Skills in medical communication

DRTVRAO MD 1

DrTVRao MD

SKILLS IN MEDICAL COMMUNICATION

DRTVRAO MD 2

CONSULTATION COMMUNICATIONS SKILLS PROBABLY THE MOST IMPORTANT SKILL IN MEDICINE

HIPPOCRATIC OATH

bull I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone

bull All that come to my knowledge in the exercise of my profession or in the daily commerce with men which ought I not to be spread abroad I will keep secret and will never reveal

bull Practice of ethics reduces litigations it is true

DRTVRAO MD 3

bull Developing strong communication skills is integral to becoming an effective health provider In recent years good doctorndashpatient communication has been linked to improved patient satisfaction better patient care and a decrease in malpractice lawsuits

COMMUNICATION SKILLS IN MEDICAL PRACTICE

DRTVRAO MD 4

bull Knowledge

bull Ability to elicit information from patients

bull Interpersonal skills to respond to patientsrsquo feelings and concerns

WHAT DOCTORS NEED

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bull To diagnose and treat disease

bull To establish and maintain a therapeutic relationship To offer information and educate

COMMUNICATION SKILLS

DRTVRAO MD 6

bull Recognised its importance medical schoolscolleges have strived to teach students not only the science of medicine but also the art of communication Unfortunately creating methods for teaching communication skills that are effective and enjoyed by most students is challenging

CREATING SKILLS IN MEDICAL COMMUNICATION CONTINUES TO BE A CHALLENGE

DRTVRAO MD 7

bull Remember that every patient could be you your mother your brother or your sister How would he or she feel waiting for the doctor to come into the room

RESPECTING PATIENTS A GREAT SKILL

DRTVRAO MD 8

bull Introduce yourself to the patient

Explain your role

bull Shake hands but donrsquot force physical contact if

bull patient is uncomfortable Call the adult patient Mr Mrs or Ms (do not use first name ) Maintain privacy

bull Keep doors and curtains closed

bull Acknowledge and greet others in the room

RESPECTING PATIENTS MAKES YOUR JOB EASY

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Maintain a professional appearance

Clean neat ldquoconservativerdquo See dress code in syllabus Goal is to inspire confidence

YOUR APPEARANCE INCREASES CONFIDENCE

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bull Make sure the patients comfortable

bull Sit at the patientrsquos level Be aware of the patientrsquos personal space (can vary among cultures) Continue to consider the patientrsquos comfort during the history and physical

MAKE YOUR PATIENTS COMFORTABLE

DRTVRAO MD 11

CONSULTATION SKILLS THE MOST IMPORTANT SKILL IN MEDICINE

bull To get the most out of the consultation for the patient foremost and for the doctor

bull To plan the consultation using a frameworkbull To adapt your style of consulting to meet the needs of the

patient bull To handle difficult situationsbull To have ldquorescuerdquo plans when things go wrongbull To use time efficiently in the consultationbull To be able to assess and improve the consultation

DRTVRAO MD 12

bull In order to deliver effective healthcare doctors are expected to communicate competently both orally and in writing with a range of professionals managers patients families and carers

COMMUNICATION SKILLS PART OF YOUR MANAGEMENT

DRTVRAO MD 13

COMMUNICATION IS THE MAJOR PART OF MEDICINE

bull Good communication skills are integral to medical and other healthcare practice

bull Communication is important not only to professional-patient interaction but also within the healthcare team The benefits of effective communication include good working relationships and increased patient satisfaction Effective communication may increase patient understanding of treatment improve compliance and in some cases lead to improved health

DRTVRAO MD 14

Task Orientated

Behaviour Orientated

Doctor centred Patient centred

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COMMUNICATION SKILLSSOME TECHNIQUES

bull Developed fluent dialogue with patient

bull Used silence effectively allowing patient enough time to express thoughts or feelings

bull Actively encouraged patient through use of supportive words or comments

bull Dialogue with patient was enhanced by effective use of non-verbal behaviour

bull Used open exploratory questions ndash inviting patient to become actively involved

bull Adjusted language as appropriate to suit particular needs of the situation

DRTVRAO MD 16

bull Some people think only intellect counts knowing how to solve problems knowing how to get by knowing how to identify an advantage and seize it But the functions of intellect are insufficient without courage love friendship compassion and empathy

KNOWLEDGE CAN UNDERSTAND A PROBLEM BUT CANNOT SOLVE WITHOUT EMPATHY

DRTVRAO MD 17

bull Empathy ldquoThe ability to understand and share the feelings of anotherrdquo from Greek empatheia (from em- lsquoinrsquo + pathos lsquofeelingrsquo) This sums up what empathy is I am here with you I give you hope and accompany in your feeling

MOST IMPORTANT DEMAND FROM PATIENTS

EMPATHY

DRTVRAO MD 18

bull Is the ability to understand the patientrsquos experiences and feelings accurately as well as to demonstrate that understanding to the patient 1048700 Is an active process 1048700 Is more than sympathy or feeling sorry for someone

PRACTICE LITTLE EMPATHY JUST NOT SYMPATHY

DRTVRAO MD 19

bull Empathy requires listening Remain quiet and let the patient talk

bull Silence can be helpful dont be afraid of it Use open ended questions Use ldquocontinuersrdquo and echoing

