Communication Skills Week 3 pt 2 PDF

The Family Consultation Key features: awareness of observing the patient in context the task of understanding who the patient regards as family (taking care not to make assumptions) the identification of the family’s influence on care and treatment, and the role of family beliefs in...

The Family Consultation Key features: awareness of observing the patient in context the task of understanding who the patient regards as family (taking care not to make assumptions) the identification of the family’s influence on care and treatment, and the role of family beliefs in treatment adherence  It is not the number of people present that transform an individual interview into a family consultation Brown and Rutter (1966) showed that, with the use of interviewing techniques, sensitive, reliable and valid measures of subtle aspects of family life and relationships can be obtained from a single interview with one parent. Aspects such as the consultation venue and the presence or absence of family members will affect both the process and content of the consultation.  In addition to the verbal aspects of a family consultation, the genogram (or family tree) is one of the most useful techniques at our disposal, as it allows the clinician to gain a clear overview of the family as well as help engaging all family members New information shows up when: drawing a family tree, and ‘forgotten events’, patterns over generations individuals have left the family in the past reveal themselves. supported by research, in that patients reported that they felt the genogram helped their physicians understand them better and thus provide better healthcare  Factors such as the nature of the health problem, the recognition (or not) that the problem exists , previous personal and family experience of coping with difficulties , the expectations of different family members the vulnerabilities or resilience of each member of the group will determine the different dynamics that could arise Examples of this would be in working with cancer patients and their families. ,in our daily practice with children when breaking bad news in primary care family consultations  What to take into consideration Culture Ethnicity Family composition ( divorced, adopted, remarriage) appearance of massive socio‐economic differences between people, ever‐increasing geographical mobility, neighbourhood violence influence of the electronic media and social networks In order to care for these challenges practitioners will need to shift from a linear cause‐and‐effect model to one that reflects on clinical practice. Doctors can also promote positive change by informing families about ways of using new technology effectively The advantages of working, whenever possible, with the whole family will continue to include the opportunity to deal with dynamics and with more than one problem at the same time Skills specific to family consultations will be needed when there are unspoken ‘secrets’ between family members, since those can and probably will jeopardise the clinician’s effectiveness Consulting with Children and Young People despite the importance of consulting with children, literature reviews suggest that often children are not active participants in their own consultations and that their views are rarely sought or acknowledged within the heathcare setting  Calgary‐Cambridge model provides a guideline to communicate with children and their parents, and more medical schools are incorporating either this or similar models into their curricula, so that the new graduates will carry these skills with them the general principle is that children should be involved as much as possible in decisions about their care, even if they are not able to make decisions on their own When obtaining consent, the doctor must establish whether the child is legally competent (in legal terms ‘has capacity’ to give consent). Some clinicians have argued that children over 5 years should be considered c ompetent to be involved in healthcare decisions concerning them  Calgary‐Cambridge model provides a guideline to communicate with children and their parents, and more medical schools are incorporating either this or similar models into their curricula, so that the new graduates will carry these skills with them the general principle is that children should be involved as much as possible in decisions about their care, even if they are not able to make decisions on their own When obtaining consent, the doctor must establish whether the child is legally competent (in legal terms ‘has capacity’ to give consent). Some clinicians have argued that children over 5 years should be considered c ompetent to be involved in healthcare decisions concerning them  If, however, a competent child under the age of 16 is insistent that his or her family should not be involved, the child’s right to confidentiality must be respected, unless such an approach would put him or her at serious risk of harm. In Scotland, there is no statutory legislation, but there is clear case law to guide practitioners. A child aged 16 and 17 cannot refuse treatment if it has been agreed by a person with parental responsibility or the court, and it is in his or her best interests In essence, the doctor’s role is to integrate the views of the carers and