Introduction to communication patterns

1. 13th international Course, Slovenia EURACT Introduction to communication patterns Amanda Howe MA MEd MD FRCGP Professor of Primary Care University of East Anglia, Norwich, U.K.

2. 13th international Course, Slovenia EURACT Objectives By end of keynote: Be able to identify your ‘taken for granted assumptions’ about doctor – patient communication in family medicine Have reconsidered some established models for analysis Become aware of contribution of different disciplines to this field of learning and research Be able to apply some simple tools to your consultations Have begun to think of some areas for study in practice Be able to identify issues in consultation where communication patterns may mislead us

3. 13th international Course, Slovenia EURACT Definitions1 To communicate – impart, reveal, bestow • succeed in conveying one’s meaning • have something in common with another A pattern • something to be copied, a model • a design or guide when something is to be made • recognisable repetitive structure thus, Communication patterns - A set of behaviours by which people habitually seek to convey meaning to another NB – may not be ‘successful’ or ‘model’ 1Chambers English Dictionary, 1998

4. 13th international Course, Slovenia EURACT Assumptions • What do you ‘take for granted’ in your communication with patients? • Discuss • Consider further after the workshop Your own learned styles(s)? Need to modify this to patients? Time limits? Tasks to be achieved? Language and cultural barriers?

5. 13th international Course, Slovenia EURACT Models of communication in family medicine Doctor centred versus patient centred Calgary – Cambridge ‘OLOBA’ Objective Led Outcome Based Analysis Broader consultation analysis models • Leicester Assessment Package • LIV-MAAS • MRCGP video rating scale • Consultation Quality Index • >>>> (NB. these look at communication and clinical care)

6. 13th international Course, Slovenia EURACT Evidence based assumptions in these models • How we communicate is essential to successful outcomes – both diagnostic and relational • There are recognisable components to the consultation (not necessarily sequential in time) > initiating, building rapport, gathering information, providing structure, effective explanation, shared decision making • The opening component of the consultation must give scope to the patient to communicate ‘reveal’ • Some parts of the consultation must be doctor – led • Behaviours can be observed and evaluated • but meaning cannot be interpreted by an ‘outsider’

7. 13th international Course, Slovenia EURACT Disciplines which contribute to studies of communication • Family medicine (core clinical skill) • Psychology • Sociology (influence of power & culture) • Linguistics (meaning, communication styles) • Ethics and law (constraints, confidentiality) • Education (learning, research into impacts) • Humanities (indirectly but effectively) • Philosophy (epistemology)

8. 13th international Course, Slovenia EURACT Practical Approaches • Use an accredited evidence based checklist • CPD opportunity to look at one’s consultations (video, observer, simulated patients) • Audit patient feedback – CQI, LIV-MAAS • Audit diagnoses – especially any ‘mishaps’ - for contribution of communication problems • Reflect on ‘difficult consultations’ – especially cultural barriers, anger, somatisation – consider further training if needed • Read and think!

9. 13th international Course, Slovenia EURACT Communication patterns - recommendations • Consultations should include recognisable components > initiating, building rapport, gathering information, providing structure, effective explanation, shared decision making • The opening component of the consultation must give scope to the patient to communicate ‘reveal’ • ‘Microbehaviours’ e.g. clarification, checking, and safety netting are crucial to effective communication • Nonverbal behaviours may be as important as verbal • Continuous reflection on this aspect of professional behaviours is essential for all FMPs

10. 13th international Course, Slovenia EURACT Communication - can be misleading • PSYCHOLOGICAL IMPAIRMENT – drugs, depression, damage, disability • DISTRUST – vulnerability, power, abuse • LANGUAGE BARRIERS • ‘CHARACTER’ – introversion / extroversion, emotional literacy / expressiveness • ‘IMITATING’ vs genuine EMPATHY/RESPECT >> looking behind the message • SYSTEMS CONSTRAINTS – time, design >> need for underlying attitudinal development, organisational facilitation and self management

11. 13th international Course, Slovenia EURACT Introduction to communication patterns Amanda Howe MA MEd MD FRCGP Professor of Primary Care University of East Anglia, Norwich, U.K.