This document discusses effective communication and counseling skills for doctors. It emphasizes letting patients express themselves, active listening, establishing eye contact, and using a positive tone. When counseling parents of a non-improving or critically ill child, doctors should explain the situation clearly, instill hope while being honest, and offer emotional support during and after the child's death. The goal is to help parents understand through empathetic communication.

1. Communication skills

2. Key communication skills
 Let parents express in own words
 Observe non verbal clues
 Encourage the patient to continue speaking
 Establish eye contact
 Active listening

3. Verbal communication
• What to say ?
 How to say?
 Whom to say?
 When to say?
 What you should not say?

4. Important points in
communication
• Feel good about yourself
 Learn to avoid using ‘I’ and ‘ME’
 Instead use ‘YOU’ and ‘WE’
 Pause, pace, pitch, and voice modulation

5. The SOFTEN technique
S = smiling
O = open body posture
F = friendly energy
T = touching while talking
E = eye contact
N = nodding in affirmation

6. Non verbal communication
(body language)
• Eye contact
 Facial expressions

7. Communication pitfalls
• Using highly technical language
 Not showing appropriate concern
 Not listening
 Failing to verify whether understood
 Displaying apathy

8. Telephonic
consultation

9. Issues related to
telephonic consultation
 Convenient for parents (too much time and
energy spent to see the doctor – just for few
minutes)
 Convenient for doctors (quality time for
clinic patient - improves outcome)
 Should be selective and safe
 Must develop methods to avoid interference

10. Telephonic consultation – when?
 Minor problem that may not require physical
examination
 Follow-up report after initial consultation
 First aid advice in an emergency till parents
reach the doctor

11. Telephonic consultation when
not?
 Patient not known (not a regular patient)
 Acute illness in neonate or young infant
 When condition can not be judged properly
(exaggerated or ambiguous statements by parents /
symptoms potentially serious such as excessive
crying or lethargy / chronic problems)

12. Telephonic consultation
when not?
 When specific therapy may be
necessary
 When parents insist on being seen
(even when you feel otherwise)

13. Ideal way
 Have a trained doctor to attend phones who
follows preformed protocol (even simple
advice needs your Ok / you speak if parents
insist)
 Monitor conversation; intervene if necessary
 Insist on talking to a treating doctor if
patient is already under treatment
 Legality issues? – ideally need for

14. Counseling parents of
children who are not
improving

15. General rule
 Counseling is an art
 Depends on communication skills
 Explain in simple language using similes
related to common life situations (drug
may not work even when chosen
correctly – pencil does not write if
given to newborn)

16. General rule
 Use words cautiously – ABC –
accurate / brief / clear
 Balanced statement of prognosis
 “Patient” hearing and repeated
explanation

17. Acute serious illness
 At first visit, explain details of illness
and its evolution to present serious
stage
 Do not find faults with previous
therapy (pneumonia who came in with
hypoxia)

18. Acute serious illness
 Instill hope and confidence (many such
children improve) with subtle hint (few
may develop problems, let’ s hope we
don’t face it)
 Estimate time and course of
improvement – wait for sustained
progress before announcing

19. Acute serious illness
 Explain each move from time to time before
implementing if possible
 More the serious illness and not improving,
more we must talk to parents
 Do not show anger, frustration, rudeness or
diffidence – be “patient” and tolerant to
parental outbursts
 Offer an option of second opinion

20. Acute illness in office practice
 Spend adequate time; explain problem,
anticipated course, and its rational
management
 Convince parents about safety of observation
with minimal action (are you sure, is the
question that needs confident answer)

21. Acute illness in office practice
 Be transparent; spell out what you don’t
know but add that you know how to
know!
 Document provisional diagnosis and its
basis with instructions for therapy and
follow-up

22. Chronic disease
 Explain in details (like teaching session)
 Describe all the options of investigations and
management ( MR / asthma / JCA / epilepsy)
 Discuss pros and cons of treating and not
treating or different modes of therapy
 Chart out anticipated course on compliant
therapy, limitations of “cure”and adverse
drug reactions along with monitoring

23. Chronic disease
 Leave the choice of other systems of
medicine to parents and do not criticize (but
emphasize on transparency, access to
unbiased information and evidence based
approach in allopathy)

24. Managing death
 It is said that -
If one looses a parent, past is lost
If one looses a spouse, present is lost
But if one looses a child, future is lost
 Hence parents cannot tolerate death of a
child – they need support

25. In the event of death
anticipated
 Ensure that senior doctor is a spokesperson
and not juniors or resident doctors (other
doctors must repeat what senior has talked)
 Parents must be subtly warned about non-
improving situation (we are trying our best
but so far there is no improvement)

26. In the event of death
anticipated
 Confide in 1-2 close relatives about the
inevitable unfavorable outcome
 Let parents be a witness to continuous
monitoring and necessary interventions

27. In the event of death
 Do not announce death suddenly (condition is
worsening though we won’t give up / next half
an hour is crucial, if there is no improvement
by then, we may not make it)
 When death is announced, let parents vent
their feelings (we are sorry we could not save
your child)

28. In the event of death
 Ensure every help to ease the situation
 Consider the possibility of subsequent
discussion with parents to make them feel
that everything possible was tried and that
they had not faulted

29. Summary
 Counseling is an art – not taught in medical
school – make an effort to learn
 It should not be a casual approach -
especially in serious conditions, ideally
carried out in a specified place with privacy
and not in a hurry
 More the serious nature of the disease, more
should be the “talking”