Communication & counselling

1. Health education
Communication
IEC (Information Education Communication)
BCC (Behaviour change Communication)
Counselling
Advocacy: Act of pleading or arguing with
a view to influence decision or policy in a
stated direction

2. Communication
Two way process of exchanging ideas,
feelings and information
Two aspects: Content & Relationship
Communication can take place if there is
Common interest / purpose
Mutual benefit
Mutual understanding(relationship of trust)

3. The Communication Process
Receiver
Feedback
ChannelMessageSource

4. Sender
Objective: SMART
Abilities and limitation
Message, channel, audience & utilize
feedback

5. Message
Content: ideas, information
Code: Verbal, nonverbal
Treatment: Arrangement, Sequencing,
Tone and tenor(emotion)

6. Channel
– means by which the message travels
between the source and the receiver;
– a mode of coding and decoding
– can be in the form of interpersonal
or mass media

7. IPC
• Better interaction provides scope for
clarifying doubts, immediate feedback
and building rapport
• Personalised attention is more effective for
motivation and guiding into action
• Useful for people with lower IQ & laggards

8. Mass media
• Useful for rapid dissemination
• Quick public attention / sensitization
• Effective for elite section

9. Group discussion
• Effective to arrive at a decision not
possible to attain by individual effort
alone e.g. refuse disposal
• Long term compliance: cessation of
smoking

10. Receiver
Decoding (listening):
attention,comprehension,absorption
Mental filtering
Change of behaviour
Change in Knowledge (Recall)
Change in Opinion (Agreement)
Change in Attitude (Approval)
Change in practice

11. Change in behaviour
Awareness
Motivation
a) Interest (stage of initiation)
b) Evaluation (direction)
c) Decision making (attempt)
Action: transition from attempt into
action, needs guidance / social
intervention

12. What Are the BarriersWhat Are the Barriers
To Communication?To Communication?
Physiological: Impaired vision/hearing/
speech
Psychological: Low IQ, Anxiety, tension
Environmental: Noise, illumination
Cultural: Language, illiteracy, level of
knowledge & understanding

13. Barriers to
communication
Noise, Distractions
Inappropriate medium
Assumptions/Misconceptions
Emotions
Language differences
Poor listening skills
Inconsistency
Human failings (tiredness, stress)

14. Utilities of communication
1. Dissemination of information
2. Education
3. Behaviour change (BCC)
4. Counselling
5. Advocacy
6. Informed participation
7. Management decision

15. Communication skills
Effective speaking skills
Verbal & nonverbal skills
Listening skill
Questioning Skill

16. Effective speaking skills
1. Make the receiver comfortable
2. Personal touch
3. Friendly tone of voice
4. Give complete information
5. Invite clarification

17. Verbal skills
Pitch of voice
Pace
Tone

18. Nonverbal skills: ROLES
1. Relax
2. Open & approachable
3. Lean towards clients
4. Eye contact
5. Sit squarely and smile

19. Listening skill
Attention
Comprehension
Absorption

20. Questioning skill
• Rapport building
• Privacy
• Confidentiality/Beneficence
• Sensitivity towards the condition/situation
• Non-threatening and non-judgemental
• Probing but no leading question

21. Seven ‘C’s and Behavior change process
Clarify the message
command attention
knowledge
Cater to the heart and
head
Create trust
Approval
Convey a benefit
Intention
Practice
Advocacy
Call to action
Consistency counts
Create confidence to speak out

22. Counselling
• Helping process aimed at problem solving
Help in identification and understanding
the problem
Help in identifying alternative solutions
Help in chosing the best possible
alternative

23. Counselling techniques
1. Focus of attention
2. Acceptance
3. Empathy
4. Probing
5. Paraphrasing
6. Summarising
7. Advising

24. Do doctors need communication?
Historically the emphasis was on the
biomedical model in medical training
which places more value on technical
proficiency than on communication skills.
Poor communication causes a lot of
medico-legal and ethical problems.

25. Communication: With whom?
Patients & care-givers
Nurses & auxiliary staff
Colleagues
Administrators
Evidence in court
Reporting research findings
Talking to the media
Public & legislature

26. Communication: How?
The medical interview is the usual
communication encounter between
the doctor and the patient.
It can be classified according to the
purpose of the interview into 4 types:
History taking
Breaking bad news
Consultations
Obtaining informed consent

27. Questions to ask yourself after
each consultation
Was I curious?
Do I know significantly more about
this person as a human being than
before they came through the door?
Did I listen?
Did I make an acceptable working
diagnosis?
Did I explore their beliefs?

28. Questions to ask yourself after
each consultation/2
Did I use their beliefs when I started
explaining?
Did I share options for investigations
or treatment?
Did I share in decision-making?
Did I make some attempt to see that
my patient understood?
Did I develop the relationship?

29. Dealing with emotional Patients
Set an example: don’t ask patients to calm
down.
Get patients’ attention: lower your voice.
encourage them to sit down but let them
control their emotions at their pace.
Listen not just to the patients needs, but
also for underlying issues/concerns and
unexpressed expectations.

30. Dealing with emotional Patients/2
Avoid arguments, use disarming
statements.
Consider rolling with the resistance and
agreeing with the patient if possible.
Take a step back from the demand and ask
probing questions to find underlying
concerns. This may change a rant into a
conversation.

31. Dealing with emotional Patients/3
Don’t assume things, ask to find out
Don’t get emotionally involved, keep your
professional attitude.
Don’t give false reassuring comments.
Say no in a tactful manner to the patient’s
unrealistic wishes & demands.

32. Breaking Bad News
Clinicians are responsible for delivering
bad news, this skill is rarely taught in
medical schools, clinicians are generally
poor at it.
Medical education typically offers little
formal preparation for this task.

33. THE PAST AND THE
PRESENT
 Hippocrates advised concealing most
things from the patient.
 Older physicians, who trained during
the 1950s and 60s, were taught to
"protect" patients from disheartening
news.
 In the past decades traditional models of
patient care have given way to an
emphasis on patient autonomy.

34. BREAKING BAD NEWS/2
 Many health care professionals tend
to define 'bad news' as worst case
scenarios (eg. telling a patient they
have cancer or that their loved one has
died), But a knee cartilage problem
requiring rest for a waitress may mean
no pay

35. BREAKING BAD NEWS/3
 Any news that drastically and
negatively alters the patient’s view of
his or her future.
 It results in a cognitive, behavioral,
or emotional deficit in the person.
 Receiving the news that persists for
some time after the news is received.

36. Principles of effective
communication
 Requires planning and thinking in terms
of outcomes.
Follows the helical model (what one
person says influences what the other says
in a spiral fashion so that communication
gradually evolves through interaction).
Demonstrates dynamism (what is
appropriate for one situation is inappropriate
for another).

37. Barriers to effective communication
Personal attitudes
Language
Time management
Working environment
Ignorance
Human failings (tiredness, stress)
Inconsistency in providing
information

38. Questions