Communication Skills PDF

1. Principles of Communication Definition of communication: It is the successful transfer of a message and meaning from one person or group to another. It involves both parties. Rapport with the patient: Effective communication skills that provide successful patient care and good doctor pa...

1. Principles of Communication Definition of communication: It is the successful transfer of a message and meaning from one person or group to another. It involves both parties. Rapport with the patient: Effective communication skills that provide successful patient care and good doctor patient relationship. It is most easily established during the patient's first visit and enhances the likelihood that the patient will comply with the treatment plan. Steps of communication: a) The sender has an idea to communicate. b) The sender encodes the idea in a message (words, body movements, or facial expressions). c) The message travels over a Channel (Medium, by which the sender sends the message) d) The receiver decodes the message (Translate the original Message) e) The receiver sends feedback to the sender. Obstacles to successful communication (Noise): a) Obstacles to the Sender: Lack of knowledge about the massage, negativity towards the receiver, or improper choice of words b) Obstacles to the Message: Badly expressed message, words with different meaning, or body language and gesture decoding. c) Obstacles to the Channel: The length of communication, background noise, or overcrowded space. d) Obstacles to the Receiver: The intelligence and education level, lack of interest and difference in perception, or poor listening. e) Obstacles to the Feedback: Unclear priorities, neglected feedback culture, or not enough participation. Barriers to communication: 1. Physical 2. Attitude 3. Emotional 4. Cultural 5. Language 6. Gender 7. Psychological 8. Perceptual 9. Lack of focus 10. Feedback and eye contact issues Principles of communication: a) Conciseness: The briefness of the message. b) Clarity: Focus on the core points of your message. c) Correctness: The accuracy of thoughts, figures, and words. d) Concreteness: It is about being specific and definite rather than general. e) Completeness: Giving the recipient all the information they need. f) Courteousness: Being polite, friendly, professional, open and honest. g) Coherence: Make sure your message flows well and is laid out logically.  2. Non-Verbal Communication in Healthcare Definition: all forms of communication that do not involve words. It is the prevalent form of communication: 70% is nonverbal, 23% involves tone, and only 7% is through spoken words. NVC Importance in Medicine: Building Rapport with Patients, Demonstrating Empathy, Cultural Sensitivity, Assessing Patient Emotions, Improving Clinical Outcomes. Key Non-Verbal Skills for Medical Students: a) Eye contact: Maintain eye contact without staring. The right balance depends on cultural context and the individual patient's comfort level. b) Body Language Awareness: Adopt an open posture (its opposite is closed), facing the patient with uncrossed arms. Lean slightly forward to show interest and engagement. Nod or use small gestures to show you’re following the conversation. Avoid distractions. c) Facial Expressions: Match your facial expression to the situation. d) Tone and Pitch of Voice: Speak in a calm, reassuring tone. Match your vocal tone to the emotional context—use a softer voice when discussing sensitive or difficult topics. e) Touch: Use touch appropriately. Be mindful of cultural and personal boundaries. f) Proxemics: Maintain a comfortable distance. (not too close or far). Interpreting and Validating Nonverbal Behavior: a) Observation: for clues about emotional states. b) Avoid Assumptions c) Cultural Sensitivity: Nonverbal cues may vary across cultures d) Validation: asking clarifying questions or discussing concerns directly with the patient. Nonverbal Communication Skills for Healthcare Professionals: Observing Patient Behavior, Adapting Behavior according to situation, Using Positive Nonverbal Cues, and Avoiding Negative Cues. Application in Clinical Settings: a) During a Medical History Interview: Sit at eye level with the patient and maintain open body language. Nod or verbally acknowledge. b) Breaking Bad News: Use a soft tone and maintain eye contact to show empathy. A gentle touch on the hand can be appropriate, depending on the patient’s comfort level. c) During Physical Examinations: Pay attention to the patient’s facial expressions or body language to gauge their comfort level. Reassure the patient non-verbally. Cultural Considerations: Different cultures interpret non-verbal cues differently. For example, eye contact may be seen as respectful in one culture but as aggressive in another, and a handshake may not be appropriate, especially between different genders. Understanding these differences is crucial for effective patient care.  3. Verbal Communication Definition of Verbal Communication: Is the use of spoken words and sounds. Effective Verbal communication includes the following: 1. Content and Word Choice: The speaker should avoid unclear, ambiguous, or unnecessarily technical language. 2. Grammar and Pronunciation: Incorrect grammar can impede the clarity of the message. 3. Tone: There are three types of tone: a) Expressive Tone: An expressive tone is spontaneous, emotional, and uninhibited. We use this tone. It is often inappropriate in a healthcare setting because it takes the focus of the discussion off the patient and puts it on the HCW. b) Directive Tone: This is the tone one uses to give orders and exert leadership. It is generally not an appropriate as patients seek expert treatment that includes understanding and empathy. Problem-Solving Tone: A problem-solving tone is rational, objective, and unbiased. It is what the patient rightfully expects from the HCW. 4. Emphasis: The emphasis you place on certain words or parts of a sentence can lead to vastly different interpretations by the patient. 