COMMUNICATION THE CENTRAL ACT IN FAMILY MEDICINE مهارات للاتصال

1. COMMUNICATION THE CENTRAL ACT IN FAMILY MEDICINEمهارات للاتصال Dr. DuaaHiasat

2. Communication Objectives: To increase the audience self-awareness about their own communication style To increase the audience understanding of their patient’s communication style

3. My Goal is that: at the end of this presentationYou’ll know • Why good doctor-patient communication is important. • What creates good communication. • What you can do as a doctor to create that good communication • To apply more effective skills in establishing and maintaining doctor-patient relationship.

4. Communication Skills • Appropriate communication skills helps doctors to feel less frustrated and more satisfied in their work . • It reduces conflict by preventing the misunderstanding which is so often the source of difficulties between doctors and patients. (Levinson et al 1993).

5. “The good clinician treats the disease, but the great clinician treats the patient” William Osler (Canadian Physician, 1849-1919)

6. WHY STUDY COMMUNICATION SKILLS? • One of 4(core) essential components of clinical competence • Knowledge • Communication skills, • Problem solving, and • Physical examination. • All are inextricably linked(لا ينفصم): • outstanding expertise in any one alone is not sufficient.

7. Communication CYCLE

8. 6 Steps of Communication Process Message received Message decoded • Idea occurs • Message coded 3. Message sent 6. Feedback

9. Communication barrier Anything that gets in the way of clear communication during these steps • Physical disabilities • Psychological attitudes and prejudice • Cultural diversity

10. Ideas occur Possible problems: • The message is ill-conceived • It is vague or incomplete; • Associated with critical emotions e.g. shame or anxiety Solution Put your patient at ease –Create rapport

11. Possible problems: • The wrong language may be choose • The tone is inappropriate. • Solution • Interpret patient’s cues • Watch your voices tone-Talk in a non-threatening tone of voice. • Respect culture differences 2. Message coded

12. 3. Message sent through medium Possible problems may include: • Interruption • Doctors interrupt their patients after 18 seconds. • Doctors very often assume that the first complaint mentioned is the only one that the patient has brought. (Beckman 1984). Solution Improve your listening skills

13. 4. Message received • Possible problems: • Hearing problems • Psychological Solution • Speak slowly. • Use nonverbal communication

14. Verbal Communication Skills • Questioning Paraphrasing مقتبسا • Reflection انعكاس Probing تحقيق • Confrontation مواجهة Mirroring المتطابق • Interpretation ترجمة Summarizing تلخيص • Mastering varieties of skills to use them if needed: If one skill doesn't work the other may work

15. 5. Message decoded • Possible problems: • The sender has send incomplete or ambiguous message e.g.. He has used jargon or technical terms. It is only Fungal infection Solution Give explanation to any medical term

16. 6. Feedback Possible problems: Passive listening Blocking Lecturing Premature Reassurance

17. Health Care workers should: • Allow patients to express their fears or anger. • Encourage them to talk about their feelings. • Avoid arguing. • Remain calm. • Talk in a non-threatening tone of voice. • Provide quality care.

18. Communication Skills • Nonverbal communication

19. Verbal Communication • Much of the communication process in the clinical interview is verbal interchange. • Some aspects of verbal communication play an important role in establishing and maintaining rapport

20. Verbal communication Facilitation & Active Listening Funnel of Verbal Communication Skills • We want to balance between facilitation and active listening in one hand …on the other hand focusing and using time effectively . • This funnel will help to maintain this balance • To organize The flow of facilitation and active listening

21. سلامات?Verbal Communication Skills Questionining : Use open-ended questions. How is the pain?- كيف هو الألم Probing تحقيق : or “I’d like to hear about…” Confrontation مواجهة :“You look sad… أنت تبدو حزينة” OR “ You look anxiouse “Tell me more قل لي أكثر”

22. VERBAL Communication Questioning : • Indirect Qs (Open-ended Qs) • Direct Qs (Yes or No) • Suggestive Qs

23. Closed Questions -Yes/No Open Ended Questions Where is the pain.? How is the pain? What it looks like? When is usually coming? • No chest pain, shortness of breath, or nausea, right? • “Not been suicidal, right?”

