COUNSELLING OF

PATIENT
Amir Masaud Pirzada
ENT & HNS SZABMU PIMS
Supervisor Prof Anjum Khawar
Objectives
• Definition
• Communication
• Providing all the required information
• To avoid unwanted events
Definition of Counselling
• Patient counseling is a broad term
which describes the process through
which health care professionals attempt
to increase patient knowledge of health
care issues.
Cont..
• Patient counseling
• verbal or written
performed on an individual basis or in groups, & provide
directly to the patient or caregiver.
Importance of Counselling
• RECOGNITION about their well being.

• ENCOURAGES the patient to establish a working

relationship with doctor.

• MOTIVATES the patient to take medicine for

improvement of his/her health status.
Patient counseling methods:

A. Introduction of the session.

B. Content of the session.

C. Conclusion of the session

 INTRODUCTION
• Review the patient record.

• Introduce yourself

• Explain the purpose of counselling session.

• Obtain information about initial treatment.

• Always Always provide friendly enviornment.

Contents of Counselling
• Name and indication of the drug/surgery.
• Dosage regimen
• Duration of therapy.
• Assist the patient.
• Duration of action of drug.
• Emphasize the benefits of completion.
• Potential side effect of drugs.
• Outcomes of Procedure.
Counselling process items:
• Provide accurate information.

• Use language that the patient is likely to understand.

• Use the appropriate counselling aids to support counselling.

• Present the fact and order in a logical order.

• Maintain control & direction of the counseling session.

• Probes for additional information.

• Use open‐ended question.

• Display effective non‐verbal behaviours.

Counseling conclusion steps:
• Verify the patient understanding via feedback.

• Summaries by acknowledging or emphasizing key

points of information.

• Provide an opportunity for final concerns or

questions.

• Help the patient to plan, follow up and next

consecutive steps.
• For better counselling and to achieve desired results,
it is important to have;

Good
communication Skills.
Communication
• is the transfer of information meaningful
to those involved.
Primary functions

1. It establishes an ongoing relationship between the

Doctor and the patient.

2. It provides the exchange of information necessary to

assess a patient’s health condition, implement
treatment of medical problems, and evaluate the effects
of treatment on a patient’s quality of life.
Questions in mind of Patient

• They have unanswered questions

• They have misunderstandings
• They experience problems to therapy
• They can “monitor” their own responses to treatment
• They make their own decisions regarding therapy
• They may not reveal information to you unless you initiate
a dialogue
The healthcare professional must be
able to
• Understand the illness experience of the patient
• Perceive each patient’s experience as unique
• Good relationship with patients
• Build a therapeutic alliance with patients to meet mutually
understood goals of therapy
• Develop self-awareness of personal effects on patients
Key elements of Interactive
communication:
• Open‐ended questions

• Awareness of nonverbal cues

• Active listening

• Reflective responses

• Verification of understanding.
 Open‐ended questions
• A key component of interactive communication is
using open‐ended questions.

• Open‐ended questions are questions that start with

who, what, where, when, how and why and require
more than a yes/no response. These questions
encourage disclosure of information.

• Closed‐ended questions and leading/restrictive

questions elicit yes/no responses and limit the
information sought from the receiver. These types of
questions should be avoided.
 Nonverbal cues
• Appropriate nonverbal cues are also critical for
effective communication.

• Facial expressions, body posture, gestures, tone of

voice and use of eye contact are all forms of
nonverbal communication.

• People tend to believe the nonverbal message.1

1. Harvey M. Rappaport et al. The Guidebook for Patient Counselling. Lancaster, Pennsylvania:
Technomic
Publishing Company, 1994
 • Friendly and smiling facial expressions.

• Varied eye contact(consistent, but not startling.)

• Professional appearance.

• Relaxed, warm and comfortable gestures.

• Attentive body posture(slightly leaning forward)

• Appropriate personal space(18‐48 inches).2

• Varied voice rate and volume to keep the individual

interested. However, a high pitched voice should be
avoided.
2. Tindall, William N, Robert S. Beardsley, Carole L. Kimberlin.
Communication Skills in Pharmacy Practice
(fourth edition). Baltimore, Maryland and Philadelphia, Pennsylvania :
Lippincott Williams & Wilkins, 2003
Distracting non-verbal clues
• Lack of eye contact may indicate little confidence or
interest.

• Any gesture which can produce disturbance

• Unfavorable tone of voice

• Slouching or weight shifted to one side(may indicate

lack of interest)

• Messy work environment

Active listening
• When we think of communication skills, we usually
think of skills relating to the manner in which we
speak. Equally important, and perhaps more difficult
to learn, is the ability to listen well.
How to be an Active Listener
• One time one Task, don’t be distracted.

• Don’t jump to conclusion before discussing all pros

and cons of treatment plan.

• Communicating stereotypes that you have

internalized. (Solution is react to information, not the
person).

• Faking interest in what is being discussed. (Solution

Use good eye contact, this will help you concentrate)
• Judging the individual based upon his or her
appearance or condition. (Solution Focus on content,
nonverbal cues and the manner in which something is
said).
Active feed back.

• I see…

• No, I don’t feel that way, but tell me why you do…

• Yes, that’s how I’ve found it to be...

Reflective responses
• Reflective responses reflect back to the sender the
receiver's understanding of both the content of what
was said and the feelings that were expressed.

• A major advantage of these responses is that they

allow an individual to be empathic without having to
agree.
 Verification of understanding
• Verifying understanding prevents misunderstandings.
It is an important skill in the communication process
because it is a checkpoint for communication.

• This process involves asking the receiver to state

back the message that was sent by the sender and
enables confirmation of what a person knows ... not
what we think they know.

• E.g "Just to make sure I've discussed everything, can

you tell me how you are going to take your
medication?"
Breaking Bad News
• The aim for any health-professional is to use their
skills to deliver bad news clearly, honestly and
sensitively in order that patients can both understand
and feel supported.
• SPIKES - The Six-Step Protocol for Delivering Bad
News

• STEP 1: SETTING UP the Interview

• STEP 2: Assessing the Patient’s PERCEPTION
• STEP 3: Obtaining the Patient’s INVITATION
• STEP 4: Giving KNOWLEDGE and Information to the
Patient
• STEP 5: Addressing the Patient’s EMOTIONS with
empathic responses
• STEP 6: Strategy and Summary
Concluding Points
• Know the purpose of counselling
• Know the record of patient
• Good background knowledge
• Good communication skills
• Be empathic
• Be logical