Communication Skills: A Guide for Doctors (PDF)

COMMUNICATION SKILLS Ioannis Pantazopoulos Scientific Collaborator EUC Virshup BB, et al. Am J Med Qual 1999;14:153-9  Benefits of good communication skills v Meaningful and trustworthy relationship between doctors and patients v Better understanding of patient’s problems v Us...

COMMUNICATION SKILLS Ioannis Pantazopoulos Scientific Collaborator EUC Virshup BB, et al. Am J Med Qual 1999;14:153-9  Benefits of good communication skills v Meaningful and trustworthy relationship between doctors and patients v Better understanding of patient’s problems v Useful in managing difficult clinical encounters v Decreases work stress v Increases job satisfaction v Improves patient’s level of satisfaction v Increases compliance to the advices given by the doctor v Positive impact on patient’s psychology, mental health, tolerance, power and quality of life Components of communication Although nonverbal component of the communication is frequently considered less important, literature suggest that it significantly influences important outcomes like patient’s satisfaction, adherence to advices and clinical outcome Roter DL, et al. J Gen Intern Med 2006;21:S28-34  Barriers to good communications v Lack of insight v doctors do not give enough heed to the importance of keeping patients adequately informed v Non-verbal components are frequently neglected v Language barrier v Lack of adequate knowledge about the disease or treatment options v Human failings like stress, tiredness or lack of time Learn to listen to the patients patiently Ø Listening is an active process that involves imbibing all the information expressed verbally or nonverbally by the patient. Ø It is a major part of communication process. Ø It helps in better understanding of the patient’s problem and finding better decisions. Robertson K. Aust Fam Physician 2005;34:1053-55  Communication strategies that may help the doctor to improve listening skills 1. Make the patient and the attendant comfortable. 2. Show interest in what the patient is saying with your mannerism, body language and active involvement. 3. Mannerism like patting shoulder, holding hands or nodding may convince the patient that you care for them and have understood his/ her problem. 4. Be careful not to interrupt him/her when he/she is expressing something. 5. While concluding, one must ask the patient if he would like to add something more. Before starting formal interview with patient 1. Respect the patient’s confidentiality and maintain privacy. 2. Be the first one to greet the patient. 3. Be prepared and know the patient’s name. 4. Establish eye contact and maintain it at reasonable intervals. 5. Put the patient at ease. Conducting medical interview with the patient The interview should be patient centric rather than disease centric. It is vital that the patient’s interview is conducted to achieve three essential goals that is: gathering of information, building a healthy doctor-patient relationship education of the patient Practical advices 1. Pay attention to both the verbal and non-verbal clues from the patient 2. Provide information on what the patient wants to know and promptly respond to the patient’s reaction. 3. Discuss nature, course and prognosis (both short term and long term) of the disease, treatment options available and necessity of the investigations. 4. Discuss in detail regarding necessity and feasibility of expensive investigations and drugs and their effect on main course and outcome of disease. 5. Involve the patient in the decision making. 6. Motivate patients regarding adherence to lifestyle modifications. 7. Always comprehend details in simple language. Communicating with the attendants 1. Never be informal with them. 2. Conduct conferences once and if possible twice daily. 3. Talk about and appreciate the efforts made by them. 4. Most of the attendants surfs internet and gather lots of information. Try to satisfy their queries by giving better references. 5. Always explain the dynamic nature of disease. This is especially important for critically ill patients. 6. Second opinion should be sought proactively. 7. Never express shock. 8. Consent taking is very important part of counselling.  Communicating with colleagues Junior doctors including postgraduate students, fellows and interns along with nursing and supportive staffs are part of the team. Κeep them united and motivated. 1. Never talk low about your colleagues or scold residents, fellows or other students in front of patients or attendants. 2. Greatest courtesy should be displayed for all staffs including nurses, paramedical staffs and other supporting staffs. 3. Lead by setting examples. 4. Try to teach them the basics and the principles of management of commonly encountered diseases in your ward. 5. Audit and regular feedback improves in professional practice. Never delay to give appreciation and dare to give positive criticism. 15% of the doctor-patient interactions were labelled as “difficult” encounters Jackson JL, et al. Arch Intern Med. 1999;159:1069-75 Managing difficult encounters  Strategies for managing difficult encounters Dependent patients Maintain a professional demeanour with well established boundary Involve the patient in decision making Assure him that he will not be abandoned/neglected and will be given full attention in subsequent visits  Strategies for managing difficult encounters Demanding patients Avoid judgemental approach Empathetically ensure the patient that he will get the best medical care Strategies for managing difficult encounters Manipulative patients Be empathetic and listen to his problems attentively while sharing frustration over poor outcomes Reformulate the treatment plan with the patient after having set limitations over expectations Strategies for managing difficult encounters Self-destructive patients Set realistic expectations and recognize the fact that complete resolution is limited. Delve into the reasons for non- adherence to therapy (money, time or family support). Arrange for psychological support. Breaking bad news  Be primed up for the interview Maintain privacy Sit relaxed with the patient Maintain constant eye-to-eye contact and avoid any time pressure and interruptions Allow an undistracted and focussed discussion. If the patient wishes someone else to be with them, allow the patient to choose among the relatives or friends. Assess the patient’s knowledge and attitude Assess the patient’s desire to get the level of details of information  Actual breaking of bad news Use of simple and non-technical words, giving information in small portions and periodic assessment of the impact are some of the communication tools that can be extremely useful. Addressing the patient’s emotions  Treatment plan and summarize Formulate and discuss future plan of treatment with patients and/or attendants by involving them in the decision making. Thank you for your attention!