Notes for communication skills for anaesthetist

1. COMMUNICATION SKILLS FOR ANAESTHETIST
DR. RAVIKIRAN H M
INTRODUCTION
Latin communicare-to impart, participate
Communication process: Process of exchanging ideas, feelings and information
It is a key skill for anesthetic practice.
It is one of the ANTS(anesthetist non technical skills)(interpersonal skill)
Effective communication:
1. Improve health outcome
2. Patient satisfaction
3. Reduce error, misunderstandings, distress & negligence claims
Settings:
1. ICU
2. Pain clinic
3. Labour ward
4. Preoperative consulatation
5. Intraoperative
6. Handover in recovery
Interaction with:
 Peers
 Patients
 Patient family
 Colleagues
BASICS OF COMMUNICATION

2. 1. Verbal: through words
2. Paraverbal: tone, pitch & pace of speech
3. Non verbal: gesture, body posture, facial expression & eye contact
4. Visual: Comprises charts, graphs, pictograms, tables, maps, posters.
Components of communication process:
– Sender (source)
– Receiver (audience)
– Message (content)
– Channel(s) (medium)
– Feedback (effect)
TYPES OF COMMUNICATION:
ONE-WAY TWO-WAY
Didactic Method Socratic Method
Flow of communication is one way – from
communicator to audience
Two way communication in which both the
communicator and the audience take part
Disadvantages:
1. Knowledge is imposed and learning
authoritative
Advantages:
1. Active participatory and democratic
process
Classification
conscious
based on logic
& reasoning
subconscious
metaphor,
symbolism &
imaging

3. 2. Little audience participation and no
feedback
3. Does not influence human behavior
4. Makes no attempt at removing
misconceptions and misunderstandings
5. Communicates message even if
unintelligible or unacceptable
6. Autocratic process(ruler have all power)
2. More likely to influence human behavior
3. Better audience participation and feedback
Examples:
1. Lecture method (Chalk and talk method)
2. Television
3. Radio
4. Newsprint
Examples:
1. Focus Group Discussion (FGD)
2. Symposium
3. Panel discussion
VERBAL NON-VERBAL
Face-to-Face communication Indirect interaction
Advantages:
May be loaded with hidden meanings
Persuasive(power to convince)
Advantages:
Silence speaks louder than words
FORMAL NON-FORMAL
Follows line of authority Grape-vine communications: no prescribed
structure
Advantages: May be more active than formal
channels
MODELS:
1. Square
2. Tate’s
Square model:
For every message there is a sender & a recipient.
4 aspects:
1. Content: straight forward
2. Appeal: implication that recipient needs to do or not to do
3. Self revelation: discloses something about sender

4. 4. Relationship: b/w sender & recipient
Disadvantage: it does not focus on different aspect of message
Tate’s model:
Contested consultation
Brings differing expectation & intentions to interactions.
Explore patient priorities like belief, hope & fear.
Chief complaint is less important.
Barriers:
1. Physical: most reliable. ex. Automated doors
2. Natural: distance, time & location
3. Human action
4. Administration: protocols & procedures
Communication during induction:
1. Evocative: intended to invoke reassuringly pleasant or familiar images
2. Descriptive: explain to patient what he/she might expect to feel
3. Functional: to assess physiological stability (eg. Pt. himself keeps mask over his face)
Handover guidelines:
1. After monitors connected
2. Important & relevant
3. Stay till first reading
4. Post-op instruction
5. Review before transport to ward
Significance:
 Medical
Most followed

5.  Legal
 Ethical
 Personal
COMMUNICATION METHODS
Audio-Visual Aids
• Audiovisual aids: No health education can be effective without audiovisual aids
• Auditory aids: Radio, cassette tape-recorder, microphone, amplifier, earphone, public address
system, disks
• Visual aids:
– Not requiring projection: Chalk-board, leaflets, posters, charts, flannelgraph, exhibits, models,
specimens, diagrams, photographs
– Requiring projection: Slides, filmstrips, overhead projector, epidiascope
• Combined A-V aids: Television, sound films (cinem(a), synchronized slide-tape combination,
multimedia, videotape system, drama, skits
Delphi Method
• Delphi method: Is a ‘systematic interactive forecasting method’ for obtaining consensus
forecasts from a panel of independent geographically dispersed experts
• Method:
– Carefully selected experts answer questionnaires in two or more rounds
– After each round, a facilitator provides an anonymous summary of the experts’ forecasts from
the previous round as well as the reasons they provided for their judgments
– Thus, participants are encouraged to revise their earlier answers in light of the replies of other
members of the group
– Range of the answers decrease and the group will converge towards the ‘correct’ consensual
answer
– Finally, the process is stopped after a pre-defined stop criterion (e.g. number of rounds,
achievement of consensus, stability of results) and the mean or median scores of the final rounds
determine the results
• The objective of most Delphi applications: Reliable and creative exploration of ideas or the
production of suitable information for decision making

6. Counselling
• Definition: Counselling is face-to-face communication through which a person is helped to
make a decision or solve a problem
• Counselling helps clients make informed choices
• COUNSELLING IS DIFFERENT FROM ADVICE: In Counselling, ‘Choice is given to clients’
• Elements of Counselling: (GATHER Approach)
– G: Greet the clients (make them comfortable, give attention)
– A: Ask/ascertain needs/problems or reasons for coming
– T: Telling different methods/options/choices to solve the problem
– H: Help client to make voluntary decisions
– E: Explain fully the chosen decision/action/method
– R: Return for follow-up visit
Reference:
1. BJA
2. PSM review by Vivek Jain