FFP1 Introduction to Communication and History Taking PDF

SEPTEMBER 2024 FFP1 Introduction to Communicatio n Skills Dr Emer O'Brien Clinical Lecturer Department of General Practice Presented by Dr. Abeer Khalaf Family Medicine Lecturer GP Department- RCSI Bahrain FFP1 LEARNING OUTCOMES 1. Use effective strategies (e.g., communication, collaborati...

SEPTEMBER 2024 FFP1 Introduction to Communicatio n Skills Dr Emer O'Brien Clinical Lecturer Department of General Practice Presented by Dr. Abeer Khalaf Family Medicine Lecturer GP Department- RCSI Bahrain FFP1 LEARNING OUTCOMES 1. Use effective strategies (e.g., communication, collaboration, interventions) as part of a team 2. Describe global trends in morbidity and mortality using Global Burden of disease study data 3. Display knowledge of the basic framework of the Calgary Cambridge Model in communication 4. Discuss the application of professionalism, leadership and resilience (i.e. the constructs of Personal and Professional Identity) to manage self and engage with patients, colleagues and communities. 5. Describe the biomolecular, cellular and biochemical fundamental to life, and the principles of pharmacology 6. Describe the social determinants of health and the breadth and function of the public health and health promotion role. 7. Explain the pathological and immunological processes underlying disease 8. Identify the characteristics of medically important microbiological organisms and pathogenesis of bacterial infections 9. Explain the principles of microbiological diagnostic investigation FFP1 LEARNING OUTCOMES 1. Use effective strategies (e.g., communication, collaboration, interventions) as part of a team 2. Describe global trends in morbidity and mortality using Global Burden of disease study data 3. Display knowledge of the basic framework of the Calgary Cambridge Model in communication 4. Discuss the application of professionalism, leadership and resilience (i.e. the constructs of Personal and Professional Identity) to manage self and engage with patients, colleagues and communities. 5. Describe the biomolecular, cellular and biochemical fundamental to life, and the principles of pharmacology 6. Describe the social determinants of health and the breadth and function of the public health and health promotion role. 7. Explain the pathological and immunological processes underlying disease 8. Identify the characteristics of medically important microbiological organisms and pathogenesis of bacterial infections 9. Explain the principles of microbiological diagnostic investigation LECTURE LEARNING OUTCOMES 1. Demonstrate an appreciation of communication skills within the consultation 2. Be aware of the Calgary Cambridge Consultation Model 3. Explain in detail the first 4 headings of the Calgary Cambridge consultation model 4. Learn the formal structure of history taking and how it relates to the consultation model 5. Be aware of summarising your findings, forming a differential diagnosis and management plan 6. Identify the patient’s ideas, concerns and expectations throughout the consultation ‘Medicine is learned by the bedside and not in the classroom’ Sir William Osler  CALGARY CAMBRIDGE CONSULTATION MODEL Widely-used model to assist in structuring interactions with patients Developed by Suzanne Kurtz & Jonathan Silverman 1996 and later revised Many other consultation models exist e.g. Pendleton Model (1984), Neighbour Model (1987), Fraser Model (1992 and 1999) Different techniques to manage consultations COMMUNICATION SKILLS Calgary Cambridge Consultation Model Overview COMMUNICATION SKILLS Calgary Cambridge Consultation Model Overview Over the next 3 semeste For rs now! COMMUNICATION SKILLS Calgary Cambridge Consultation Model Overview INITIATING THE SESSION: ESTABLISHING A RAPPORT Greet your patient, ask his/her/their name Introduce yourself and say what you do (e.g. your role): ‘Hello, Mr Brown, I’m ………, one of the medical students…’ Make sure that Mr Brown is seated comfortably Show interest and respect Gain consent to proceed ‘Mr Brown I am going to ask you a few questions about what brought you here today, about your past history and your family history, is that ok?’ INITIATING THE SESSION: IDENTIFY THE REASON(S) FOR CONSULTING YOU The opening question: identify the problem(s) the patient would like to address ‘Mr Brown, would you like to tell me why you are here today?’ Listen to the patient’s opening statement: listen attentively, without interrupting or directing your patient’s response Check with the patient to confirm the problem(s) Agenda setting: negotiate an agenda with your patient, taking both his/her/their and your own needs into account COMMUNICATION SKILLS Calgary Cambridge Consultation Model Overview GATHERING INFORMATION: EXPLORATION OF THE PROBLEMS Encourage your patient to tell the story of the problem(s) ‘Would you like to tell me more about that?’ Open and closed questioning techniques Open question: ‘Can you tell me about your cough?’ Closed question: ‘Does your cough get worse when you exercise?’ Listen attentively to facilitate your patient's responses verbally & non-verbally GATHERING INFORMATION: EXPLORATION OF THE PROBLEMS Pick up on cues, expressions, body language Use appropriate language, avoid jargon – e.g. ‘Have you experienced any degree of dyspnoea?’ vs ‘Have you felt breathless?’ Establish dates/sequence of events – e.g. when did certain symptoms start Clarify if unclear e.g. Patient: ‘I took a turn, doctor’ Doctor: ‘Could you explain that in more detail please?’ Summarise – to ensure you have interpreted what the patient said correctly AND also shows that you have been listening; that you are attentive to the patient IDEAS CONCERNS AND EXPECTATIONS Throughout the consultation be aware of the patient’s - Ideas: beliefs about the cause of the problem Concerns: worries about their symptoms e.g. ‘do I have cancer?’ ‘will I be able to continue to work and pay the mortgage/rent?’ Expectations: what help does the patient expect for the problem Important to consider how the problem is affecting their life/Impact on daily living COMMUNICATION SKILLS Calgary Cambridge Consultation Model Overview PROVIDING A STRUCTURE TO THE CONSULTATION Flow Logical structure/sequence Timing Organisation Summarise regularly before moving to next section ‘So, the chest pain that brought you here started yesterday, is worse when you breathe in deeply and seems to ease when you take ibuprofen’ Sign-post e.g. as you move to past medical history ‘Now I might ask you about your health before now, if that’s ok?’ COMMUNICATION SKILLS Calgary Cambridge Consultation Model Overview BUILDING THE RELATIONSHIP WITH YOUR PATIENT Non-verbal behaviour eye-contact, facial expression, tone/volume/rate of speech posture, position, movement computer as barrier confidence Developing rapport use of empathy, acknowledge patient views, provides support Involving the patient ‘So based on what we have talked about, what I’m thinking right now is... What do you think about that?’ VIDEO LINKS Effective communication https://youtu.be/MyKfYCZG-l0 VIDEO LINKS Flawed communication https://youtu.be/iezthflsFp4 HISTORY TAKING SEQUENCE Introduction and Consent Presenting Complaint History of Presenting Complaint Past History - Medical History, Surgical History Medications Allergies Social History Family History Systems Review Summary Differential Diagnosis Management Plan HISTORY TAKING SEQUENCE Introduction and Consent Initiating the Presenting Complaint Session History of Presenting Complaint Past History - Medical History, Surgical History Medications Allergies Social History Family History Systems Review Summary Differential Diagnosis Management Plan HISTORY TAKING SEQUENCE Introduction and Consent Initiating the Presenting Complaint Session History of Presenting Complaint Past History - Medical History, Surgical History Medications Allergies Gathering Social History Information Family History Systems Review Summary Differential Diagnosis Management Plan INTRODUCTION AND CONSENT ? INITIATING THE SESSION: ESTABLISHING A RAPPORT Greet your patient, ask his/her/their name Introduce yourself and say what you do: ‘Hello, Mr Brown, I’m ………, one of the medical students…’ Make sure that Mr Brown is seated comfortably Show interest and respect Gain consent to proceed ‘Mr Brown I am going to ask you a few questions about what brought you here today, about your past history and your family history, is that ok?’ INITIATING THE SESSION: IDENTIFY THE REASON(S) FOR CONSULTING YOU (I.E. ESTABLISH PRESENTING COMPLAINT) The opening question: identify the problem(s) the patient would like to address ‘Mr Brown would you like to tell me why you are here today?’ Listen to the patient’s opening statement: listen attentively, without interrupting or directing your patient’s response Check with the patient to confirm the problem(s) Agenda setting: negotiate an agenda with your patient, taking both his/her/their and your own needs into account HISTORY OF PRESENTING COMPLAINT ? GATHERING INFORMATION: EXPLORATION OF THE PROBLEMS Encourage your patient to tell the story of the problem(s) ‘Would you like to tell me more about that? ‘ Open and closed questioning techniques Open question: ‘Can you tell me about your cough?’ Closed question: ‘Does your cough get worse when you exercise?’ Listen attentively to facilitate your patient's responses verbally & non-verbally GATHERING INFORMATION: FOR PAIN = SOCRATES S site T timing O onset E exacerbating factors/relieving C character factors R radiation S severity – grade the pain from 1 to 10, impact on A associated activities of daily symptoms living e.g. ADLs GATHERING INFORMATION: FOR PAIN = SOCRATES FOR CHEST PAIN S site e.g. T timing e.g. Duration, Central/left/right frequency O onset e.g. When, sudden vs gradual E exacerbating C character e.g. Dull, factors/relieving sharp, pressure, burning factors e.g. Activity R radiation e.g. To neck, worsens, rest relieves left arm A associated S severity – grade symptoms e.g. Shortness of breath, the pain from 1 to nausea, vomiting, cough 10, impact on etc activities of daily GATHERING INFORMATION: FOR PAIN = SOCRATES FOR JOINT PAIN S site e.g. Which joint? T timing e.g. Duration, Which part of joint? frequency O onset e.g. When, sudden vs gradual E exacerbating C character e.g. Dull, factors/relieving sharp, throbbing, burning. factors e.g. Activity R radiation e.g. To other worsens, rest relieves joint, or bone or body part A associated S severity – grade symptoms e.g. Redness, swelling, the pain from 1 to stiffness, etc 10, impact on activities of daily GATHERING INFORMATION: SOCRATES FOR OTHER SYMPTOMS S site T timing O onset E exacerbating factors/relieving C character factors R radiation S severity – grade the pain from 1 to 10, impact on A associated activities of daily symptoms living e.g. ADLs GATHERING INFORMATION: SOCRATES FOR COUGH S site T timing e.g is it worse at night or during the day? O onset e.g When, sudden vs gradual C character e.g. Dry, E exacerbating wet/productive, barking factors/relieving R radiation factors e.g. Does A associated exercise or dust worsen it? Does sitting up improve it? symptoms e.g. Fever, shortness of breath, sputum S severity e.g. Able to attend work/school, sleep etc. PAST HISTORY PAST MEDICAL HISTORY (PMH)/PAST SURGICAL HISTORY (PSH) Open Questions How is your health generally? Do you have any known medical conditions? Are you attending a doctor or clinic regularly? Have you had any previous operations? Or investigations done in hospital? Any previous musculoskeletal/cardiac/respiratory/gastrointestinal problems? Closed Questions Do you have asthma? high blood pressure? high cholesterol? diabetes? depression? epilepsy? rheumatic fever or heart disease? stroke? MEDICATIONS Current medications Prescribed or over the counter (OTC) Herbal remedies Recreational drug use – if relevant to consultation List of medication what are they for? when prescribed? compliance? tolerated/side effects? ALLERGIES Any known allergies to : medication latex Extent of allergy: what happened when exposed e.g. nausea/ vomiting/ rash/ swelling/ collapse/ hospitalisation Mild reaction vs anaphylaxis SOCIAL HISTORY Home who do you live with e.g. partner/parents? do you have any dependents/children? do you have good support from family and friends/neighbours? Occupation stressful, sedentary, how do you manage work/life balance? Hobbies sport, how much exercise/week others SOCIAL HISTORY (CONTINUED) Smoking History do you smoke, have you ever smoked, how many, for how long? one pack year = 20 cigarettes/day/1 year Alcohol Historydo you drink alcohol, would you drink everyday, how much, how often? Glass of beer 1 unit 11 units/week female, 17 units/week male Pint of beer 2 units Glass of wine 1-2 units 1 measure of spirits 1 unit FAMILY HISTORY Parents/Siblings living or deceased chronic conditions Any known conditions that run in family e.g. cystic fibrosis, haemochromatosis? Any conditions that can occur frequently in families, e.g. diabetes, heart disease, stroke or high blood pressure? BEYOND THE SCOPE OF YEAR 1 Systems review Summary of findings Differential Diagnosis Management Plan SMALL GROUP TUTORIALS – COMMUNICATION SKILLS Before the tutorial: – Review your lecture – Review the relevant notes in the SYSTEMS FOLDER on Moodle A GP Tutor will facilitate the tutorial Each tutorial lasts 1h30. 10-12 students will be present in a tutorial. Students form triads; patient, doctor and observer LECTURE LEARNING OUTCOMES 1. Demonstrate an understanding of communication skills within the consultation 2. Be aware of the Calgary Cambridge Consultation Model 3. Explain in detail the first 4 headings of the Calgary Cambridge consultation model 4. Learn the formal structure of history taking and how it relates to the consultation model 5. Be aware of summarising your findings, forming a differential diagnosis and management plan 6. Be aware of the patient’s ideas, concerns and expectations throughout the consultation REFERENCES Kurtz SM, Silverman JD, Draper J (1998) Teaching and Learning Communication Skills in Medicine. Radcliffe Medical Press (Oxford) Silverman JD, Kurtz SM, Draper J (1998) Skills for Communicating with Patients. Radcliffe Medical Press (Oxford) Kurtz, SM, Silverman JD, Benson J, Draper J (2003) Marrying Content and Process in Clinical Method Teaching: Enhancing the Calgary–Cambridge Guides. Academic Medicine. Simon, C., Everitt, H., van Dorp, F. (2020) Oxford Handbook of General Practice, 5th Edition QUESTIONS?