6. COMMUNICATION SKILLS
• BREAKING BAD NEWS (DEATH)
• ILEAL PERFORATION
• CA RECTUM PER MANUAL COLOSTOMY
• CONSENT FOR LAPARASCOPIC
CHOLECYTECTOMY
• BELOW KNEE AMPUTATION DIABETIC
FOOT
• SWAB LEFT IN ABDOMEN POST SURGERY
• STOMA CARE
• LADY WITH 3 CM BREAST LUMP WITH NO
LYMPH NODES PALPABLE
10. Types
1.History taking & delivering
information
2.Informed consent
3.Breaking bad news
4.Difficult consultation –agitated,
anxious, incapacitated
5.Communication with family
6. Sexual history & abuse
KFHU
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11. INFORMED CONSENT
1.PREPARATION
Introduction Give your own name
Check patient’s name,
Explain what you are doing
and by what authority
Background Check what the pt already
knows
Explore how much he or she
actually wants to know
11
FOUR STAGES
12. 2.EXPLANATION
What is wrong: Explain the diagnosis in
simple language.
Action: What is proposed action?
Does it differ from national or
other guidelines, if so justify.
Outcome: Describe the likely short and
long term outcomes
Choices: Describe all viable choices
including doing nothing
KFHU
12
INFORMED CONSENT
13. 2.Explanation-cont..
Complications: Explain all serious
complications and
those with a risk >1%
Describe the actions that will be
taken to prevent each
Explain how complications will be
managed if they do occur
Right of refusal: Make it clear that the final
decision
is the pt’s alone
Give the patient time to think
about
the decision
13
INFORMED CONSENT
14. 3.Check competence to give consent :
Tell me what you have understood?
4.Closure
Open question: Is there anything else you
would like to discuss?
Record: Record what was discussed
and what was agreed
14
INFORMED CONSENT
15. Module for Informed Consent
• Mr Mohammed is diagnosed to have
papillary Ca Thyroid and scheduled for
thyroidectomy.
• Obtain an informed consent.
• 1.Introduction and identification
• 2.Explanation of diagnosis
• 3.Explaining surgical options
• 4.Explaining intended procedure
KFHU
15
16. Module for Informed Consent-2
• 5.Explaining pros and cons
• 6. Explains consequences of not operating
• 7.Measures to be taken to avoid
complication or to treat complications if
they may arise
• 8. Realistic hope (prognosis)
• 9.Leaves Mr Mohammed to decide and
sign.
KFHU
16
17. SPECIAL SITUATION
• Incapacitated, unconscious patient – surrogate
decision maker not available in emergency /OR
decision making
• Two consultants and Medical director
would sign
• Consent is ‘presumed’ not ‘obtained’
• Later in appropriate situation should be
obtained
KFHU
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18. Module –Breaking Bad News
• Abdulaziz, 52 yrs old male, diagnosed as
Colorectal Ca.
• Deliver the news to Mr Abdulaziz
• Skills- P anticipates queries, prepares for
consequences before entering the room
• Never carry Stetho, show no hurry, body
language sympathetic – enter the room
KFHU
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19. Module –Breaking Bad News- 2
• Identifies himself and the Pt
• Asks Abdul about how much he understands abt
his ailment
• Enquires about Abdul’s personal & family/social
support
• Describes physical & diagnostic findings
• Skill : sits close to Abdul with a comforting
gesture
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20. Module –Breaking Bad News-3
• Declares the diagnosis- skill –touches hands,
pats the shoulder, and assesses Abdul’s
condition.
• Describes the investigative/ management
options
• Describes realistic prognosis
• May suggest second opinion
KFHU
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