This document discusses effective communication skills between doctors and patients. It emphasizes the importance of building rapport through both verbal and non-verbal channels such as greeting the patient, introducing yourself, making eye contact, and using an open body posture. Building rapport accounts for 80% of a patient's success or experience with a doctor. Effective communication involves listening skills, using open-ended questions to allow patients to provide more details, and tailoring the communication approach to each individual patient.

1. Building a Rapport
Non-verbal and verbal
channels

2. No matter what job you have in life, your success will be
determined----- % by your academic credentials----- % by
your professional experiences, and -----% by your
communication skills
Imad Hassan
Good doctors bad doctors
Communication Mastery Plus “What Patients Love or
Hate About Their Doctors
Check your answers

3. No matter what job you have in life, your success
will be determined 5% by your academic
credentials, 15% by your professional experiences,
and 80 % by your communication skills
Imad Hassan
Good doctors bad doctors
Communication Mastery Plus “What Patients Love
or Hate About Their Doctors

4. Can you recall 6 phases of a communicative act
between a doctor and a patient?

5. Read the given scenario and provide your
answer /opinion

6. A new patient attends for a health check
following registration. You meet him in the
waiting room and walk with him to your room.
How do you start the consultation? What your
posture will be?
Read the given alternatives and choose one/or
choose both and speak about advantages and
disadvantages of both alternatives

7. Alternative one
You; ”Hello Mr, Rogers. Please sit down. I am
Claudia and I am a nurse practitioner, one of
three nurses in the practice”
Patient: “Hello. If you are Claudia, then I am
Sam,

8. Alternative Two:
You: “Good morning, Mr. Jones. Please sit down.
I am Sister Edwards”
Patient: “Good morning Sister”

9. Scenario
You already know that your patient’s name is
Mr. Jenkins; will you call him Mr. Jenkins or Joe?
Do you think patient can have preferences for
the use of a first or last name?

10. • Marilyn Edwards (communication skills for
nurses) states that patients can have true
preferences for the names. This is proved by
the results of the survey which involved 475
patients; a study of patients consulting their
GPs; the results showed that only 77 out of
those 475 patients did not like being called by
their first name, most of who were aged 65
years (MsKinstry), 1990).

11. Some research (Makoul et al, 2007) also
suggests that majority of the patients prefer to
be called by their first names. This makes them
feel more relaxed and put them at easy with the
doctor.

12. We already spoke about the role of greeting
patient for an effective communication. This is
confirmed by Silverman et al (2005), where we
read that below given considerations are the
keys to successful communication between the
doctor and the patient;

13. Greeting the patient
Introducing yourself
Clarifying your role
Obtaining the patient’s name
Demonstrating interest and respect
Attending to the physical comfort of the patient
These aspects are one part of building a rapport

14. Referring to the above given scenarios, we can
rely on the advice of the author of the present
book (Edwards M.) where we read that the
manner of address will vary depending on
various factors:
Age of patient
Knowing the person through school or socially

15. The patient might have been seen every week
for wound management over the past year
How comfortable the nurse feels with the
patient

16. Greeting:
Going back to those scenarios of greeting, it
must be stated that the first greeting is more
informal and will suit some patients, while the
second is slightly more formal. Besides, it is vital
to check the spoken name with the patient
record as it reduces mistaken identity what is
fundamental to patient safety (Makoul et al,
2007).

17. There are proves that most of the patients do
not like to be called by the title Mrs. As it makes
them feel old.

18. Showing an interest in the patient as a person
and not as a condition, and actively using both
verbal ad non-verbal communication skills are
part of the effective rapport building process.

19. Roberston (2008) emphases non-verbal means
of communication that help doctors facilitate
the process of communication:
• An open posture, facing, leaning slightly on to
the patient
• Appropriate body movement and distance
from the patient;
• Appropriate eye contact, being aware of
cultural norms

20. • An open facial expression, appropriately
responsive to the patent’s story;
Marilyn Edwards states that utilization of non-
verbal means needs proper knowledge and
management as, very often, non-verbal
communication skills can have a negative
influence due to misinterpretation as it was in
the James Cook’s case.

21. One key issue of using body language/non-
verbal communication means is that a patient
shall be convinced that a doctor or a nurse is
listening, interested and following what the
patient is saying.

