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Communication issues TMT 2013 Presentation Transcript

  • 1. Cultural Awareness Training Communication Issues in Aboriginal Health Hung The Nguyen hunguyen250369@gmail.com TMT, Cairns 07/02/2013Monday, 4 February 2013 1
  • 2. Outline !some principles !some barriers !some strategies 10/29/10 7Monday, 4 February 2013 2
  • 3. Communication Principles Content Process Perceptual Skills 17Monday, 4 February 2013 3
  • 4. What we communicate about in a medical interview Initiating the session CONTENT Gathering information Physical examination Explanation and planning Closing the session 10/29/10 18Monday, 4 February 2013 4
  • 5. Communication Principles Content Process Perceptual Skills 17Monday, 4 February 2013 5
  • 6. How we communicate during a medical interview Gathering information patient’s narrative PROCESS question style: open to closed attentive listening facilitative response picking up cues clarification time-framing internal summary appropriate use of language additional skills for understanding the patent’s perspective Exploration of the patient’s problem to discover the : ! biomedical perspective ! patient’s perspective sequence of events ideas and beliefs symptom analysis concerns relevant systems review expectations effects on life feelingsMonday, 4 February 2013 6
  • 7. Communication Principles Content Process Perceptual Skills 17Monday, 4 February 2013 7
  • 8. Perceptual Skills = Our awareness of what the patient is thinking and feeling and of what we are thinking and feeling. Our sensitivity to Our decision patients’ making, attitudes, values, attitudes, beliefs and values, beliefs, thoughts about thoughts about the illness or the the patient or doctor or the illness; consult;Monday, 4 February 2013 8
  • 9. Communication Principles Content Process Perceptual Skills 17Monday, 4 February 2013 9
  • 10. Cross-cultural Communication Principles " Developing empathy" Tolerating ambiguity " Suspending judgment 10/29/10 17Monday, 4 February 2013 10
  • 11. Developing empathy Empathy is “the capacity to take the perspectives of others, to be sensitive to their inner experience and to engage with them compassionately, rather than simply sharing their emotions (sympathy)”. N Haslam eMJA 2007 How do we do it? Immerse yourself. 10/29/10 26Monday, 4 February 2013 11
  • 12. Cross-cultural Communication Principles " Developing empathy" Tolerating ambiguity " Suspending judgment 10/29/10 17Monday, 4 February 2013 12
  • 13. Tolerating Ambiguity • Tolerance - endurance, permissiveness, patience, easiness, acceptance, margin, allowance, leeway • Ambiguity – multiple meanings How do we cope with uncertainty in general practice? Be curious. 10/29/10 23Monday, 4 February 2013 13
  • 14. Cross-cultural Communication Principles " Developing empathy" Tolerating ambiguity " Suspending judgment 10/29/10 17Monday, 4 February 2013 14
  • 15. Suspending Judgement • Being non-judgmental is rarely attainable... • …until we better understand the situation, sought and obtained all relevant information or are asked for our opinion. • How do we do it? Build relationships. 24Monday, 4 February 2013 15
  • 16. Cross-cultural Communication Principles " Developing empathy" Tolerating ambiguity " Suspending judgment 10/29/10 17Monday, 4 February 2013 16
  • 17. Barriers to effective communication Non-verbal cues Non-verbal cues Physical Environment Physical Environment What did not What did not Plannedand unplanned activities Planned and unplanned activities happen? happen? Doctor-patient relationship You, the GP Patient factors Socialenvironment Social environmentMonday, 4 February 2013 17
  • 18. Barriers to effective communication Non-verbal cues Physical Environment What did not Planned and unplanned activities happen? Social environmentMonday, 4 February 2013 18
  • 19. Indigenous Encounters Things you can do: "before any encounters "during the encounters "after the encountersMonday, 4 February 2013 19
  • 20. Before Any Encounter Be aware of impeding factors Patient may feel that they are not in control • power • numeracy and literacy • time • environmentMonday, 4 February 2013 20
  • 21. Before Any Encounter Be aware of impeding factors Differing modes of discourse • indirect • use of narrative • non-verbal communication cues • gratuitous concurrenceMonday, 4 February 2013 21
  • 22. Before Any Encounter Be aware of impeding factors Process of the medical interview can be inflexible • multiple and complex issues • presentation of more than one patient • use of narrativeMonday, 4 February 2013 22
  • 23. Before Any Encounter Be aware of impeding factors tendency or dominance of the biomedical exchange • disease vs social concerns • clinical caring vs holistic caringMonday, 4 February 2013 23
  • 24. Before Any Encounter Be aware of impeding factors staff knowledge of local indigenous culture • behavioural norms • communication styles • cultural world viewsMonday, 4 February 2013 24