24. Examples of Open-Ended Questions سلامات …؟ • سلامات …؟ • كلمني أكثر ؟ • كيف حالك اليوم ؟ • كيف ممكن أفيدك ؟ • بماذا تشعر ؟ • استعمال أداة الاستفهام كيف أوماذا • طلب المزيد من التوضيح ، مثل قول : (حدثني أكثر عن نفسك ... ماذا أيضا ؟ ، أشرح لي، صفه لي...؟ How can I help you ? What can I do for you ? Tell me more …. What else? كلمني أكثر …؟

25. Closed-ended questions: • Useful in clarifying information & gathering factual data • Can be answered by “Yes” or “No”. • Their value is extremely limited in obtaining reliable information • Effective in generating specific & quick responses to a clearly defined topic (e.g., asking about red flags)

26. Verbal Communication Skills Mirroring المتطابق : Restate using patient’s words Dr: What makes your headache worse? Pt: I notice that it’s the worst when I am under stress Dr: It’s worst when you are under stress?

27. VerbalCommunication Skills Paraphrasing- مقتبسا : Restate in your own words Dr: What makes your headache worse? Pt: I notice that it’s the worst when I am under stress. Dr: If you are under stress it gets worse?

28. Verbal Communication Skills Reflection-انعكاس: Reflect the pt’s comment or pt’s question back to him Pt: “is it cancer dr.?” Dr: “Do you think it is really cancer !...” Interpretation-: ترجمةtry to link the story together, to fine out the significant of every part of patient's story

30. Facilitation & Active ListeningVerbal Communication Skills Summarizing- تلخيص • Summarize the patient’s main points.  to keep on track • Summarize to move to the next point

31. Paralanguage Paralanguage is the voice effect that accompanies or modifies talking and communicates meaning, includes: • Velocity(fast, slow, hesitate) • Tone • Volume • Sighs and gruntsتتنهد وهمهمات • Pauses and inflections

32. Verbal and Vocal information. There is a real difference between verbal and vocal information. • The verbal message refers to the words literally transmitted. • The vocal message includes the emotional quality, the tone of voice, and the frequency and length of pauses information that is lost when the words are written.

33. Metacommunication • communicating about communicating • “Do you follow me?” • “You seem worried; is that right?” • “I’m not sure I get what you’re saying.” • “Is it ok if I ask you some questions about that?”

34. Some tips • Use of appropriate vocabulary • Phrasing questions in simple language appropriated to the patients level of understanding • Avoid of medical jargon • The patients cultural level and education should be considered. • Ask their patient to volunteer their ideas

35. Non Verbal Communication • Non verbal communication is often ignored.

36. Personal appearance • Personal appearance is a significant part of nonverbal communication. Patients consider house staff who wear white coats with conventional street clothes as more competent than those who wear scrub suits.

37. If white coats are worn, the patient sees only the collar, tie, and shoes, and it is therefore important to keep these items neat.

38. Non Verbal Communication

39. Non Verbal Communication has been classified as • Body language • Physical characteristics • Paralanguage • Touching • Artifacts and • Environmental factors

40. Body Language • Specific gestures and their interpretation are of importance only when judged in the context of the circumstances surrounding them. • A single gesture has clinical relevance only as part of a sequence of actions.

41. Higher patient satisfaction is associated with a physician’s forward body lean and rotation of the torso toward the patient .

42. Patient also responds more favorably to the physician who his chin in his hands and gazes directly at the patient

43. Physicians whose communication styles have been considered patient oriented have been observed to change body position more frequently than physicians whose conversations were physician centered.

44. Mirroring When good rapport exists between two people, each will mirror the other’s movements. Some people unconsciously rapport with another by mirroring that person’s movements or body posture

45. Touch A close personal interest in the patient can be communicated by the appropriate use of touch. The most socially acceptable method in Western countries is a handshake, enabling the physician to establish early contact with the patient , a firm handshake is most acceptable.

46. Usually, the limp or “wet dishrag” handshake indicates lack of interest or insincerity, especially if it is rapidly withdrawn. • A moist palm is a sign of nervousness or apprehension. • The “halfway there,” fingers-only handshake indicates reluctance or indecision.

47. However, the handshake continues to be modified culturally, and a person should be extremely wary of misinterpreting another person’s handshake without understanding his or her cultural background.

48. Touching can be an effective method for communicating concern or compassion and can break down some of the defensive barriers to communication. • Caution should be exercised, however, not to use it excessively or earlier than is socially permissible.