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Effective Communication Skills for Challenging Consultations

This session will focus on identifying communication techniques for challenging consultations, discussing research evidence, and practicing breaking bad news. Learn how communication skills can make a difference in patient outcomes and satisfaction.

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Effective Communication Skills for Challenging Consultations

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  1. RCSI Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn Talking to Patients and Relatives Angela O`Dea, Marie Morris, Peter Gillen

  2. Objectives for today: • Identify the communication techniques which can be used with emphasis for challenging consultations with patients and their relatives • Discuss the relevant research evidence regarding communication issues with patients and relatives • Practice using the skills of Breaking Bad News

  3. What are the difficult conversations that you face? • What kinds of conversations or situations require expert communication skills? • What makes them challenging?

  4. What difference do communication skills make?

  5. Evidence • blood sugars (HbA1c) • metabolic complications (hyperosmolar state,diabetic ketoacidosis,coma) • systolic blood pressure • Asthma control • Quality of Life and self efficacy

  6. post-op pain headache return visits length of stay

  7. Patient……Engagement AdherenceSatisfaction20%

  8. reductions in legal action reductions in complaints patient satisfaction

  9. Burnout

  10. Empathy and job satisfaction/burnout Doctors with high empathy scores have higher job satisfaction and lower burnout.

  11. Communication skills training worksand…… leads to improved patient outcomes

  12. ….Up to 50% of patients complaints/concerns are not elicitedIn 50% of doctor patient interactions, doctors and patients do not agree afterwards what the plan isDoctors and patients agree on the chief complaint in 76% of somatic problems and in only 6% of psychosocial problemsDoctors interrupt patients at the beginning of the consultation after 11/12 seconds. 50 % of medications are wastedBetween 10% - 90 % patients are non adherent to medical recommendations

  13. One way of breaking bad news

  14. Spot the skills • https://vimeo.com/141213476

  15. Patient presents problem: gathering information - parallel search of two frameworks The bio-medical perspectiveThe patient’s perspective (Disease framework) (Illness framework) Sequence of events Ideas & beliefs Symptoms & signs Concerns & feelings Investigations Expectations Underlying pathology Effects on life Differential diagnosis Understanding the patient’s unique experience of illness Integration of the two frameworks Collaborative explanation and planning:shared understanding and decision making

  16. Initiating the session Providing structure Gathering information Building the relationship Physical examination Explanation and planning Closing the session

  17. Kaiser Permanente • The Four Habits are: • Invest in the Beginning • Elicit the Patient’s Perspective • Demonstrate Empathy • Invest in the End

  18. Breaking Bad News: SPIKE • Setting up • Perception • Invite the patient • Knowledge • Emotions

  19. Gathering information exercise • Instructions: • Divide up into teams of three: • Player A • Player B • Referee • Player A : Think of a car. • Player B : Find out what kind of car player A is thinking of. • RULE: Player B is not allowed to ask direct questions about the make and model. Player A is not allowed to tell player B what the make and model is until correctly guessed . • Referee: Ensures rule is not broken . • The winning team is the team who gets the right answer first.

  20. Getting things off to a good start… • Introduction and agenda • Use of open and closed questioning • Identify patient’s/relative’s starting point • Try not to interrupt !

  21. Effective communication skills • Attentive listening • Attend to verbal and non-verbal cues • Avoidance of medical terminology- - Jargon

  22. Jargon !

  23. Making the conversations easier… • Use of “signposting” • The `warning shot’ for BBN • Periodic summarising • Chunk and check information • Checks patients understanding • Summarises briefly and clarifies plan of action

  24. Empathy • The art of demonstrating that you ‘get’ the emotion behind what is being expressed

  25. Empathy versus sympathy and compassion • Empathy is a skilled response • Sympathy and compassion are reactive responses. • Developing the skill of empathy is a more realistic goal for medical education. • Emotional insights should inform clinical decision making

  26. Empathy • https://www.youtube.com/watch?v=-4EDhdAHrOg

  27. Name it!

  28. Empathy saves time Physicians interrupt after 18 seconds It takes patients 2.5 minutes on average to tell their story – uninterrupted. • Empathy saves time overall

  29. Power of empathy

  30. How we assess communication skills

  31. Online review of skills

  32. Practice Cancelled Op video – Communication with the patient • Good and bad versions

  33. Practice RTA - communication with relative Videos • RTA 2 first 4 mins 25 seconds • RTA 1 Second 5 mins 18 seconds

  34. Afternoon Practice 6 cases 20 minutes per case Facilitated by Faculty One trainee interacts with each patient – others observe and give feedback

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