the young person. The challenge here is to maintain an effective clinical relationship while the health responsibilities transfer from the adults to the young person essential skills to maintain a good therapeutic alliance. awareness that in triadic consultations the needs of the parent could inadvertently take priority (despite the guidance from good medical practice stating that doctors need to have the best interests of their patient, the child, as their first concern) our ability to deal sensitively with the needs of the parent while assessing and treating the child, Doctors also need to know about adolescent development (both physical and p sychosocial, including the development of abstract thinking) to assess key issues that influence clinical communication, the young person’s adherence to the medical advice; adolescent risk‐taking behaviours; worries about confidentiality, the relationships between the young person and his or her family the young person’s difficulties in understanding the impact of his or her behaviour on others. Parents and health professionals play a key role in the consultation process and have the power to facilitate children’s participation. empowering them to make decisions about care, raises a need to train doctors and educate young people to achieve this participation, and then design studies to measure its effectiveness, because patient‐centred consultations with children and young people are key in any successful health service redesign  Positive Social networking can help develop new social connections and friendships and keeps young people connected to friends and family Can be used to discuss educational topics, offering teachers a platform for collaboration with other teachers and communication with students outside the classroom Social networking sites can facilitate face‐to‐face interaction Can maximise support groups and networks for young people, also making easier to organise events. Source of employment (e.g. LinkedIn). Assist police to catch criminals who declare their offences online Contribute to health services boosting their image as leaders in the field. Improve communication with young people. We have a Facebook account in our youth service and we also use the site to make important announcements on the services we offer, the therapeutric groups we run, the teaching we do and so forth. Use of virtual worlds as role‐play simulations as a communication, therapeutic and teaching tool Clinicians working with children and young people need to adapt and respond to new clinical environments, financial constraints technological advances. Social networking sites, such as Facebook, MySpace, Bebo and Twitter, are now used by 1 in 4 people worldwide Such activity may seem harmless, but some researchers suggest that social media may affect our mental health and well‐being But, what is social media? Social media is an array of Internet sites that enable people from all over the world to interact through discussion, photos, video and audio. It is a means of communicating that has become pervasive for young people all over the world. Therefore, it would be a good exercise to look at the evidence for its pros and cons  Negative Spending too much time has been linked with lower academic grades wasting time It was ) concluded that the main reasons that young people use social media are for self‐distraction and boredom relief because it delivers a reinforcement when they log on, in the form of supportive comments and ‘likes’. This behaviour could lead to addiction. It has also become a way of gaining attention, since social media tends to create excessive drama. Many people on social media sites present an idealised version of their lives, leading others to make upward social comparisons, which can lead to negative emotions Perceived need to be electronically connected and available at all times. This could be related to becoming even more sleep deprived (texting and gaming until early hours). Cyberbullying  Social networking sites enable ‘sexting’, which can lead to criminal charges and the unexpected proliferation of personal images (Wolak et al. 2012 Misinformation (Marino 2012). Desensitisation to aggressive behaviour after exposure to aggression (Krahé et al. 2011). Takes time out of face‐to‐face communication, both at home (families who reported spending less time with one another rose from a level of 8% in 2000 to 32% in 2011; USC 2012) and with peers. This could lead to young people losing out on the ability to learn about and read social cues of nonverbal communication and interact mindfully in the moment. Relatively easy to make a fake account. Increased vulnerability to security attacks such as hacking, identity theft Social media can lead to both positive and negative communication experiences with children and young people, but it is essential that as doctors we understand new technologies and the promise they offer to revolutionise education and communication. The Older Patient Doctors working with older people need to specialist knowledge and technical skills to deal with complex issues such as the assessment of cognitive function and mental capacity should also include more general skills (e.g. increasing confidence in talking with older people and how to maximise the opportunities for conversation), In teaching