Patient Communication in Healthcare

Introduction to Clinical Communication & IM

• This presentation covers patient-centered consultation and care.
• It's part of a larger curriculum (VM 2.6).
• Presented by Dr. Maie Hilmy (Psychiatry) and Dr. Salwa Ismail (Dermatology).

Intended Learning Outcomes

• Define clinical communication skills, the medical consultation, person-centered care, patient-centered care, and holistic care.
• Describe the features of a patient-centered consultation, person-centered care, patient-centered care, and holistic care.
• Understand patient perspectives.
• Explain the importance of person-centered care and its impact on the quality of care.
• Identify key communication skills that facilitate patient-centered consultation.

Communication

• Communication involves imparting or exchanging information through speech, writing, or other methods.
• It also includes successfully conveying or sharing ideas and feelings.

Consultation

• A consultation is the act of discussing something with someone before making a decision about it.
• It also involves meeting with an expert (like a doctor) for advice or treatment.

Who is the Expert?

• Doctor: Expertise in history-taking, clinical reasoning, management, and identifying/treating problems.
• Patient: Expertise in their own health, needs, and capabilities.

The Patient's Perspective

• Pre-formed thoughts/beliefs/worries
• Explanatory models of illness (cause, disease process, course, symptoms, effects of illness)
• Patient desires/values
• Socioeconomic condition
• Family situation/lifestyle

The Doctor's Perspective

• Information about the causes of problems (disease model)
• Structure of healthcare systems
• Professional regulation

The Doctor-Patient Partnership

• Listen to patients
• Ask for and respect their views about health.
• Respond to their concerns and preferences.
• Be honest and merciful with patients.

Tasks in the Consultation

• Define reasons for patient attendance.
• Consider other problems.
• Choose the appropriate action for each problem with the patient.
• Achieve shared understanding of the problem with the patient.
• Involve the patient in management and encourage them to accept responsibility.
• Use time and resources appropriately.
• Establish or maintain rapport.

What do Patients Want?

• Patients want empathy, congruence, and unconditional positive regard.
• Patients want to be greeted and treated with respect, have their ideas about their health considered, have their concerns understood, and be attended to by the healthcare professional
• Patients want to be spoken to in terms they can understand.
• They expect to have a chance to be involved in their care and decisions.
• They want to understand the treatment plan and related information.
• They want the healthcare professional to show care and concern and to spend the appropriate amount of time with them.

What is 'Clinical Communication'?

• A comprehensive framework for healthcare communication that considers diverse patient needs.

Communication Process

• Listening
• Collecting data
• Interpreting
• Focusing

Content, Tone of Voice, Body Language

• Tone of voice accounts for 38% of communication, while body language is 55%.

Poor Communication

• Leads to inaccurate patient medication history taking.
• Results in inappropriate therapeutic decisions.
• Contributes to patient confusion and disinterest.
• Causes noncompliance.
• Can cause harm if information isn't exchanged appropriately.

Patient Behavior

• Patients may not ask questions in a consultation.
• They may accept statements without discussion.
• They may understand the plan later.

Patient-Centered Care

• A philosophy that prioritizes shared decision-making.
• Focuses on the whole patient, considering social contexts and individual preferences instead of only the disease or body part.

Patient-Centered Communication

• Aims to provide care that aligns with patient values, needs, and preferences.
• Encourages patient input and participation in healthcare decisions.

Person-Centered Care

• Considers the patient as a whole (physically, psychologically, socially, and spiritually).
• Integrates patient needs and preferences into care planning and delivery.

Aspects of Person-Centered Care

• Respecting patient values and beliefs.
• Ensuring continuity between and within services.
• Coordinating and integrating care efforts.
• Offering emotional support.
• Involving family members and friends.

Person-Centered Care Priorities

• Helping patients meet their needs when needed.
• Enabling patients to actively look after themselves.
• Reducing the burden on healthcare services.

Practicing with Patients

• Listening to the patient's narrative, understanding their experience and priorities, and how health & healthcare features in their lives.
• Understanding what the patient wants, and what influences their choices.

What to practice:

• Creating a welcoming and comfortable environment.
• Encouraging patient to feel welcome and comfortable.
• Implementing warm rooms, sense of privacy to minimize distractions.
• Conducting a proper introduction, maintaining good eye contact and ensuring the sitting level is similar and arranging the furniture appropriately.
• Providing a chaperone when needed.
• Exploring patient perspective by using body language and effective communication to develop a warm supportive atmosphere.
• Considering open questions as appropriate.
• Reflecting back and acknowledging the patient's responses.

