Soft skills for Successful Clinical Practice.pdf

Soft skills for Successful
Clinical Practice
(SBV-Samhita, 2020)
Dr KR Sethuraman MD PGDHE
Senior Professor & Dean of Medicine
AIMST University, Malaysia
(Endowed Chair in Medical Education, SBV)
12/21/2020 1
Soft Skills Talk - SBV Samhita-2020

Attitude refers to a set of emotions, beliefs, and behaviour
toward a particular person, object, or an event.
Attitudes are often the result of upbringing & life-experiences.
12/21/2020 2

Today’s Agenda...
Present themes for the budding doctors & young
professionals to consider and adopt as a way of
professional life and continuous self improvement:
• Soft skills to cultivate, which align with the desirable traits in
doctors that the patients appreciate
• Know-How of effective patient doctor communication
conducive to harmonious and successful practice
• Going beyond mere professionalism to be a Humanistic care-
provider
• Acquiring these soft skills in the present times of Exam-
orientated approach to learning Medicine.
12/21/2020 3

“Indian Medical Graduate” (IMG)
(New MBBS Curriculum)
• Major Roles & Responsibilities
1. Clinician
2. Communicator = Soft skill
3. Lifelong learner
4. Professional Care-provider = Soft skill
5. Leader / member of the health care team
12/21/2020 4

Attitude, Ethics and Communication
Competencies of I.M.G.
• 3.1. Clinician, who - provides -- holistic care with compassion
• 3.3. Communicator with patients, families, colleagues and
community
• 3.5. Professional who is committed to excellence, is ethical,
responsive and accountable ---
• Shouldn’t all care-providers try to develop these desirable
traits?
• What about YOU?
12/21/2020 5

Key Skills for Clinical Professions
Soft-skills you should cultivate
• Ability to work long hours, and do it
under pressure
• Leadership and management skills
• Communication skills, compassion
• Good bedside manners
• Drive to continue life-long learning
• Analytical ability
• Time management
Professional skills
formally taught
• Clinical and
procedural skills
• Apply knowledge
to solve problems
• Effective decision-
making skills
12/21/2020 Soft Skills Talk - SBV Samhita-2020 6

Communication Skills:
the key to successful practice
12/21/2020 7

WHY Learn COMMUNICATION SKILLS?
Communication is a core clinical skill because
• As a clinician, you will do ~200,000 consultations in
your professional life
• Competency required by all medical licensing bodies
• Doctoral research at SBV (IGIDS) by Prof Varsha Murthy
(guided by me) revealed an 8-fold increase in patient
satisfaction after the PG underwent generic and
individualised training in Communication skills
12/21/2020 8

Words Of Comfort, Skilfully Administered, is the Oldest
Therapy Known to Man - Louis Nizer
CURRENT PARADOX !
➢ Global Communication & Internet Based
“Tele-medicine"
➢ Breakdown In Doctor - Patient Communication
12/21/2020 9

MISUNDERSTANDING & MAYHEM
12/21/2020 10

Communication is Contextual and a
Complex skill
Beginners often have problems
because of this…
12/21/2020 11

Lack of Questioning Skill – a real life story…
Are you married?
No
How many children?
#*%(angry mutter)
Do you have kids
Yes, I do.
Are you Married?
You libelous fool…
Hey! Don’t worry.
Ask your questions
the other way
around.
12/21/2020 12

Routine Communication, out of context, can
land one in big trouble …
Do you have kids
Yes, I do.
Are you Married?
You libelous fool…
12/21/2020 13

Sender Receiver
12/21/2020 14

Examples of Communication Problems
Average time for patient to make the opening
statement before interruptions is < 30 seconds
Doctors frequently interrupt patients
Average time before interruption
Consultant = 20 seconds; Resident = 12 seconds
Only around 25% of the patients complete their
opening statement
12/21/2020 15

Dichotomy in Information Needs
• Doctors’ Needs -
i. To Establish Diagnosis
ii. To Plan Management
• Patients’ Needs -
i. To Understand the Symptoms
ii. To Feel Known as a ‘Person’
iii. To Feel Understood by the
Doctor
12/21/2020 16

Attributes of Effective Communication
1. Accuracy
2. Availability & Timeliness
3. Understandability
4. Reliability & Evidence Base
5. Consistency
6. Balance
7. Repetition
12/21/2020 17

1 – Accuracy
Two examples of near fatal communication errors:
1. Milk drip: (a verbal inaccuracy)
Given iv (instead of through naso-gastric tube)
2. Inj plain insulin 10 ml iv (inaccurate writing)
instead of 10 units, 10 ml = 400 units
12/21/2020 18

