Communication

1. Communication or Why do I bother to talk to you!

2. Have you wondered why it is easy to talk to some people but difficult to talk to others? • ask yourself: • Are you easy to talk to? • Are you a person your patients will trust? • Are you a person who will make the most of the patient’s goals and objectives?

3. Developing Communications • You’ve been communicating since infancy…so why do you need a class for it? • Switching from “Student-Teacher” mode to “Doctor-Patient” mode. • Remember, you will be viewed as a doctor by your patients, even if you think you’re “just a student”. • Everyone is looking for a leader. It’s human nature to look for leadership. You will become a leader for your patients

4. Are you a Doctor • IF YOU DON’T THINK OF YOURSELF AS A DOCTOR, WHO WILL??

5. Communication • Is a process of sending and receiving messages with attached meanings • Elements include • source • message • receiver • feedback

6. Effective Communication • Occurs when the intended meaning of the source and the perceived meaning of the receiver are virtually the same

7. Efficient Communication • Occurs at minimum cost in terms of resources expended • “Concise Communication”

8. Communication Barriers • Physical distractions • Semantic problems • words and body language do not agree • Cultural differences • Absence of feedback • Status of the source and the receiver

9. Keys to Communication • Desire • Understand the process • translate images and sounds • Master basic skills • make it clear and understandable • convey ideas to the audience • Practice • Patience (with yourself and the patient)

10. Principles of Communication • The way your message is interpreted • Appearance & body language 55% • Tone of voice 38% • The words you use 7% • Research by Mehrabian on nonverbal communication

11. Three Basic Skills to Good Communication • Connecting with the audience • Conveying messages people understand • Checking the responses of the audience

12. People will perceive you the way you interact with them • Superior to Inferior • Inferior to Superior • Equal to Equal

13. Guidelines for Active Listening • Listen for content - try to hear exactly what is being said • Listen for feelings - try to identify how the source feels about things • Respond to feelings - let the source know that feelings are recognized

14. More Guidelines for Active Listening • Note all cues - be sensitive to verbal and nonverbal expressions • Reflect back - repeat in your own words what you heard • Don’t be afraid to ask the same questions more than once

15. Therapeutic Communication • Conversations between a doctor and a patient need to get to the essence of the problem that is presented by the patient • A plan of care designed and implemented in the briefest possible time

16. Therapeutic Communication • understand the patient’s physical and emotional needs • and hear what they are trying to say to you • Communication between doctor and patient must be correctly received • Therapeutic communication is direct to the needs of the patient.

17. Therapeutic Communication • Involves • selected communication interventions to help patients and families overcome stress and adjust to the unalterable • helping patients to identify their problems and needs • helping patients examine their options and develop a plan to correct the problems You must learn to do this well

18. What is the difference between communications with peers and those outside the health care system?

19. The Difference • Patients have unmet safety and security needs that your friends and colleagues don’t • Patients are in vulnerable positions due to being dependent on health care providers whom they don’t know personally • Health concerns are very personal and may be considered private matters to resolve by oneself

20. Your Role • Communicate therapeutically • Direct the patient toward the attainment of his or her own health care goals and objectives.

21. Patient’s health outcomes Depend • largely on your clinical knowledge • your ability to communicate in a health care setting. • MUTUAL goals and objectives. • Continuity with each visit.

22. Principles of Therapeutic Communication • Solicit feedback • verify all messages by paying careful attention to all feedback (responses) • Observe body language • the face is the most expressive part of the body • body movements can confirm or betray your verbal message

23. Principles of Therapeutic Communication • Assess appearance • this gives clues about the physical and emotional state of the patient • Respond to the real message • the tone of the voice is more important than the words being used

24. Universal Responses to Stress • Blamer • Placator • Computer • Distractor • Leveler

25. The Blamer • Uses accusatory “you” statements, sarcasm, put-downs, expressions of superiority, and loaded words intended to start fights • Voice is tense and loud or deadly quiet • Points fingers, interrupts, yells, calls names, demands, gives orders, hangs up the phone on others, walks away when being spoken to by others

26. The Placator • Has a hard time getting to the point and in making decisions • Beats around the bush, issues numerous apologies, stumbles to say what he/she means • Is frightened of offending or angering anyone, so he/she goes along with others • Denies compliments • Fidgets, eyes cast downward • **Says “Yes” when he/she really means “No”

27. The Computer • Doesn’t want their feelings known and resists discussing them when asked • Doesn’t like to show or discuss emotions, as it is a sign of weakness • Is quiet, aloof, reserved, drawn • Posture is closed, arms and legs crossed • Denies own feelings and is uncomfortable when others express theirs