Working towards...

• Professional and sensitive communication with patients, relatives, and colleagues.
• Maintaining good working relationships.
• Conduct effective consultations and gather information.
• Adapt communication style to fit patient needs.
• Demonstrate effective information sharing and responding to difficult situations (e.g., breaking bad news).
• Reflect on consultations and identify areas for improvement.

Your Structured Guide to Interviewing Patients

• This detailed guide outlines the process of interviewing patients, including preparation, initiating the consultation, gathering information, explanation, planning, and closing the consultation.

Holistic Care

• Comprehensive treatment of the entire person (physically, psychologically, socially, and spiritually) for holistic healthcare.
• This includes emotional, psychological, social, spiritual and physical aspects.

Communication Skills

• The ability to communicate clearly and effectively with patients, families, physicians, nurses, pharmacists, and other healthcare professionals.

Communication Skills Components

• Verbal communication
• Written communication
• Active listening
• Observation & assessment

Active Listening

• Emphasize face-to-face communication.
• Focus on the patient, creating a calm, unhurried, open environment.
• Set aside distractions and prevent interruptions.

Observation & Assessment

• Use effective two-way communication.
• Observe body language and gestures.
• Maintain eye contact appropriately.
• Use focused body posture.
• Be physically close for clear communication.
• Avoid being too close to avoid feeling intrusive.

Physical Barriers in Communication

• Large countertops.
• Windows with security bars and protective glass.
• Elevated work areas.
• Patients in beds feeling intimidated by those who are standing above them.

Lack of Privacy

• Avoid discussing patient data or healthcare issues in public areas (hallways, elevators, etc.).
• Do not discuss patient information with family members or friends.
• Use private areas for conversations with patients and other professionals (e.g., counseling rooms).
• Close the room door or curtains appropriately.

Phone Calls

• Identify yourself and the call's purpose clearly.
• Be prepared to repeat requests to connect with the correct person.
• Be patient and accept waiting time.
• Speak clearly.
• Listen carefully.
• Be organized and state facts calmly.
• (When answering) Identify yourself and ask for caller's identity.
• Deal with the call efficiently.
• Avoid placing the caller on hold.
• When possible arrange a call back if too busy.
• When receiving calls from upset individuals stay calm, listen, clarify the issue and handle problems as appropriately as possible.

Written Communication

• Patient Medical Record (PMR) is a primary tool for written communication.
• Healthcare professionals must accurately document patient information. Documentation must adhere to legal, ethical, and professional standards.
• Use black ink for writing notes.

Written Communication Guidelines

• Handwriting must be clear and legible.
• Incorrect information should be crossed out with a line and initialed.
• Notes should include the heading, date, time, and patient data/signature and healthcare professional's title.

Communication with patients

• Use patient titles correctly.
• Avoid making assumptions (married or single).
• Ask patients how they would like to be addressed.

Respect for the Patient

• Respond to patients as individuals.
• Avoid sharing personal information.
• Ensure sufficient interaction time & minimize interruptions
• Introduce yourself, provide context for the purpose of the interaction.
• Explain who will be reviewing the information obtained.
• Maintain a clean, neat, and organized environment.
• Appropriate note taking should not disturb the interaction.

Questioning Technique

• Clinicians should control conversations.
• Limit question types and response times for an interactive experience.
• Avoid a rapid sequence of yes/no questions.
• At the beginning of the consultation ask open-ended questions.
• Use minimal facilitators to encourage open communication
• Provide non-verbal cues like smiling/nodding.

Avoid Medical Jargon

• Translate medical terminology for patients.
• Speak clearly.

Special Situations

• Specific guidance for patient groups: embarrassing situations, mute patients, pediatric patients, elderly patients, physically challenged patients, mentally impaired patients, hearing impaired patients, chronically ill patients, hard-to-reach patients (low socioeconomic status, minorities, and illiterate), and antagonistic patients.

Tips for Effective Communication in a Dental Office

• Appointment confirmation should be clear
• Greet patients by name and maintain good eye contact.
• Ensure patients are correctly escorted to their appointments in a professional manner.
• Use medical records during consultation correctly and discuss any treatment options comprehensively.

This quiz assesses your understanding of effective communication strategies between healthcare providers and patients. It covers key characteristics of patient-centered care, the importance of non-verbal communication, and best practices for consultations. Test your knowledge on how to empower patients and improve health outcomes through effective dialogue.