. ACTIVE LISTENING…(cntd…) 4. Give Feedback • Remember that what someone says and what we hear can be amazingly different. • Repeat back or summarize to ensure that you understand. • Restate what you think you heard and ask, "Have I understood you correctly?"

42. Techniques to improve listening skills SUMMARIZE Pull together the main points of a speaker PARAPHRASE Restate what was said in your own words QUESTION Challenge speaker to think further, clarifying both your and their understanding

43. Paraphrasing is simply restating what another person has said in your own words. Use phrases such as: In other words… I gather that… If I understand what you are saying… What I hear you saying is… Pardon my interruption, but let me see if I understand you correctly… Practice Paraphrasing

44. Non-Verbal Communication 55% Face and body: non-verbal communication or face and body language. 38% voice dynamics: tone + inflection + volume + accent + non-word sounds; and...

45. Non- Verbal Communication • Visual: expression, eye contact, eye movement • Listening: carefully, actively, memory • Kinesthetic: Posture, distance, mobility, muscle tone, hand movement, etc

46. RECOGNIZING NON VERBAL COMMUNICATION • FACIAL EXPRESSION • GESTURES & POSTURES • VOCAL CHARACTRISTICS

47. RECOGNIZING NON VERBAL COMMUNICATION • PERSONAL APPREARENCE • TOUCH • TIME & SPACE

48. Example of body language • Folded arms and leg crossed away from you: • Rejection • Tapping fingers: • Impatience • Avoiding eye contact: • Untrustworthy

49. Effective Communication Skills (Models)

50. Effective Communication Skills • Greet the person by their names (أبو فلان). • Make eye contact ,introduce yourself warmly • Smile(ease the tension on either side) • Shake hands. Ask the person to sit down by indicating a chair. • establish a rapport by asking a simple open- ended question , • explain that you may need to take notes,