Communication skills

1. Communication skills

2. Key communication skills Let parents express in own words Observe non verbal clues Encourage the patient to continue speaking Establish eye contact Active listening

3. Verbal communication What to say ? How to say? Whom to say? When to say? What you should not say?

4. Important points in communication Feel good about yourself Learn to avoid using ‘I’ and ‘ME’ Instead use ‘YOU’ and ‘WE’ Pause, pace, pitch, and voice modulation

5. The SOFTEN technique S = smiling O = open body posture F = friendly energy T = touching while talking E = eye contact N = nodding in affirmation

6. Non verbal communication (body language) Eye contact Facial expressions

7. Communication pitfalls Using highly technical language Not showing appropriate concern Not listening Failing to verify whether understood Displaying apathy

8. Telephonic consultation

9. Issues related to telephonic consultation Convenient for parents (too much time and energy spent to see the doctor – just for few minutes) Convenient for doctors (quality time for clinic patient - improves outcome) Should be selective and safe Must develop methods to avoid interference

10. Telephonic consultation – when? Minor problem that may not require physical examination Follow-up report after initial consultation First aid advice in an emergency till parents reach the doctor

11. Telephonic consultation when not? Patient not known (not a regular patient) Acute illness in neonate or young infant When condition can not be judged properly (exaggerated or ambiguous statements by parents / symptoms potentially serious such as excessive crying or lethargy / chronic problems)

12. Telephonic consultation when not? When specific therapy may be necessary When parents insist on being seen (even when you feel otherwise)

13. Ideal way Have a trained doctor to attend phones who follows preformed protocol (even simple advice needs your Ok / you speak if parents insist) Monitor conversation; intervene if necessary Insist on talking to a treating doctor if patient is already under treatment Legality issues? – ideally need for documentation of telephonic advice?

14. Counseling parents of children who are not improving

15. General rule Counseling is an art Depends on communication skills Explain in simple language using similes related to common life situations (drug may not work even when chosen correctly – pencil does not write if given to newborn)

16. General rule Use words cautiously – ABC – accurate / brief / clear Balanced statement of prognosis “Patient” hearing and repeated explanation

17. Acute serious illness At first visit, explain details of illness and its evolution to present serious stage Do not find faults with previous therapy (pneumonia who came in with hypoxia)

18. Acute serious illness Instill hope and confidence (many such children improve) with subtle hint (few may develop problems, let’ s hope we don’t face it) Estimate time and course of improvement – wait for sustained progress before announcing

19. Acute serious illness Explain each move from time to time before implementing if possible More the serious illness and not improving, more we must talk to parents Do not show anger, frustration, rudeness or diffidence – be “patient” and tolerant to parental outbursts Offer an option of second opinion

20. Acute illness in office practice Spend adequate time; explain problem, anticipated course, and its rational management Convince parents about safety of observation with minimal action (are you sure, is the question that needs confident answer)

21. Acute illness in office practice Be transparent; spell out what you don’t know but add that you know how to know! Document provisional diagnosis and its basis with instructions for therapy and follow-up

22. Chronic disease Explain in details (like teaching session) Describe all the options of investigations and management ( MR / asthma / JCA / epilepsy) Discuss pros and cons of treating and not treating or different modes of therapy Chart out anticipated course on compliant therapy, limitations of “cure”and adverse drug reactions along with monitoring modalities

23. Chronic disease Leave the choice of other systems of medicine to parents and do not criticize (but emphasize on transparency, access to unbiased information and evidence based approach in allopathy)

24. Managing death It is said that - If one looses a parent, past is lost If one looses a spouse, present is lost But if one looses a child, future is lost Hence parents cannot tolerate death of a child – they need support

25. In the event of death anticipated Ensure that senior doctor is a spokesperson and not juniors or resident doctors (other doctors must repeat what senior has talked) Parents must be subtly warned about non-improving situation (we are trying our best but so far there is no improvement)

26. In the event of death anticipated Confide in 1-2 close relatives about the inevitable unfavorable outcome Let parents be a witness to continuous monitoring and necessary interventions

27. In the event of death Do not announce death suddenly (condition is worsening though we won’t give up / next half an hour is crucial, if there is no improvement by then, we may not make it) When death is announced, let parents vent their feelings (we are sorry we could not save your child)

28. In the event of death Ensure every help to ease the situation Consider the possibility of subsequent discussion with parents to make them feel that everything possible was tried and that they had not faulted

29. Summary Counseling is an art – not taught in medical school – make an effort to learn It should not be a casual approach - especially in serious conditions, ideally carried out in a specified place with privacy and not in a hurry More the serious nature of the disease, more should be the “talking”