The Concept of Communication Skills in M edicine

1. The Concept of Communication Skills in Medicine Dr. salah r el-faqih

2. What is Communication • Is the act by which information is shared between humans • It is the process by which we relate and interact with other people. • It is a mutual process between 2 sides (Dialogue) not a one sided monologue. • It includes listening & understanding with passion & respect as well as expressing views & ideas and passing information to others in a clear manner.

3. COMMUNICATION THEORY • Communication is a learned skill or a series of learned skills which is based on 3 pillars: • Accuracy • Efficiency • Supportiveness • All combined contribute to effective communication

4. Communication: Why? • Effective communication is the basis of mutual understanding & trust. • Poor communication causes a lot of misunderstanding & hinders work & productivity.

5. Types of communication

6. Verbal Communication • Speaking to the person • Look straight in the eye • make eye-ball contact • Show respect • Clear message • Relevant • Use understandable language • Support by illustrations if needed • Good listener • Allow them to understand the message and reply • Listen carefully • Make a dialogue ant not one way instruction

7. Communication & Medicine • Historically the emphasis was on the biomedical model in medical training which places more value on technical proficiency thanon communication skills. • Recently learning communication skills & evidence based practice become integral part of modern medicine training. • In healthcare institutions ,effective communication is essential for patient safety

8. From the doctors What is required • Support patients in caring for themselves to improve and maintain their health • Work in partnership with patients • Listen to patients and respond to their concerns and preferences. • Give patients information in way they can understand • Taking patient’s views into consideration when assessing their condition • Respond to patients questions , keep them informed & share information . • Support patients to self care • Treat patients politely and considerately • You must make sure, wherever practical, that arrangements are made to meet patient’s language and communication needs. • Respect patients rights to confidentiality • You must be considerate to relatives, carers and partners be sensitive and provide information and support.

9. continue-From the doctors What is required • Communicate effectively with colleagues within and outside the team • Make sure your patients and colleagues understand your role and responsibilities in the team and who is responsible for each aspect of patient care • You must treat your colleagues fairly and with respect • When referring a patient you must provide all relevant information about the patient.

10. Do doctors need communication? • Doctors need to learn essentials of good communication more than other professionals because patients are humans with sensitive needs. • Doctors cannot practice medicine without effective communication skills. • Poor communication causes a lot of medico-legal and ethical problems.

11. Communication: With whom? • Patients & care-givers • Nurses & auxiliary staff • Colleagues • Administrators • Evidence in court • Reporting research findings • Talking to the media • Public & legislature

12. Communication: How? • The medical interview is the usual communication encounter between the doctor and the patient. • It can be classified according to the purpose of the interview into 4 types: • History taking • Breaking bad news • Consultations • Obtaining informed consent

13. Effective communication • Ensures good working relationship • Increases patients satisfaction • Increases patients understanding of illness & management • Improves patients compliance with treatment • Reduce medico-legal problems • Reduce uncertainty

14. Principles of effective communication • Ensures an interaction rather than a direct transmission process (telling someone what to do or only listening is not enough). • Demonstrates involvement as well as flexibility in relation to different individuals and contexts.

15. Principles of effective communication • Requires planning and thinking in terms of outcomes. • Follows the helical model ( i.e. what I say influences what you say in a spiral fashion and coming back around the spiral of communication at a little different level each time is essential). • Shows empathy & learn how to handle emotional outbreaks.

16. COMMUNICATE AS A TEAM • patient • family • physician • other health care providers • psychologist • nurse • social worker • dietician

17. Communication with peers • Mutual trust & respect • Exchange information • Ask your seniors • Do your share of work

18. Communication & Medical care • Good communication should be established between the patient , the family and the treating multidisciplinary team. • patient & family should be encouraged to participate and verbalize in the ward round discussion about: • Offered medical care & treatment • Rehabilitation • Follow- up/re-admission plans • Doubts & worries.

19. Communication & Medical care • Proper information to patient and family regarding services available and how they can utilize them. • Information should be made available on: • Health Education/ Counseling & Psychiatry. • Endocrine, Metabolic, Neurology & nephrology. • Cardiology, Respiratory, GIT & hematology. • Nutrition, Immunization & ambulatory care. • Infections & infection control. • Clinical pharmacy & therapeutics. • Hygiene and Safety.

20. Communication skills: Some techniques • Develope fluent dialogue with the patient • Use silence effectively, allowing patients enough time to express thoughts or feelings • Actively encourage the patient through use of supportive words or comments • Dialogue with patients is enhanced by effective use of non-verbal behaviour • Use open, exploratory questions – inviting patient to become actively involved • Adjusted language as appropriate, to suit particular needs of the situation

21. Listening vs Hearing • Hearing - a passive activity; no effort • Listening - requires • active involvement, attention • interpretation of message • understanding • takes time and effort

22. Listen with Attention • focus on patient or relative and give physical attention • suitable environment - remove distractions and interruptions, make speaker feel comfortable • eye contact • use positive body language

23. Barriers to effective communication • Personal attitudes • Language • Time management • Working environment • Ignorance • Human failings (tiredness, stress) • Inconsistency in providing information

24. The Art of Consultation • Gauging the correct amount and type of information to give to each individual patient. • Providing explanations that the patient can remember and understand & which relate to the patient’s illness framework. • Using an interactive approach to ensure a shared understanding of the problem with the patient. • Involving the patient and collaborative planning increase the patient’s commitment and adherence to plans made. • Continuing to build a relationship and provide a supportive attitude.

25. Initiating the Consultation • Establishing a supportive environment. • Developing an awareness of the patient’s emotional state. • Identifying as far as possible all the problems or issues that the patient has come to discuss. • Establishing an agreed agenda or plan for the consultation. • Enabling the patient to become part of a collaborative process.

26. Closing the interview • Confirming the established plan of care. • Clarifying next steps for both doctor and patient. • Establishing contingency plans. • Maximizing patient adherence and health outcomes. • Making efficient use of time in the consultation. • Continuing to allow the patient to feel part of a collaborative process and to build the doctor-patient relationship for the future.

27. ConsultationFramwork

28. Doctors-Patients Relationship • Developing rapport to enable the patient to feel understood, valued and supported. • Encouraging an environment that maximizes accurate and efficient information gathering, planning & and explanation. • Enabling supportive counseling as an end in itself.

29. Doctors-Patients Relationship/2 • Involving the patient so that he/she understands and is comfortable with the process of the consultation. • Increasing both the physician’s and the patients’ satisfaction with the consultation. • Developing and maintaining a continuing relationship of trust & respect over time.

30. Conclusion • Communication between the patients, family and heath team play a vital role in the compliance to outpatient clinic visits and in-patient care programs. • Good communication is essential for proper doctor-patient relationship and help avoids problems of misunderstanding. • Effective communication is the key to success in professional career. • Effective communication is essential to the practice of high quality medicine