22. Body language can be conscious or unconscious.
Body language is often a subconscious activity
intended to create a balance between inner
feelings and outer space. All aspects of body
language relate to both the patient and the
nurse.

23. The movement of arms and legs
Body posture
The manner of sitting
Regular gestures such as stroking hair or
touching the nose

24. Read the body language good and bad signs
distinguish them from each other
try to elaborate what they mean
Eye contact for some seconds ;
Lounging with arms and legs dangling
Smile with open lips and tilt the head slightly
Firm handshake
Sitting with palms up

25. Eye contact for some seconds ;
Lounging with arms and legs dangling-show that a person
is relaxed
Smile with open lips and tilt the head slightly –shows a
person is attentive
Firm handshake –shows interest and respect
Sitting with palms showing-open posture

26. Read the types of body language and
say what they suggest
Fiddling with hair
Quickened breathing or clenched fists
Sitting on the edge of the chair with legs outstretched
and feet crossed
Hands clasped behind the head
Patient tapping the feet, looking down, having his head in
his hands

27. Negative
Fiddling with hair –insecurity
Quickened breathing or clenched fists –tension
Sitting on the edge of the chair with legs outstretched
and feet crossed –can signal indifference
Hands clasped behind the head-suggests arrogance
Patient tapping the feet, looking down, having his head in
his hands –probably bored

28. Read the given verbal and non-verbal communicative
tools; decide which of them show active or passive
listening:
Tapping pencil
smiling
Darting eyes
‘tell me more”
‘tell me that again”
Nodding
Sighing

29. Tapping pencil =passive listening
smiling –active listening
Darting eyes -passive listening
‘tell me more”-active listening
‘tell me that again” -active listening
Nodding-active listening
Sighing-passive listening

30. Playing with hair
Looking at clock
“what you are saying is…”
Saying “really’
Saying: “Uh huh” a lot

31. Can you think of other signs of active listening?
If good then why?

32. Scenario
Mrs W attends for her routine check of blood pressure.
She is visible upset when the nurse enters the room.
The nurse has 10 minutes for the procedure so begins
to ask other questions to complete the documentation.
She asks Mrs W what has upset her, and learns that her
best friend has been diagnosed with breast cancer.
Continue the scenario. Think and say on behalf of the
nurse …..

33. Read two alternative scenarios for the
development of the communication process and
choose the better option; say why you chose
this

34. The nurse, after having heard about the diagnose
of the patient’s friend, says ‘ I am sorry to hear this;
Then she silently gives her a tissue and directs her
to the chair.
When finished she explains how the treatment will
be carried out for the following days.
Then she says goodbye and sees the patient out of
the room.

35. Second version of the present scenario
….The nurse puts down her pen, puts the tissue
box on the desk and listens while the patient
talks about her feelings. Mrs W shares her
feelings and concerns ; the nurse suggests to sit
down, offers a glass of water and says blood
pressure and documentation can wait until she
is not relaxed and calmed down.

36. Look at the doctors’ positions in the given videos, what do you
think about their posture/ do you feel patients’ are given
freedom to speak out ; what body language signs can you name?
https://www.youtube.com/watch?v=4PoRzH6V9pU
https://www.youtube.com/watch?v=S4wWClQhZaA
&t=383s
https://www.youtube.com/watch?v=gsjKcQUsQY8
(Watching full videos not needed)

37. Asking questions as the crucial element of building a
rapport and collecting the important and useful
information about the patient
What do we know about the techniques of
questioning a patient?
Are their any special considerations related to
professional conduct?

38. There are three types of questions utilized by a
doctor:
Open-ended questions
Closed questions
Focused questions

39. Can you name open and closed questions?
Which types of question are more effective
while interviewing a patient and why?
Is physical examination always followed by up
the verbal consultation or reverse?

40. Read the given scenario and analyze the following points;
Is the given dialogue an example of an effective
doctor-patient interview?
What types of questions does the doctor utilize?
Does the choice of the types of the questions enable doctor to
get the best possible answer from the patient?

