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Doctor patient communication and relationship


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Behavioral Dentistry
Second Year

Published in: Health & Medicine
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Doctor patient communication and relationship

  1. 1. 03/06/1434 1 COMMUNICATION SKILLS: Doctor-Patient Communication and Relationship 13/04/2013 Dr. Mohamed Salah Khalil (Ph.D-Neuropsychology) Associate Professor-Consultant Clinical Psychologist Coordinator of Postgraduate Clinical Psychology Program 1 DR. MOHAMED SALAH What can studying communication skills offer us as medical practitioners 13/04/2013 Increased Doctor Job Satisfaction Decreased Conflict Within The Consultation More Accurate And Efficient Interviews Better Clinical Hypothesis Generation Increased Patient Satisfaction Increased Patient Understanding And Recall Improved Compliance And Disease Outcome Decreased Medico Legal Complaints Actual Savings In Time More Structure And Control Of The Difficult Consultation 2 DR. MOHAMED SALAH
  2. 2. 03/06/1434 2 Impacts of Good Communication Skill 13/04/2013 However, the most important findings that have frequently been reported on the impact of communication are in the following aspects: Effective Diagnosis & Treatment Outcome Patient’s Adherence Doctor’s Competence & Self-Assertion. Patient’s Satisfaction. 3 DR. MOHAMED SALAH Patient Satisfaction 13/04/2013 From a psychological perspective, there is two type of patient’s satisfaction: Cognitive Satisfaction: How satisfied is the patient with their understanding of the diagnoses, treatment, and prognoses. This is related to the doctor’s Verbal Behavior. Emotional Satisfaction: This is related to the doctor’s non-verbal behavior. The ability to show care and concern by tone of voice, eye gaze, facial expression, body movement and posture 4 DR. MOHAMED SALAH
  3. 3. 03/06/1434 3 INTERVIEWING AND COMMUNICATION SKILLS 13/04/2013 CORE COMMUNICATION SKILLS: Core communication skills covers three dimensions: Doctor -patient interpersonal skills Information gathering skills Information giving skills and patient education Advanced Communication Skills Skills for motivating patient adherence to treatment plans Other applications of core communication skills in specific situations (e.g., dealing with anger, dependent personality dis., breaking bad news). 5 DR. MOHAMED SALAH The LEARN Mnemonic 13/04/2013 LISTEN actively with respect ELICIT the health beliefs of the patient ASSESS priorities, values and supports RECOMMEND a plan of action with adequate explanation and understanding NEGOTIATE by involving the patient in next steps and decisions 6 DR. MOHAMED SALAH
  4. 4. 03/06/1434 4 The SCANS Mnemonic S= Setting, Situation C = Centeredness, Co-operation A= Active listening, Assessment, Acknowledgement, Agreement N = Negotiation S= Summary, Safety Net 13/04/20137 DR. MOHAMED SALAH C L A S S Techniques - The CLASS System Context (Physical Setting) Listening Skills Acknowledgement Strategy Summary 13/04/20138 DR. MOHAMED SALAH
  5. 5. 03/06/1434 5 Context (Physical Setting) Privacy Eye Level - Even Personal Space Body Language Relaxed Eye Contact 13/04/20139 DR. MOHAMED SALAH Context (Physical Setting) 13/04/201310 DR. MOHAMED SALAH
  6. 6. 03/06/1434 6 Techniques - The CLASS System Context (Physical Setting) Listening Skills Acknowledgement Strategy Summary 13/04/201311 DR. MOHAMED SALAH Listening Skills • Open Questions • Facilitating • Clarifying • Time & Interruptions 13/04/201312 DR. MOHAMED SALAH
  7. 7. 03/06/1434 7 Open-Ended Questions Questions that have many answers Closed questions have a specific answer Examples: How are you? “How can I help you?’ “And then what happened?’ Tell me about your pain.” Serve as an invitation Beware – Patient may ramble awhile 13/04/201313 DR. MOHAMED SALAH Effective Communication: Verbal Strategies 4/13/2013DR. MOHAMED SALAH KHALIL14 Open Questions Elicit information How would you describe your relationship with your parents? Closed Questions Gather specific information Do you have a good relationship with your parents? Combining Open and Closed Questions
  8. 8. 03/06/1434 8 Facilitating Sending an “I’m with you” message May encourage development of hope Simple gestures or phrases: Nodding, smiling “Tell me more” Uh-huh Pausing appropriately Repeating a keyword the patient uses 13/04/201315 DR. MOHAMED SALAH Clarifying Know exactly what the patient is saying Examples: “Let me see if I’ve got this straight…” “So what you’re saying is…” “Do you mean ____ or ___ ?” Use a translator, social worker or other facilitator 13/04/201316 DR. MOHAMED SALAH
  9. 9. 03/06/1434 9 Paraphrasing and Reflection 4/13/2013DR. MOHAMED SALAH KHALIL17 patient: Everything is boring. There’s nothing new going on, nothing exciting. All my friends are away. I wish I had money to do something different. Paraphrase: With your friends gone and no money around, there is nothing for you to do right now. Reflection: You feel bored with the way things are for you right now. WHAT ABOUT NON-VERBAL? It’s not what you say - it’s the way that you say it! There are several other positive non-verbals that can be used to indicate we are listening supportively - often known under the mnemonic S.O.L.E.R. Sitting Square on to the patient with an Open position, Leaning slightly forward with Eye contact in a Relaxed posture. The most important is eye contact followed by facial expression and inflection of voice. 13/04/2013DR. MOHAMED SALAH18