communication skills with older people there is a need to differentiate between involving the patient and actually expecting him or her to make decisions about treatment. In addition to taking factors such as the patient’s cognitive state into account, we should also be teaching clinicians to make an assessment of an individual patient’s preferred communication style and then adjust their approach accordingly  End of Life Issues What is ‘end of life care’? End of life care refers to the treatment and care of children and adults who are likely to die within the next 12 months, due to an advanced progressive incurable condition, including both cancer and noncancer diagnoses, general frailty with coexisting conditions or life‐threatening acute conditions. It aims to support the person to live as well as possible until they die and to die with dignity Additional challenges Relationship building is crucial and may have to occur within a short time frame; information gathering and sharing may be more challenging at times of emotional or physical stress. End of life care will inevitably involve sharing bad news, communicating risk and uncertainty and responding to highly emotionally charged situations.  Decisions not to attempt cardiopulmonary resuscitation (DNACPR) are commonly encountered in end of life care and serve to illustrate some of these points. A good outcome will depend on several factors, including:  a healthcare professional’s knowledge about the legal and professional ‫ ؤ‬ framework in which such decisions must be made (e.g. whether or not a ;patient can ensure that cardiopulmonary resuscitation is attempted) the healthcare professional’s confidence in talking to patients about sensitive issues relating to death (on which may impact, for example, worries about dealing with conflict, or about the effectiveness of the professional’s own communication skills) the attitudes and beliefs of all involved towards withholding life‐sustaining treatment (which may reflect the professional’s own, or the patient’s, religious or cultural beliefs). Anxiety about any of these factors may adversely affect the outcome. Mental health matters  Modern medical practice now tends to use a biopsychosocial model in an attempt to explain the interrelationship between social (e.g. poverty, unhealthy life choices), psychological (e.g. stress) and biological (e.g. genetic expression) elements To undertake a comprehensive psychiatric history, advanced consultation skills are undoubtedly needed. Such as Calgary‐Cambridge model Three‐Function Model cognitive behaviour therapy psychodynamic psychotherapy  The consultation style depends somewhat on the therapeutic model being used, but a successful outcome will result from an enhancement of the therapeutic relationship by providing skills to strengthen the relationship in a number of ways: by setting a clear agenda or goals; by ensuring a clear joint understanding is reached and by taking into account the myriad of preconceptions that mental health generates these preconceptions influence the clinician–practitioner relationship in a number of ways. For example, a cognitive behavioural therapy trained practitioner might focus upon the interaction between how a person’s past experience or ‘core beliefs’ about him‐ or herself and the world impact upon the assumptions and actions that he or she makes  One outcome may be that an individual begins to develop defensive strategies to prevent him‐ or herself from feeling uneasy because of real or imagined criticism. Such attitudes or procedures will occur in all aspects of that individual’s life. However, the heightened anxiety felt by the patient due to the context of an ‘authoritarian’ medical consultation will more than likely result in such attitudes being brought to, and probably exaggerated by, the consultation environment. Expert consultation and rapport‐building skills are therefore needed to ensure that a clear joint understanding is reached. For example: that an effective and agreed agenda is set (agenda setting); that preconceptions can be adeptly made explicit (clarifying) that all topics are covered (ideas, concerns and expectations – ICE) that specific techniques are used to ensure that the interview achieves its goals (e.g. rapport building, empathising)  Understanding the underlying genesis or formulation of why ‘this person is presenting at this time with these particular problems’ is the key to a meaningful psychiatric consultation. For the clinician, it requires a full exploration or assessment of the person who is sitting in front of him or her, at least the best assessment possible. Specific techniques such as clarification seem to be one of the cornerstones to achieving a comprehensive understanding as it encourages the patient to feel able to participate in the formation of a shared understanding of the nature of the problem and the reasons why this problem is present and to develop a sensible and meaningful solution. However, ideal treatment will only be achieved, in medical practice but particularly within psychiatry, if the human element is acknowledged as being a major factor leading to optimal treatment outcomes. For that reason, possibly above all other reasons, advanced consultation skills will always be an essential and indispensable part of medical practice.