41. Nurse: “what can I do for you today?
Patient: “I have tried to diet but need some help’
Nurse: ‘Tell me what you have tried in the past”
Patient: ‘I have tried all the slimming clubs, I lose
weight but then put it back on”

42. Nurse: “would you like me to weight you today,
and we can plan what support I can offer you?”
Patient : “Yes please”

43. Open questions
This type of question allows greater exploration
of an issue, for example:
what brings you here today?
Describe your headache in more details

44. With this types of questions we give prompts to
a patient and make them talk freely an openly
about the case and make them expand the
matter.

45. Negative versus positive sides
Open-ended questions have their role. The take
up more time, however makes a patient think
more about the case so that a doctor
understands more the concern;

46. Closed questions:
Closed questions always require simple yes/no
answer and offers little information.
Examples: do you take your inhale every day?
Does your headache become stronger in the
morning/evening?

47. Close questions are useful particularly when the
time is limited. The se questions allow the
doctor to find out the main concern and explore
one sign further.

48. Can you provide an example of a focused
question?
Read he scenario and try to types of the
questions/focused questions;

49. Nurse: what can I do for you today?
Patient: I have tried to diet but need some help
Nurse: tell me what you’ve tried in the past
Patient: I have tried all the slimming clubs, I lose weight
but then put it back on
Nurse: would you like me to weigh you today, and we can
plan what support I can offer you?

50. Nurse: what can I do for you today?---open
Patient: I have tried to diet but need some help
Nurse: tell me what you’ve tried in the past –
focused question to help elaborate
Patient: I have tried all the slimming clubs, I lose
weight but then put it back on
Nurse: would you like me to weigh you today,
and we can plan what support I can offer you?-
closed

51. Read the given questions and say if they are
useful:
You don’t cough at night, do you?
When did you last have a night cough?

52. These types of questions are called leading
questions which are considered unhelpful and
better avoided.
Leading questions suggest desired answer and
are difficult for the patient to disagree with.
They actually to not allow the patient to think
around the question but just come up with the
answer which can lead to spontaneous decision.

53. There are more types of questions –compound
questions- which are also considered not
appropriate for gaining information from the
patient: do you have any pain, bleeding from your
mouth or any sensation of throwing out?
This type of question is also called as –backtracking,
and is considered useless; it is recommended asking
questions individually which allows the patient to
think about the question properly

54. In order to ensure the effectiveness of the
communication, it is always better to use all
three types of questions: open, close-ended and
focused; the other two types of questions-
leading and compound must be avoided.

55. Reflecting
Reflecting is also considered to be one of the
most effective techniques while interviewing a
patient.
What do you know about reflective skills?
How, do you think, reflective skills are
demonstrated by the doctor/nurse?

56. There are some techniques utilized by the doctor,
which ensure demonstration of reflective skills:
Paraphrasing
Showing empathy
Summarizing
Speak about them; try to elaborate these
techniques and use them in the sentences;

57. Read the short dialogue and try to underline
each technique in the dialogue
Patient: “I know I should stop smoking, what
with my asthma and the kids getting at me, and I
can’t afford it. I have tried to give up before, but
started again when the wife was ill. I really need
to stop”;
Nurse: it sounds like you would like to give up
smoking with some help

58. • Patient: “I do want to stop, but it’s hard with the
worry about job losses.”
• Nurse: “I can understand that you are worried
about your job, I read about it in the paper “
• Patient: “” My breathing’s been bad for the last
two weeks, my inhaler doesn’ t help much. I have
go to do something.’

59. Nurse: It is hard to stop smoking, but it would
help your breathing and we can offer you help
with this.”

60. Check your answers
Patient: “I know I should stop smoking, what
with my asthma and the kids getting at me, and I
can’t afford it. I have tried to give up before, but
started again when the wife was ill. I really need
to stop”;
Nurse: it sounds like you would like to give up
smoking with some help (paraphrasing)

61. • Patient: “I do want to stop, but it’s hard with the
worry about job losses.”
• Nurse: “I can understand that you are worried
about your job, I read about it in the paper “
(empathy)
• Patient: “” My breathing’s been bad for the last
two weeks, my inhaler doesn’ t help much. I have
go to do something.’

62. Nurse: It is hard to stop smoking, but it would
help your breathing and we can offer you help
with this.” (summarizing).