28. The Distracter • Jumps from one mode to the other, following urges about what he wants to say • Combines the characteristics of the Blamer, the Placator, and the Computer, continuously shifting modes, talking nervously, and making little sense • Expends a lot of energy, but doesn’t focus on the problem or get anything solved

29. The Leveler • Communicates with a sincere yet direct approach to manage conflict in stressful situations • Posture is relaxed and open and eye contact is maintained. Body movements are relaxed • Can control temper, speaks up to ask for what he wants, ask questions to understand better • Can say “No” to requests without guilt

30. Each patient’s response is unique • Even a minor illness can cause emotional and physical reactions • Think about how a illness, a bad cold, has made you emotionally irritable, zapped your energy, and made you unable to carry out your responsibilities for a few days • Even though you feel better in a few days, the illness still affected you

31. Did the ‘bad cold’ cause you to miss something you really wanted to do? Were you disappointed? • Has a test grade suffered because you were sick? • The point is, everyone’s performance is affected by sickness, thus self-esteem is affected as well • You may be able to perform well enough to get by, but your performance will be less than optimal and can cause emotional distress

32. Empathy versus Sympathy • The most important therapeutic communication technique EMPATHY • When you demonstrate empathy, you participate in the life of another and perceive his/her thoughts or feelings • It means you can place yourself in the patient’s place and see the human side of the patient • It also means you’re sensitive to the patient’s private world

33. Empathy versus Sympathy • Sympathy implies taking on the other’s needs and problems as if they were your own and becoming emotionally involved to the point of losing your objectivity • Lose your objectivity and you will be unable to think clearly or analyze problems with the patient’s well being in mind

34. To empathize rather than sympathize, you must show feelings but not get caught up in feelings or overly identify with the patient’s concerns

35. More Empathy • Once you have perceived the emotional response, you must then respond to feelings and values in the situation and arrive at what is really important to the patient • You must show you have sensitivity to the situation by communicating carefully both verbally and nonverbally • Ultimately, empathy allows the person to feel he is really understood

36. Even More Empathy • Means that you remain emotionally separate from the other person, even though you can see the patient’s viewpoint clearly • This is not the same as crying, laughing, worrying with the patient • It is different than sympathy…

37. Summary • Therapeutic communication • establishes and maintains collaborative relationships with patients • creates mutual health goals and objectives • leads patient satisfaction to a higher level • allows for an increase in the quality of health care

38. Summary • Communication is both verbal and nonverbal • words • body language • appearance • tone of the voice Side note: The nonverbal are more significant than actual words spoken

39. Summary • 4 basic principles • verify that messages have been received correctly by using feedback • carefully consider nonverbal cues, body language, and facial expressions • personal appearance - hygiene, grooming, and clothing • when nonverbal behavior and tone of voice don’t match spoken words - respond to the nonverbal messages and tone of the voice, not the spoken words

40. Summary • You can’t read the minds and hearts of those with whom you communicate --- some of the message will be misinterpreted • You will misinterpret patients • Patients will misinterpret you Our goal is to keep this to a minimum

41. Solution • You must remain open and continually strive to improve your ability to communicate with patients • DO NOT BE AFRAID TO ASK THE SAME QUESTION TWICE • REITERATE or SUM UP what the patient has told you (chance for the patient to correct the story)

42. Self Esteem How does it affect your communication skills

43. Self Esteem Definition • Is the worth or value you place on your self • The way you feel about yourself

44. Self Esteem • Your level of self esteem affects the words you speak and your non verbal behaviors • such as • facial expressions • tone of voice • gestures • body positions

45. Self Esteem • To communicate effectively with patients • you will want to create a positive impression by presenting a professional image • having a polished appearance • authoritative voice • confident manner

46. Self Esteem • High self esteem • allows direct, clear, honest communication, sets high goals and objectives • Low self esteem • promotes indirect, vague, dishonest communication, presents as being lonely and/or isolated & does not set goals

47. Self esteem is learned and constantly changes over time with new experiences • Positive experiences increase self esteem • Negative experiences decrease self esteem

48. Patient’s Self Esteem • As the doctor works with a patient and establishes a relationship, the goal is to provide a nurturing environment to promote self esteem in the patient

49. Self esteem directly effects our basic style of communication • Lack of self esteem leads to a lack of confidence in dealing with people • you must learn to create a positive professional image

50. Stress of Illness • Self esteem declines because the person can not perform all the life activities he/she could do prior to the illness • Two components • physical • stages = onset, course, prognosis • psychosocial • emotional response • sadness, fear, anger