Patient Centered Communication Skills, Non-Verbal Communication PDF

PATIENT CENTERED COMMUNICATION SKILLS, NON-- VERBAL NON COMMUNICATION Tamar Melikidze 1  WHY LEARN COMMUNICATION SKILLS? …To be an effective doctor, you need to learn effective clinical communication skills...

PATIENT CENTERED COMMUNICATION SKILLS, NON-- VERBAL NON COMMUNICATION Tamar Melikidze 1  WHY LEARN COMMUNICATION SKILLS? …To be an effective doctor, you need to learn effective clinical communication skills 2  THE BENEFITS OF GOOD COMMUNIC ATIONS: FOR DOCTORS FOR PATIENTS Reducing stress and Improved health burnout outcomes Reducing complaints and Early identification of litigation health problems Hight satisfaction Avoiding exacerbations, crises, expensive interventions Decreasing medical expenditures 3  CONSULTATION IN MEDICINE Consultation is cornerstone of Doctors working prosses, because during consultations are completed doctors main functions – solving problems related to patients health 4  THREE FUNCTIONS OF THE MEDICAL INTERVIEW (Cohen-Cole, 1991) 1. Gathering data to understand the patient’s problems 2. Developing rapport and responding to patient’s emotion 3. Patient education and motivation 5  THE SIX PHASES OF THE CONSULTATION (BY BYRNE AND LONG) 1. The doctor establishes a relationship with the patient 2. The doctor discovers or attempts to discover the reason for the attendance 3. The doctor conducts a verbal and/or physical examination 4. The doctor, the doctor and patient, or the patient (in that order of probability) consider the condition 5. The doctor and occasionally the patient detail further treatment or investigation 6. The consultation is terminated, usually by the doctor 6  THE SIX PHASES OF THE CONSULTATION (BY BYRNE AND LONG) 1. Establishing relationship with the patient: Invitation Introducing yourself Smile! Place the patients Eye contact 7  THE SIX PHASES OF THE CONSULTATION (BY BYRNE AND LONG) 2. discovering the reason for the attendance: Open Questions Closed Questions Active listening 8  SKILLS FOR COLLECTING INFORMATION Open questions Very important during initial stage, Major method of determining the main reason of the visit Encourage a patient to formulate his own thoughts, feelings, desires, requests 9  SKILLS FOR COLLECTING INFORMATION Closed or specifying questions Do not ask closed questions when finding out the reason of a visit e.g.: when you feel pain in your chest, does it move to your left arm? 1 0  DOCTORS’ COMMUNICATION SKILLS Research data: Physicians often interrupt patients even before they finish their first sentence. Average time – 18 seconds; Only 18% of patients are allowed to complete their first sentence; Only 23 % of patients are able to reveal the reason of their visit to a physician during initial stage of consultation.  …“Listen to your patient; he is telling you the diagnosis” (Sir William Osler, XIX s.) 1 1  FORMS OF NON-VERBAL COMMUNIC ATION Posture: sitting, standing, erect, relaxed; Proximity: use of space, physical distance between www.cbc.ca communicators; Touch: handshake, pat, physical contact during physical examination; 1 2  FORMS OF NON-VERBAL COMMUNIC ATION  Body movements: hand and arm gestures, fidgeting, nodding, foot and leg movements;  Facial expression: raised eyebrows, frown, smiles, crying;  Vocal cues: pitch, rate, volume, rhythm, silence, pause, tone, speech errors, affect, responsiveness; 1 3  FORMS OF NON-VERBAL COMMUNIC ATION Use of time: early, late, on time, rushed, slow to respond; Physical presence: race, gender, body shape, clothing, grooming; Environmental cues: location, furniture placement, lighting, temperature, colour. 