63. Based on practical examples try to elaborate
the definition for each of the techniques given
above:
Paraphrasing: it is the ---------- of ------- in a
slightly different format to ---------- the
information has been correctly ----------. Go over
what the patient had said from ---- to ----- to
check you understand what the patient means.

64. Paraphrasing: it is the repetition of words in a
slightly different format to check the
information has been correctly interpreted. Go
over what the patient had said from time to
time to check you understand what the patient
means.

65. ------------ it is when the patient feels the
doctor/nurse acknowledges the motional
content.

66. Empathy- it is when the patient feels the
doctor/nurse acknowledges the motional
content.

67. Giving Information
What do we know about delivering the
information?
Do you think there are special considerations
while delivering information?

68. • Look at the image;
• What do you think the patient suffers from?

70. Read the dialogue
Check the types of questions the doctor asks
Say if the questions are good technique based
Change the questions to make them more
structured and improved;

71. • Patient: Doctor, I’ve headache since yesterday evening.
• Doctor: Have you taken any medicine so far?
• Patient: Saridon, but the headache hasn’t disappeared.
• Doctor: You’ve a running nose. Looks like your headache is a result of sinus infection, and not
the regular one that results from anxiety and fatigue. Lemme check.
• (The doctor checks the patient thoroughly.)
• Doctor: It’s quite clear that the infection in your sinus is the reason for your headache. I’ll
prescribe an antibiotic to clear the infection and a pain reliever to relieve the pain.
• Patient: Thank you, doctor.

72. Listen to and analyze the dialogue
https://www.eslfast.com/robot/topics/health/h
ealth23.htm

73. Watch the videos again and analyze
effectiveness of the patient questioning
techniques applied by the doctor in each case;

74. https://books.google.ge/books?id=_7jABQAAQBAJ
&pg=PT37&dq=Nurse:+would+you+like+me+to+wei
gh+you+today,+and+we+can+plan+what+support+I
+can+offer+you?&hl=ka&sa=X&ved=2ahUKEwi40O
6AvcTtAhXCqaQKHSwZAukQ6wEwAHoECAMQAQ#v
=onepage&q=Nurse%3A%20would%20you%20like
%20me%20to%20weigh%20you%20today%2C%20a
nd%20we%20can%20plan%20what%20support%20
I%20can%20offer%20you%3F&f=false

75. Preparation for the pair/group presentation
Objective:
To check the students’ understanding of the doctor-
patient communication process with the focus on
rapport building aspects such as: environment,
distance/space between the patient and the doctor,
level of confidentiality, position of the doctor, voice-
speed and tone, other non-verbal signs, proper
time, proper types and number of questions,
demonstration of effective listening (provide prof);

76. Format
7-10 minute Power point presentation including:
General statements on the topic (theory)
Analysis of the video
Partners have to prove their equal contribution

77. Rubrics
Original
1. Knowledge around the topic – 1 point;
2. Review of the available modern material related to the topic -1point;
3. Relevance to the topic of the presentation-1point;
4. Clear, understandable ideas-1 point;
5. Application of the related vocabulary and style-1 point;
6. Correct organization of the structure of the presentation-1point;
7. Visual and technical side of the material-1 points;
8. Culture of arguing and listening -1 point;
9. Correct and balanced application of body language-1 point;
10. Ability to respond to the questions around the task-1 point;
Total-10 points

78. Adjusted to online classes
1. Knowledge around the topic – 2 points;
2. Review of the available modern material related to
the topic -2 points; (references necessary)
3. Relevance to the topic of the presentation-2 point;
4. Clear, understandable ideas-1 point;
5. Correct organization of the structure of the
presentation-1 point;
6. Visual and technical side of the material-1 points;
7. Ability to respond to the questions around the task-1
point;
Total 10 points

80. https://www.youtube.com/watch?v=-1Ba9juSMfM
https://www.youtube.com/watch?v=-
JSxDoNzy0g&t=9s
https://www.youtube.com/watch?v=oHreolyshYY

81. https://books.google.ge/books?id=tbjABQAAQB
AJ&pg=PT4&dq=communication+skills+in+docto
rs&hl=ka&sa=X&ved=2ahUKEwi5kOior7DtAhUL-
aQKHQpTD7o4WhDrATACegQIAhAB#v=onepage
&q=communication%20skills%20in%20doctors&
f=false