BASIC CONCEPTS OF MEDICAL COMMUNICATION

PUTU SUTISNA

Lectures main objectives: To describe the importance of good communication with patients To describe the factors that may influence the outcome of communication between the doctor and patient To explain the technique of conducting effective communication with patients that involves questioning, listening and facilitating

 Communication imparting, conveying or exchanging of ideas, news, knowledge etc.

Several methods of communication: Two friends talking Radio/ TV Newspaper/book Wrting a letter Telephoning/fax Teaching/lecturing Doctor or nurse with patient

Purposes of Communication are to:

form & maintain relationship give information convey feelings persuade solve problems alleviate distress make decisions give reassurance

Aim of a physician (since ancient time):

To cure sometimes, relieve often, comfort always

Communication in Medicine
Doctor patient/family Doctor doctor Doctor community

Main areas covered in Block MC

1. A.Taking medical history and review of body systems B. Giving information to patient C. Special approach to specific patient/situation 2. Paper presentation and discussion 3. Writing medical letters & notes, and CV 4. Scientific writing (5. Health education & health promotion for community at large)

Good communication skills can be learned. Prerequisites: Written instructions (references) Opportunities to practice Feedbacks (SGD) Discussion on performance (SGD)

Doctor-Patient Communication
Influencing Factors
Patient-related factors - Physical symptoms - Pathological factors related to illness - Previous experience of medical care - Current experience of med care

 Doctor-related factors -Training in communication skills - Self-confidence in ability to communicate - Personality - Physical factors (e.g. tiredness) - Psychological factors (e.g. anxiety)

 Interview setting requirements - Privacy - Comfortable surroundings - Appropriate seating arrangement

Guidelines for conducting interview with patient

A. Beginning 1. Greet patient by name, shake hand (?) 2. Ask patient to sit down 3. Introduce yourself 4. Explain purpose of interview 5. Say how much time available 6. Explain need to take notes

B. Main part of interview 1. Maintain +ve atmosphere, warm manner, eye contact 2. Use open questions, esp at beginning 3. Listen carefully 4. Be alert and responsive to verbal & non verbal cues 5. Facilitate patient verbally & non-verbally 6. Use closed questions when appropriate

7. Clarify what patient has told you 8. Encourage patient to be relevant C. Ending 1. Summarize what patient has told you 2. Ask if patient wants to add anything 3. Thank patient

 Key skills for communicating effectively with patient Questioning Listening Facilitating

1. Questioning
Main purpose of interviewing patient: to obtain information about patients condition accurate, complete and relevant Good communication with patient alone contributes to correct diagnosis in 80% of cases

 Open questions
should be used as much as possible to obtain great deal of information from patient Would you please tell me how you have been feeling in the past few days? I understand that you have had pain. Would you please tell me more about it? Can you tell me what brings it on?etc

 Closed questions
Give patient little choice in the way to answer Usually elicits little information, only yes or no. Have you been feeling unwell today? I see from your GPs notes that you have had chest pain. Do you still have the pain? Was it tight or dull pain? Did it go down your arm? Did it get worse when you exercised?

Advantages of open questions More relevant information in given time Patient feels more involved Patient can express all concerns and anxieties about problems When to use close questions? To obtain specific information not yet given by patient In emergency cases

2. Listening
Features of active and effective listening: Gathering and retaining information accurately Understanding implications for patient of what is being said Responding verbal & non-verbal signals or cues Demonstrating you are paying attention and trying to understand

Non-verbal cues: Eye contact Posture Gestures Facial expressions Way voice is used

3. Facilitating
Related with effective listening. Aim to help patient to talk fully about problems. Verbal way Please go on and tell me more about your pain. Yes, I understandplease continue. Non verbal ways: Leaning slightly forward toward patient Making eye contact Nodding head at appropriate time

Communication with Family

How family can help?
Provide emotional & social support Provide practical support Provide understanding of beliefs about illness & treatment

 Provide information about family history Help avoid/overcome bad patient compliance Overcome difficulties arising from secrets Anticipate/address problems that may affect other family members

NOS
Too many or complicated questions Not allowing patients to tell story in their own words Unnecessary interruption Failing to pick up verbal & non-verbal cues

Patients respect doctors who are warm and sympathetic are easy to talk to introduced themselves appear self-confident listen to the patients and respond to their verbal cues ask easy-to-understand questions

Summary The ability to communicate effectively and

sensitively is essential in medicine Communicating effectively with patients involves the core skills of questioning, listening and facilitating Good communication leads to: accurate history taking and diagnosis, patients compliance with treatment plan, patients satisfaction with the care given The skills of good communication can be learnt and retained

THANK YOU