  • 25. Before Any Encounter Be aware of impeding factors importance of family and advocacy • significant family members • AHWs • ALOsMonday, 4 February 2013 25
  • 26. Before Any Encounter Establish credibility be a good communicator and educator • body language • rapport and relationship • holistic approachMonday, 4 February 2013 26
  • 27. Before Any Encounter Establish credibility show respect for old people show respect for AHWMonday, 4 February 2013 27
  • 28. Before Any Encounter Establish credibility dealing with death and dying • elders, children • deceased names • blaming or cause of deathMonday, 4 February 2013 28
  • 29. Before Any Encounter Establish credibility have a low threshold for seeing acute cases early • late presentation • menMonday, 4 February 2013 29
  • 30. Before Any Encounter Establish credibility be aware of the different health patterns and presentations • health status • specific guidelinesMonday, 4 February 2013 30
  • 31. CandiceMonday, 4 February 2013 31
  • 32. During the Encounter develop rapport from the beginning Connecting • the social situation • talk the “lingo” • informal speechMonday, 4 February 2013 32
  • 33. During the Encounter Gathering information get a grasp of their “world view” • cultural dimensionsMonday, 4 February 2013 33
  • 34. During the Encounter Gathering information Allow the patient to be in control • time • active listening • clarify agendas • speculate rather than interrogateMonday, 4 February 2013 34
  • 35. During the Encounter Gathering information communication strategies • be comfortable with silence • be comfortable with no eye contact • use the “3 minute rule” • use preface for sensitive questions • beware of “yes” only answers • be sensitive to non-verbal cuesMonday, 4 February 2013 35
  • 36. During the Encounter Gathering information involve the family • collaborative history • serious diagnoses - decision making, support, communication • social issues, emotional wellbeing issues - part of the managementMonday, 4 February 2013 36
  • 37. During the Encounter Gathering information ask for personal meaning of physical illness • spiritual causation (through signs in the natural world) • role of social events • personal relationships and blamingMonday, 4 February 2013 37
  • 38. During the Encounter Gathering information use patients’ terms and language • comfort • “break the ice” • focuses on the patientMonday, 4 February 2013 38
  • 39. During the Encounter Gathering information gender issues • be sensitive • check with the personMonday, 4 February 2013 39
  • 40. HenryMonday, 4 February 2013 40
  • 41. During the Encounter communication strategies - keeping things “simple” Telling “their story” • appropriate short sentences • speak slowly and distinctly • avoid unnecessary detail • provide one idea at a time • use simple words • listen to patient’s choice of words • avoid using the negative form in questions • avoid using prefixes on abstract wordsMonday, 4 February 2013 41
  • 42. During the Encounter Telling “their story” communication strategies - impact • use repetition - throughout management phase, use summarising technique, future meetings • talk with pictures - avoid eye contact, tackle lower literacy and numeracyMonday, 4 February 2013 42
  • 43. During the Encounter Telling “their story” deal with one issue at a time • the one the patient nominates in this consultationMonday, 4 February 2013 43
  • 44. During the Encounter Telling “their story” avoid disempowering the patient • provide choice • “keep it simple” does not meaning holding back on relevant information • provide handoutsMonday, 4 February 2013 44
  • 45. During the Encounter medication management issues Telling “their story” • effective communication - shared understanding, education tools, involve AHW • “to be taken with food”; “do not take when drinking alcohol” • be aware of terms like “dinner”, “tea time” • simplify drug regimen • routes of administration • does administration aids • storage issuesMonday, 4 February 2013 45
  • 46. During the Encounter Telling “their story” use AHW • patient support • interpretation - language, body language, social situation, ‘unspoken words’ • cultural broker • buffer, safety reasonsMonday, 4 February 2013 46
  • 47. During the Encounter Telling “their story” use family members • serious and complex problems - palliative care, domestic violence, aged care, emergency careMonday, 4 February 2013 47
  • 48. During the Encounter when and if things go wrong • costs Safety netting • transport • procedural access • visible and available services • expected course of the condition • family obligations • cultural safety concernsMonday, 4 February 2013 48
  • 49. During the Encounter clear follow-up advice Closing write down tasks provide handouts give referral lettersMonday, 4 February 2013 49
  • 50. After the Encounter any uneasiness about the encounter? Reflective practice • administrative or practice management issues • medical nature • social and emotional concerns • cultural nature • ethical and legal concerns • communication process • your role and responsibilitiesMonday, 4 February 2013 50