1 4  VERBAL AND NON-VERBAL COMMUNIC ATION “55% of your message comes from visual cues. 38% comes from how you sound. And only 7% comes from the actual words you say. That means a mighty 93% of your message is non-verbal, so shine those shoes and look energized!” The source of the figures is a 1971 study by UCLA Professor Albert Mehrabian. And it’s been widely misinterpreted ever since. Mehrabian’s findings apply to situations where there’s conflict between what’s said and the non-verbal style used to deliver it. So when you say “great work - I love it!” through clenched teeth with rolling eyes, the words don’t mean much. The numbers don’t apply when your words and non-verbal behavior are in sync. www.scenechange.com.au 1 5  DIFFERENCES BETWEEN VERB AL AN D NON-VERB AL COMMUNIC ATION ??? VERBAL NON-VERBAL Has clear endpoints – we Continues as long as communicators are in each know when the message other’s presence: has come to the end Even if people are together in silence, non-verbal communication is present. The difference between comfortable and non- comfortable silence is often mediated by our non-verbal communication. 16  DIFFERENCES BETWEEN VERB AL AN D NON-VERB AL COMMUNIC ATION ??? VERBAL NON-VERBAL occurs in a single mode – can occur in several modes either spoken or written at once. We can send or receive non-verbal cues all at once. All our senses can receive signals simultaneously. 17  DIFFERENCES BETWEEN VERB AL AN D NON-VERB AL COMMUNIC ATION ??? VERBAL NON-VERBAL is mostly under our voluntary is at the edge or beyond control our conscious awareness is the channel most responsible Verbal messages are more for our attitudes, emotions and effective communicating affect. discrete pieces of information Non-verbal communication plays and in conveying our an increasingly important role intellectual ideas and thoughts when someone is unable and unwilling explicitly express feelings verbally. 18  ROLES OF VERBAL AND NON- VERBAL COMMUNIC ATION Non-verbal communication can work to accent, qualify, regulate, take the place or to contradict verbal communication. In most circumstances, verbal and non-verbal communication work together to reinforce each other. We can intentionally use our non-verbal communication to reduce uncertainty and misunderstanding in our verbal communication. 1 9  ROLES OF VERBAL AND NON- VERBAL COMMUNIC ATION Communication research has shown that when verbal and non-verbal communication “messages” are inconsistent or contradictory, non-verbal messages will override verbal messages. 2 0  RISK OF THE CONSULTATION FAILURE Reasons? Lack of time; Nurse in the room; Another person interrupts the appointment; Poor rapport (mutual understanding) in the beginning of consultation; When more than one person take part in the appointment (mother and child, husband and wife); 2 1  CONFIDENTIALITY The principle in medical ethics that the information of a patient reveals to a health care provider is private and has limits on how and when it can be disclosed to a third party. PRIVACY The state or condition of being free from being observed or disturbed by other people. The state of being free from public attention. 2 2  CONFIDENTIALITY AND PRIVACY Article 27 Healthcare provider shall keep confidentially the information about the patient both within the period of his/her life as well as after patient’s death. Article 28 1. Disclosure of confidential information by healthcare provider is permitted only if: a) patient’s informed consent is obtained; b) nondisclosure of information will endanger the life and/or health of the third person; c) information about the patient is used for the scientific or medical training purposes and if this information is introduced in the manner that the identification of the patient is impossible; d) Georgian legislation provides for this. 2. Consent of the patient shall be presumed for the disclosure of confidential information by healthcare provider to other healthcare providers who participate in the process of medical care of that patient. 2 Law of Georgia on the Rights of Patients 3  CONFIDENTIALITY AND PRIVACY Article 30 Only persons who directly participate in providing of medical services shall attend the medical procedure, with the exception of the cases when patient agrees or requests presence of other persons. Law of Georgia on the Rights of Patients 2 4 QUESTIONS? 25 THANK YOU FOR ATTENTION! 26 PATIENT CENTERED COMMUNICATION SKILLS, NON-- VERBAL NON COMMUNICATION Tamar Melikidze 2 7