Interpersonal Skills in Medicine

Interpersonal Skills & Doctor-Patient Relationship

• Communication errors in medicine are a major factor in preventable hospital deaths, contributing to 60-70% of such cases.
• A quote by Albert Einstein highlights the danger of technology surpassing human interaction.
• Effective communication is crucial in the medical field, as it greatly influences patient care and outcomes.
• Objectives for a session include explaining basic communication skills, discussing the role of doctor-patient relationships, and emphasizing communication with special groups (mentally ill, children, elderly, those with hearing/visual impairments).
• Other objectives include discussing the stages of grief and how to effectively deliver bad news.
• There is an assignment to reflect on personal interpersonal skills with friends and family, and ways to improve them.

Definition

• Communication is defined as the imparting or exchanging of information through speaking, writing, or other mediums.

Communication Model

• Communication involves a sender, a message (including both verbal and nonverbal elements), a context (stimuli), and a receiver.
• The sender (encoder) considers the process, what to say, when and why, whom, where and how. The receiver (decoder) will take the meaning out and plan a response.

Types of Communication

• Communication can be verbal, nonverbal, or written.

Importance of Communication Components

• Nonverbal communication makes up 55% of the message.
• Verbal content only makes up 7% of communication impact.
• Vocal elements (pitch, rate, tone, volume, rhythm) contribute 38% to the overall conveyed meaning.

Characteristics of Effective Communicators

• Effective verbal communicators clarify, listen empathetically, acknowledge, encourage, and restate/repeat information.
• Effective nonverbal communicators are relaxed, open, and attentive towards the patient; maintain eye contact and appropriate facial expressions.

Types of Communication (Verbal vs. Nonverbal)

• Verbal communication is symbol-based and largely learned, with more conscious control.
• Nonverbal communication is gesture-based and largely innate, with partial control.

Active Listening

• Active listening involves specific strategies such as proper seating and body language, attentiveness, careful listening, and asking clarifying questions and responding to answers.
• Examples include maintaining appropriate eye contact and using appropriate facial expressions.

Nonverbal Communication (Body Language)

• Facial expressions are the most expressive body language component.
• Maintaining eye contact shows engagement and attention.
• Open posture (relaxed arms/chest, facing the patient, leaning forward) conveys receptiveness, friendliness, and interest.
• Closed posture (rigid arms/chest, leaning back, avoiding eye contact) can convey anger or disinterest.

Empathy

• Empathy is the ability to understand and share the feelings of another person.
• Key components of empathy include cognitive (understanding the thoughts and feelings of others), emotional (experiencing feelings similar to the other), and compassionate (caring and wanting to help).
• The process of empathy involves truly listening to and understanding another person’s emotions.

Negative Verbal Communication

• Negative verbal communication examples: ignoring others, avoiding eye contact, interrupting, rushing through explanations, impersonal treatment, making others feel rushed, forgetting common courtesies, and showing boredom, stereotypes, judging, defensive challenging, and rejecting.

Doctor-Patient Relationship

• Fundamental elements of the relationship include the patient's right to information, the ability to make decisions, respectful treatment, and responsiveness and timely attention, confidentiality, continuous care, and appropriate health care access.

Patient Information Needs

• Essential questions patients might ask in regards to their care include their diagnosis, the risk of spreading illness to others, available treatments, the safety of treatments, alternative treatments, the length to recovery, any treatment restrictions, or abstinence recommendations.

Steps to Provide Information

• First, assess patient knowledge and expectations.
• Next, give evidence-based information, include both positive and negative impacts of treatment, and avoid giving false hopes.
• Include discussing the prognosis of the disease/condition appropriately.
• Summarize provided information and check for comprehension.

Stages of Grief

• Grief stages, developed by Elisabeth Kübler-Ross and refined by David Kessler, include denial (initial shock, making sense of the situation, a way to cope with loss), anger (valid emotion during grieving process, potentially towards others, God, loved one), bargaining (desperate effort to make things right to avoid pain), depression (deep sorrow, withdraws, wondering about future), and acceptance (recognizing physical loss and adjusting to a new reality, adjusting to loss and starting a new chapter).

Breaking Bad News

• Considerations for breaking bad news include choosing the appropriate person to deliver the news (a senior member fully trained in delivering difficult news), ensuring the news is timely and delivered with consideration for the patient and/or their family, being honest, being warm, being aware of religious or cultural values, and employing basic counseling skills.
• Further instructions on communicating news appropriately include softening the bad news with good news, including patient feelings, avoiding technical jargon, not trying to give an exact diagnosis, arranging next appointment within 24-48 hours, continuing dialogue, instilling hope for a meaningful life, and creating a supportive environment for exploring meaning.

Biopsychosocial Model

• Addressing all aspects of informational care and effective communication and counseling.

Discussing Communication with Special Groups

• Special groups to consider during communication include mentally ill, difficult children, elderly, those hard of hearing, and silent patients.

Specific Steps

• Step 1: Setting: exclusivity, involvement, seating arrangement, attentiveness, composure, and availability
• Step 2: Perception: getting a sense of patient understanding of his/her condition prior to providing a diagnosis
• Step 3: Invitation: respecting the patient wishes to be told or not told about their diagnoses or treatment
• Step 4: Knowledge: using simple language to clarify condition and prognosis and address patient concerns/questions
• Step 5: Empathy: active listening and acknowledging patient feelings
• Step 6: Summarize: reflecting and confirming what was discussed and acknowledging patients feelings and concerns through questions and answers.
• Step 7: Plan for Action: developing and following a plan that will further move the situation forward.

Additional Considerations

• Doctors should be honest, warm, respectful of religious/cultural values, and skilled in counseling.
• Encourage patients, recognize and acknowledge patient concerns and feelings, and use clear, simple language.
• Provide a plan for next steps concerning treatment, while also considering the need for follow-up care with another patient with similar condition and/or written information.

This quiz explores the importance of effective communication in the doctor-patient relationship and how it impacts patient care. It covers basic communication skills, the stages of grief, and strategies for delivering bad news, aimed at improving interpersonal skills. Reflect on your own communication abilities and discover ways to enhance them in personal interactions.