5. Small Talk: Small talk is what we say to patient before we begin the session with him. An HCW can use small talk to help a nervous patient feel more at ease and build rapport. Small talk should be limited as it is not the purpose of the patient’s visit. 6. Using Commentary: It is helpful to the process if the HCW briefly comments on what they are doing, allow the patient to remain engaged in the active role and reduce anxiety for the patient during the process of care. Strategies such as small talk and commentary are best used to build and strengthen rapport with patients. When used for excessive amounts of time, can become distracting to the patient. 7. Paraphrasing: The physician should use paraphrasing for several important reasons: a) A Test of the Message for the physician b) A Test of the Message for the Patient c) A Building of Rapport with the patient d) Encourage the patient talking  4. Listening Listening is an important part of communication. It is not just an innate ability and can be developed through practice. Effective Listening is when a person listens accurately, interprets the message correctly, and gives an appropriate response. Accurately received messages create comfort, confidence, and appreciation in the minds of our customers. Steps of effective listening: 1. Receiving, 2. Understanding (Decoding), 3. Remembering (storing new and retrieving previous information), 4. Evaluating, and 5. Responding. Benefits of Good listening: Understand others and what is expected well, collaborate better with clients, team members, and supervisors, earn trust, avoid conflicts, show support, and resolve issues. Poor listening makes us seem sloppy, insincere, and unreliable to others. Barriers in listening: 1. External: Other noises or Interference, Poor connection, and Visual distractors. 2. Internal: Lack of interest, Assumptions (about a person or situation), Cultural or language difference, Gender difference, and Use of jargons (complicated technical terms) Types of Listening: 1. Appreciative listening: A person listens for what they like. 2. Critical listening: Listening with the intention of analyzing and giving a Feedback. 3. Comprehensive listening: Listening to simply understand a message, Like in a class. 4. Evaluative listening: The listener tries to find value and purpose 5. Empathetic listening: Listening while imagining yourself in the same Situation. 6. Superficial listening: The listener simply hears sounds and tries to catch the Crucial points. A-A-A of Listening: (attention – attitude – adjustment) There are four essential requirements for active listening: Intensity, Empathy, Acceptance, and Willingness to take responsibility for completeness. Suggestions for Improving Active Listening Skills: 1-Make Eye Contact 2-Avoid Distracting Actions or Gestures 3-Paraphrase 4-Ask Questions 5-Avoid Interrupting the Speaker 6-Do Not Talk Too Much 7-Exhibit Affirmative Nods and Appropriate Facial Expressions  5. Questioning Techniques Importance of asking questions effectively: 1-Improve 2-Improve critical 3-Deliver 4-Clarify important 5-Assess other's 6-Persuade Interpersonal skills thinking skills engaging conversation points knowledge others presentations Types Of Questions: 1. Open questions: They give the asked person an opportunity to elaborate and offer an in- depth explanation. Useful to learn more about something, understand the circumstances better, or listen to someone’s ideas. Usually begin with: How, What, When, Why, Which, Explain, or Describe. 2. Closed questions: Give a simple answer (often are yes or no questions). They may be used for confirmation about a specific topic or assessing whether someone else agrees you and can save time and provide with direct feedback. 3. Probing questions: ask for specific details. Also known as trigger questions. Probing questions tend to follow an open question. However, people may feel interrogated if you use too many of them. 4. Funnel questions: Begins with general questions that gradually become more specific throughout the conversation. Researchers, journalists and detectives often use them. 5. Leading questions: Often begin with a claim and end by asking whether the other person agrees. They are also referred to as reflective questions. 6. Clarifying questions: People ask them to make sure they have the correct information. Often these questions come up at the end of a conversation. Other types: Rhetorical Questions- Recall Questions-Reflective Questions- Contingency Questions- Process Questions Good Questioning Techniques: 1-Start With Open Question 2-Use active listening to 4-Statements can make prompt the patient good questions 4-Follow up with probing or 5-Avoid closed questions 6- Avoid double barreled closed questions early in the consultation questions Tips for asking effective questions: 1-Practice Active 2- Use Silence to your 3- Pay attention to your tone 4- Be Listening advantage and body language respectful  6. Communicating with difficult patients Difficult patients are those who elicit or provoke strong negative emotions from their physicians. Factors contributing to a challenging interaction: (See Image) The 10 strategies for resolving conflicts: 1. Listen intently (attentively) 2. Show them you're listening: keep eye contact and nod your head when listening. Validate what the patient is saying with statements. Physicians can also restate, paraphrase, or clarify, which shows that you understand and are listening. 3. Stay calm: Control reactions and avoid getting caught up in the patient's emotions. Also try to avoid playing the blame game. 4. Validate the patient's emotions: Validate how they feel and make them feel safe, but be mindful of tone and body language and make sure it matches what you are saying. 5. Ask the patient questions: Howe described two types of questions that can elicit more information: Dummy-up (Pretend that you don't know anything) and Reverse question (as “Good question” or “I'm glad you asked that”) 6. Apologize only when you've come up short 7. Be politely powerful with patients in error 8. Deliver a solution: Be sure to solve problems happily, quickly, and generously. 