2 – Availability & Timeliness
• Case: iv LMW heparin administered for a Transient
Ischemic Attack (clumsy hand stage)
• 2 variations in action (reactive/proactive) & 2
outcomes
– A – hemiparesis next morning;
– B – Recovers in 1 hour
I. Apathetic - reactive: doesn’t care to advice
II. Proactive: available and timely advice at the time
of prescribing and dispensing
12/21/2020 19

3 – Understandability
“You had a syncopal episode last night without any
evidence of arrhythmia.
I don’t think it was vagal but I ordered a duplex-
Doppler Echo and Holter to rule out CVS problems.
I still can’t rule out a vertebrobasilar event.”
?
12/21/2020 20

4 Reliability – Evidence Base
• Very important with new patients who are yet to
trust you
• Body language awareness is important to detect
disbelief or skepticism of the patient
• Ask “What more evidence do you need before I can
convince you?” – provide it
• Immunize Against Misinformation by others with
strong evidence that patients can Google!
12/21/2020 21

5 Consistency
• Across time span:
– e.g., during 40 weeks of ante-natal care; in chronic
diseases across months
• Across specialties (Cross Reference)
• Across the treating team:
– Chief, Asst, Resident, Intern, Nurse, Orderly etc
12/21/2020 22

6 – Balance: cost – Benefit – risk
12/21/2020 23
COST
BENEFITS

7 – Repetition
This is to ensure understanding.
But do not repeat the same words (like a parrot) .
Statement – Repetition – Explanation is effective
Example:
You want to say, “It is important to act now before it is too late.”
1 - Statement: “We think it’s important to act now”
-- pause --
2 - Repetition: “It’s important to act now, -”
3 - Explanation:“ because tomorrow may be too late.”
Making the patient repeat it is even more effective
12/21/2020 24

Cultivating Desirable Traits as a
Healthcare Professional

Dinesh Kumar V, Murugan M, Prasad B, Devi R. Good doctor and bad doctor: a
qualitative study of first year medical students’ views on professionalism. RHiME. 2018;5:58-68

Stages of Development of Soft Skills
Start
Fully evolved
Attitude
12/21/2020 28

Shaping of Attitude in Stages
INTERNALIZING
12/21/2020 29

Professional
Behaviour
Internalized
Humanistic
Value
system
12/21/2020 30

Professionalism versus Humanism

Humanism vs. Professionalism
Humanism
• Is Who you are
• Drives authentic
professional behaviors
• Harder to undermine
– when under duress
– when no one is
watching
Professionalism
• Is What you do
• May seem intact without
humanistic qualities
– “Robotic professionals”
• Can be undermined
– when under duress
– when no one is
watching
12/21/2020 32

Case-1: A school boy with Acute Knee Injury
12/21/2020 33

Professionalism – Humanism
• Taking the school-boy to
Operating Room to attend
to acute bleeding in to
the knee was
professionalism
• Listening to his mother’s
lament, suspecting a
bleeding disorder (like
haemophilia) and
• running to the OT to alart
the surgical team on the
bleeding disorder was
humanism
12/21/2020 34

Case-2. Professionalism – Humanism
Mariamma, a woman
with asthma who
needs regular
medicines but cannot
travel from a nearby
village.
Defaults on therapy
and repeatedly gets
admitted with acute
severe asthma.
12/21/2020 35

Professionalism – Humanism
• Treating Mariamma
with medications for
asthma and
counselling on
compliance was
professionalism
• Discussing her plight with
OPD nurses and orderlies
to find a solution
• Identifying and arranging
with an employee from
the same village to take
medicine to her by proxy
was humanism with
compassion
12/21/2020 36

Combining Scientific & Humanistic Medicine
12/21/2020 37
Queries to ask about
an individual patient
who has this health
problem
Current Scientific
knowledge about
this health problem
Humanistic
approach
Scientific
approach
Scientific +
Humanistic
Medicine

Take Home Messages
• Communication is “Talking With” Patients & NOT
“Talking To” Them
• The SCIENCE of Dr - Pt Communication Can Be Learnt &
Should Be Taught
• The ART of Communicating Needs –
▪ Empathy & Focus on the Patient’s Needs & Life
▪ Plans To Clear Misunderstanding
▪ Practice Of Good Communication Skills
▪ Research at SBV has shown 8-fold improvement in Patient
satisfaction after training in communication and soft-skills
12/21/2020 38

Harmony in Education
(one of Gandhiji’s favourites Paraphrased…)
Professional
12/21/2020 39
Soft Skills
Knowledge
Hard Skills

Thank You
All For A
Patient
Listening!
12/21/2020 40
Reference Book
2017

Soft skills for Successful Clinical Practice.pdf

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Soft skills for Successful Clinical Practice.pdf

Similar to Soft skills for Successful Clinical Practice.pdf (20)

More from K Raman Sethuraman

More from K Raman Sethuraman (20)

Recently uploaded

Recently uploaded (20)

Soft skills for Successful Clinical Practice.pdf