START PRACTICING EMPATHY

DRTVRAO MD 20

PATIENTOLOGISTbull Patientologists They are empathetic and understand

what the patients fears and worries are so that they can help them to manage them

bull How does a doctor become a good patientologist Unfortunately these skills are never taught formally in medical college Some doctors have a great bedside manner because they have a high EQ ( emotional quotient) Others learn how to improve their patient skills by emulating their teachers who are good clinicians

DRTVRAO MD 21

bull Enhance empathy by the way you respond to what the patient says 1048700 Show the patient you have been listening to the content of their problem Show the patient you understand their perspective on the problem

DO YOU KNOW MANY PATIENTS COMPLAIN DOCTORS ARE NOT LISTENING

JUST START INVESTIGATING

DRTVRAO MD 22

bull Education providers need to ensure that appropriate and effective training opportunities are available to doctors to develop and refine such skills in order to facilitate interaction with patients and others

PROVIDING OPPORTUNITIES FOR BETTER COMMUNICATION

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YOUR FIRST TASK TO GET HISTORY NEEDS EFFECTIVE COMMUNICATION

bull In all doctor-patient interactions a variety of communication skills will be required for different phases of the consultation During the start of a consultation doctors must establish a rapport and identify the reasons for the consultation They must go on to gather information structure the consultation build on the relationship and provide appropriate information

24

STUDENTS SHOULD BE TRAINED IN DEALING WITH

bull Students must have opportunities to practise communicating in different ways including spoken written and electronic methods There should also be guidance about how to cope in difficult circumstances Some examples are listed below a breaking bad news

bull b dealing with difficult and violent patientsbull c communicating with people with mental illness including cases where

patients have special difficulties in sharing how they feel and think with doctors

bull d communicating with and treating patients with severe mental or

bull physical disabilities

bull e helping vulnerable patients

DRTVRAO MD 25

TODAYrsquoS DOCTORS DEPENDENT ON PATIENT SATISFACTION helliphelliphellip

bull The doctor-patient relationship is improved The doctor is better able to seek the relevant information and recognise the problems of the patient by way of interaction and attentive listening As a result the patientrsquos problems may be identified more accurately

bull bull Good communication helps the patient to recall information and comply with treatment instructions thereby improving patient satisfaction

bull bull Good communication may improve patient health and outcomes Better communication and dialogue by means of reiteration and repetition between doctor and patient has a beneficial effect in terms of promoting better emotional health resolution of symptoms and pain control

DRTVRAO MD 26

bull The overall quality of care may be improved by ensuring that patientsrsquo views and wishes are taken into account as a mutual process in decision making

bull Good communication is likely to reduce the incidence of clinical errors

CLINICAL ERRORS ARE COSTLY COMMUNICATION REDUCES

DRTVRAO MD 27

EFFECTIVE COMMUNICATION BENEFITS DOCTORS AND REDUCES LITIGATIONS

bull Effective communication skills may relieve doctors of some of the pressures of dealing with the difficult situations encountered in this emotionally demanding profession Problematic communication with patients is thought to contribute to emotional burn-out and low personal accomplishment in doctors as well as high psychological morbidity Being able to communicate competently may also enhance job satisfaction

bull Patients are less likely to complain if doctors communicate well There is therefore a reduced likelihood of doctors being sued

DRTVRAO MD 28

bull Good communication within the healthcare team is essential in order to ensure continuity of care and effective treatment for patients Moreover poor communication between professional staff has been identified as an underlying factor for failed communication with patients For example a patient may be given different information regarding their condition by different members of the healthcare team

ALL MEDICAL AND PARAMEDICAL STAFF ARE IN COMMUNICATING THE FACTS TO PATIENTS

DRTVRAO MD 29

bull To diagnosis and treat disease and maintain a therapeutic relationship Data from the patient must be objective precise and reliable You must demonstrate respect genuineness and empathy These skills can be learned with practice

TO BE A BETTER PRACTITIONER PRACTICE GOOD COMMUNICATION

DRTVRAO MD 30

bull Communication skills are now regarded as a core competence Assessment of communication skills will be necessary as part of the doctors appraisal and personal development plans In addition revalidation will also take communication skills into account

COMMUNICATION SKILLS TO BE INCLUDED IN STUDENT APPRAISAL

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WHAT OUR MEDICAL STUDENTS NEED

bull Medical schools Colleges must be encouraged to provide the best possible communication skills training as part of the core undergraduate curriculum This training should have set objectives and clear methods of assessment

bull More communication skills training programmes should be developed at postgraduate level Doctors could use the appraisal process as a vehicle for discussing the success of communication skills training

DRTVRAO MD 32

bull To Err is Human Building a Safer Health Systemrdquo suggested that close to 90 of medical errors are a result of failed systems and procedures The Joint Commission which accredits and certifies more than 15000 health care organizations and programs in the United States cites team training as an essential factor in reducing risk of medical errors

bull Communication skills too are very Important

bull Professional coordination is basis of success

THE INSTITUTE OF MEDICINErsquoS 2000 REPORT

DRTVRAO MD 33

bull Programme Created by DrTVRao MD for Medical and Health Care Workers in the

Developing Worldbull Email

bull doctortvraogmailcom