9. Be politely assertive with unreasonable patients: Some patients will never be happy no matter what is said and done. With these patients, use more direct questions to find out what the ideal situation is and what will make them happy. However, if they are cursing and angry, a better approach may be to shut down the conversation until they are calmer. 10. Thank the patient and check back: No matter what the problem is, it's important to follow up. Then you can thank the patient for bringing the problem to your attention and say that you want to keep improving. Tips for communicating with older patients 1. Speak to the patient as a fellow adult. Those who are older might be used to more formal terms of address. Establish respect right away by using formal language as a default (such as Mr. or Ms.) and avoiding familiar terms, such as “dear,” which could be perceived as disrespectful. 2. Make older patients comfortable. Ask staff to ensure patients have a comfortable seat in the waiting room and, if necessary, help with filling out forms. Staff should check on them often if they have a long wait before they are seen. Patients with impaired mobility may need to be escorted to and from exam rooms, offices, restrooms, and the waiting area. They may require assistance with climbing on to the exam table or removing clothing or shoes. 3. Avoid hurrying older patients. Try speaking more slowly to give them time to process what is being asked or said, and don’t interrupt. You might suggest that your patients prepare a list of their health concerns in advance of appointments. 4. Speak plainly. Use simple, common language and ask if clarification is needed. 5. Address the patient face-to-face. 6. Write down or print out takeaway points. It can often be difficult for patients to remember everything discussed during an appointment. Older adults with more than one medical condition or health concern benefit especially from having clear and specific written notes or printed handouts. 7. Recognize that people from different backgrounds may have different expectations. Beware of cultural differences and provide translation if needed. Rapport with children 1. White coat may annoy the children 2. Examine mother's ear or older sibling before examine the child 3. Let him handle the stethoscope or the otoscope 4. Simple rewards can make the physician office a place of interest for the child  7. Adapting Communication to a Patient’s Ability to Understand Health literacy: the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. It includes the ability to understand instructions To interact most effectively with patients with low health literacy: 1. Evaluate the patient’s understanding before, during, and after the introduction of information or instruction. 2. Limit the number of messages given to a patient at one time (Less than half is retained). 3. Use “plain language.” Information is organized according to importance and broken down into understandable chunks; language is simple. Use of the active voice. Language that may be plain to one patient may not be plain to others. 4. Supplement instructions with pictures. 5. Tailor medication schedules to fit a patient’s daily routine. 6. Prepare written forms at a fifth- to sixth-grade reading level in a format easy to read. Use bullets and headings and font size of at least 12. 7. Read or provide a reader (as family members). Solving Language barriers: Use a qualified medical interpreter. The use of nonprofessional interpreters should be avoided because they are often unfamiliar with complex medical information and to prevent the loss of patient confidentiality. To work more effectively with a medical interpreter: 1. Look at and speak directly to the patient. 4. Remain patient and understanding. The interpreter should stand behind and a little to the side of the patient. 2. Use short sentences. 5. Observe the patient’s nonverbal messages. 3. Avoid the use of informal and 6. Repeat important information. unprofessional vocabulary 7. Employ “teach back.” In other words, ask the patient to repeat important instructions or information in their own words. Visual Impairment: Difficulty in seeing, even when wearing corrective lenses (glasses or contacts), as well as complete blindness. Strategies to communicate effectively with patients who are visually impaired: 1. Greet the patient, clearly identify who you are, and speak in a 2. Speak directly to the patient and adopt a normal tone of voice. normal position. 3. Tell the patient that you will be touching them before you do 4. Be verbally descriptive. so. 5. Use the words “look” and “see” normally. 6. Tell The patient when leaving the area. 7. Do not attempt to guide the patient without first asking. 8. Provide reasonable accommodations, such as audio tape or Braille formats.  Deafness and hearing loss: inability to hear well enough to rely on hearing as a means of processing information. The majority of individuals with hearing problems are 65 years of age and older, and the number of patients with these problems is expected to increase substantially in the coming years as the population ages. It may be necessary to use a professional interpreter of Sign Language (SL) in the clinical setting. Speak directly to the patient and not the interpreter and be patient and considerate. Strategies to communicate effectively with patients with hearing problems: 1. Be sure that the patient sees you. 8. Minimize the use of medical terminology 2. Interact directly with the patient and 9. Maintain eye contact with the minimize any background noise as much as patient possible. 3. Record and respect the patient’s preferred 10. Include the use and observation of method of communication. nonverbal communication. 4. If your patient hears better in one ear than 11. Rephrase or write the message. the other, note it in his medical record and position yourself accordingly. 5. Gain the patient’s attention before you speak. 12. Indicate a change in topic and don’t suddenly shift 6. Speak clearly, in a normal tone, a little more 13. Supplement the conversation with loudly, and at a moderate pace. visual aids. 7. Optimize conditions for speech reading. 14. Employ teach back: ask the patient to repeat the information.