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Chapter 4

Chapter 4 . The Art of Listening. The Steps of Active Listening. Clear the mind Paraphrase, restate, validate, reflection Repeat the last two words Use of open-ended questions Utilize silence Summarize. Specific Issues in Primary Care. Interruptions Time Constraints

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Chapter 4

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  1. Chapter 4 The Art of Listening

  2. The Steps of Active Listening • Clear the mind • Paraphrase, restate, validate, reflection • Repeat the last two words • Use of open-ended questions • Utilize silence • Summarize

  3. Specific Issues in Primary Care • Interruptions • Time Constraints • Relationships over time • Families – the context of patients

  4. Compliance/Adherence/Follow-through • Relates to empowerment • Involves patient choice • Treatment plans need to be the patient’s plan • “non-compliance” is an opportunity to discuss motivation and value system

  5. To improve compliance • Optimize access to care. • Emphasize patient education. • Use patient-centered communication during visits. • Encourage patients to bring family and others in support system to appointments. • Schedule regular follow-up visits

  6. Specifically ask patients questions about potential treatment side effects. • Choose less-frequent dosing for medications when possible. • Offer less-expensive alternatives when cost is a critical barrier.

  7. Confirm data; ask patients to routinely bring in medication bottles, blood pressure logs, diaries; call pharmacies to check refills of prescriptions; check serum drugs levels, etc. • Implement mail or telephone reminder systems. • Structure the environment (work schedule, visual cues, etc) to facilitate compliance.

  8. Initially simplify treatment regimens and advance the complexity after the patient gains experience and buy in. • Explore patient reasons in event of noncompliance. • Obtain patient feedback to confirm patient understanding. • Use team approaches in organizing delivery of health care services.

  9. Use interpreter and community leaders as “cultural brokers.” • Tap into community resources. • Instead of experiencing non-compliance as a power struggle it can be viewed as entry into discussing what might be getting in the way of following recommendations

  10. Most Importantly • Avoid judging and simply inquire “what got in the way” of adhering to the recommended treatment. • Do not assume, rather inquire in a nonjudgmental manner.

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