  10. 10. 03/06/1434 10 Time & Interruptions Acknowledge that the patient is your primary concern Records/Pages & phone calls: defer or avoid Clarify time constraints Plan a continuation of the discussion Don’t interrupt 13/04/201319 DR. MOHAMED SALAH Acknowledgement The Empathic Response Touch Normalize 13/04/201320 DR. MOHAMED SALAH
  11. 11. 03/06/1434 11 13/04/2013 Empathy • "Empathy means demonstrating an understanding of the patient's pain and distress while maintaining an objective and observant stance." Being Seen Being Heard Being Accepted The Empathic Response A verbal technique that acknowledges you have heard the patient’s emotional content. No requirement to feel the emotion. Steps: 1. Identify the emotion – open-ended questions 2. Identify its cause 3. Respond in a way that shows you understand the connection between 1 and 2 13/04/201322 DR. MOHAMED SALAH
  12. 12. 03/06/1434 12 THE MNEMONIC “NURSE” The Duke team uses the mnemonic “NURSE” to label five types of continuer statements: Name: State the patient's emotion Understand: Empathize with and legitimize the emotion Respect: Praise the patient for strength Support: Show support Explore: Ask the patient to elaborate on the emotion 13/04/2013DR. MOHAMED SALAH23 Empathy Example: “I understand that you are worried about the consequences of your injury.” Let the patient know that you understand his or her problem as if it had oc-curred to you. Support: “It must have been a terrible experience for you”. Let the patient know that you comprehend his or her feelings. Normalizing : Tell the patient that his response is appropriate and normal 13/04/201324 DR. MOHAMED SALAH
  13. 13. 03/06/1434 13 Touch May be a very important part of your non- verbal communication skills. Helps the patient feel less isolated Three rules: 1. Only touch a neutral area (hand or forearm) 2. Touch briefly, and see if the patient appreciates it 3. Never to opposite sex 13/04/201325 DR. MOHAMED SALAH Strategy: Creating the Plan Think what is best medically Assess the whole patient Propose a strategy Assess the patient’s response & modify accordingly A reasonable plan the patient will follow is better than an ideal plan the patient will ignore. Any plan is far better than no plan. 13/04/201326 DR. MOHAMED SALAH
  14. 14. 03/06/1434 14 Summary Summarize main points Any urgent questions? Any thing else! Plan next contact: • Time • Setting 13/04/201327 DR. MOHAMED SALAH Core Communication Skills A) INTERPERSONAL 13/04/2013 Non-verbal communication Skills in non-verbal communication like eye contact, physical proximity, and facial expression need to be improved to enhance patient’s satisfaction and adherence to treatment. This should convey to the patient that the Health practitioner is attentive and interested. Avoid Overreacting Some patients may appear demanding, dependent or even at times, adversarial. It is the physician's responsibility to not overreact to these situations. This can be achieved by establishing limitations (boundaries) on what can be provided and suggesting appropriate ways for the patients to contact them. Establishing Boundaries Frequent phone calls, unscheduled visits, and unrealistic expectations, are ways in which some patients lose perspective of the shared responsibility of their care. Doctors need to establish boundaries for patients in a way that doesn't belittle them. 28 DR. MOHAMED SALAH
  15. 15. 03/06/1434 15 13/04/2013 Core Communication Skills Active listening: (Well-timed silence and eye contact)// POSTURE, GESTURE, AND FACIAL EXPRESSION ---- culturally acceptable Empathy, respect, interest, warmth and support (THESE ARE THE CORE FACTORS IN RAPPORT BUILDING.------- Language: Avoid medical jargon. Non-verbal communication Avoid Overreacting Establishing Boundaries Closing the interview Core Communication Skills 13/04/2013 Information gathering skills Using an appropriate balance of open to closed questions Silence You need to learn to use silence appropriately as a way to encourage express themselves more fully, raise difficult topics and remember important Clarifying patient expectations about the consultation Clarifying the information given by the patient Sequencing of events Directing the flow of information Summarizing 30 DR. MOHAMED SALAH
  16. 16. 03/06/1434 16 Information Giving Skills And Patient Education 13/04/2013 Providing clear and simple information Using specific advice with concrete examples. Putting important things first. Research suggests that what is said first is remembered. Using repetition. Summarizing. Categorizing information to reduce complexity and aid recall. Using tools. Checking patient understanding of what has been said. Repeating instructions, using diagrams, written instructions, and sometimes- technical aids to explain difficult concepts are useful. 31 DR. MOHAMED SALAH Advanced Communication Skills 13/04/2013 Skills for motivating patient adherence to treatment plans The list below includes skills for the promotion of behaviour. Realistic compliance with treatment plans may require patients to make significant changes in their diet, lifestyle or daily routine on a short term or long term basis. Providing a rationale for behavior change Providing examples of role models Allowing opportunities for verbal rehearsal of the details of the treatment Feedback (positive reinforcement of constructive behaviour changes already achieved since earlier consultations) Finally, doctors should be aware about the clinical, communication and interpersonal skills that are required when dealing with difficult patients, (e.g., overdependent, dramatizing and exaggerating, aggressive, and antisocial personalities,). 32 DR. MOHAMED SALAH