Introduction to Communication Skills and History Taking Lecture 1 PDF

Introduction to communication skills and history taking Dr. Weam Aribi. Pediatric specialist. Teaching staff, University of Tripoli Clinical skills instructor. International Maarf University Basics of communication skills Good communication between doctors and patients is vital for medical practice....

Introduction to communication skills and history taking Dr. Weam Aribi. Pediatric specialist. Teaching staff, University of Tripoli Clinical skills instructor. International Maarf University Basics of communication skills Good communication between doctors and patients is vital for medical practice. Doctors need to build relationships, show empathy ,gather information ,explain concepts and plan treatment. Effective communication skills have strong positive influence on patient care and health outcomes. Basics of communication skills Good communication skills needed in different encounters between doctors and patients. Each encounter needs special protocol. The common encounters are: Medical interviews. Breaking bad news to patients. Discussing medical error. Challenging conversations with patients and family members. Protocol for medical interviews The C-L-A-S-S Protocol C – CONTEXT: the physical set up you choose for the interview. L- LISTENING SKILLS: how to be an effective listener. A- ACKNOWLEDGE: how to validate ,explore and address emotions and concerns. S- STRATEGY :how to provide a management plan that the patient can understand. S- SUMMARY :how to summarize and clarify the conversion ensuring comprehension. Context (setting) A private area with no distractions. Physical space:  Private space.  Set at the same level as the patient ,your eyes should be at the same level as the patient and or the relative.  No physical barrier between you and the patient. Context (setting)  Patient and family members   The patient should be seated closest to you.   Body language If you are sitting behind the desk ,the patient or family member should sit across the corner. Be informal set at the corner rather than confronting the patient. Be relaxed. Maintain eye contact except when the patient is emotional. Listening is one of the most skills in communication. Be an effective listener. Let the patient know that you are listening ,body language , confirming and clarifying important information ,no interruptions being busy with writing. God given you two ears and one tongue. Allow enough time for the conversion, do not rush. Give full attention to what the patient says. If you need to interrupt the conversation ,ap ologize to the patient before answering a phone call or other interruption. Listening skills Acknowledge emotions Explore ,identify and respond to the emotion. The empathic response: Identify the emotion Identify the cause of the emotion. Respond by showing you have made the connection between the emotion and the cause. You do not have to have the same feelings as the patient. You do not have to agree with the patient is feelings. You can use certain phrases like: Most people would be upset about this. Strategy Propose a plan that the patient will understand. Summary : Closing the interview. Summarize the discussion in a clear and concise manner. Check the patient is understanding. Ask if the patient has any more questions. Arrange for a follow up visit. How you look and behave, you need to be professional , patients are affected by the first impression, so your dress and behavior will have great impact on your patients. Respect the wish of the patient if he wishes the attendance of another person, or he or she does not wish the attendance of others. Always have a female attendant when talking or examining a female patient if you are a male doctor and vice versa. Be aware of cultural and religious differences. If there is a language barrier, get an interpreter. Other points to observe when conducting an interview with patients Communication skills and history taking Communication skills is more than history taking. Patients come to doctors for different reasons not only for acute illnesses and emergencies, but to have proper explanation for their symptoms and to resolve concerns. Many medical problems can not be cured, and patients need to leave with chronic illnesses and disabilities and many patients have special needs. Communication with patients is not only about reaching a pathological diagnosis, but to get full assessment of each individual patient and his surroundings and to assess his needs. Being a great physician The good physician treats the disease ,the great physician understands the patient and the context of the patient is illness. (you should treat the whole person not just the disease). ( it is important to know what sort of person has the disease than to know what sort of disease a person has) Introduction to history taking History and clinical examination remain the most important tool in establishing a diagnosis and evaluation of patients. History taking is an art and skill and needs a lot of practice. Human beings are not the same, there is no typical or a model patient. History taking is not only asking a set of questions ,but it is an interactive process. Introduction to history taking Follow the principles of communication protocol for the interview. Make sure the place is suitable for the interview. As you meet the patient :  greet the patient , you do not need to shake hands. Introduce your self and the attendants with you. Explain what you want to do. Take verbal consent. History taking Make sure that you are talking to the correct patient. Follow the standard scheme of history taking. The only way to master history taking is by taking more and more histories (repetition is the art of learning ) This format is used by doctors all over the world. So do not try to develop modifications to this format. History taking Scheme of history taking: Demographic data or personnel history. Presenting complaint or complaints. History of the presenting complaint ,or history of the presenting illness. Review of systems, or systemic enquiry. Past medical history. Medications and allergies. Family history. Social history. History taking Demographic data : Name. Date of birth. Sex. Marital status Occupation or job now and previous. Address , phone , email. Religion. Nationality , ethnic group. History taking Presenting complaint or complaints. Ask the patient: What are you complaining of? Or what is the problem? Or tell me the story? Record it in the patient is own wards. Record the duration of each complaint. If the patient has more than one complaint ,record them in order of severity or duration. History taking Analysis of the present complaint or complaints : Carry out detailed analysis of the present complaint. Ask open ended questions. Avoid questions that have limited answers. History of the present complaint Use of SOCRATES acronym or mnemonic : S - site. O- onset. C- character. R - radiation. A - associated symptoms. T - timing. E - exacerbating and reliving factors. S - severity. History taking Review of systems : Start by the system you think is the source of the complaint. Do full analysis of the symptoms of systems. the History taking  The body systems :  Cardiovascular system.  Respiratory system.  Gastrointestinal system.  Genito urinary system.  Nervous system.  Locomotor or musculoskeletal system.  Endocrine system and metabolism.  Skin and appendages or integumentary system.  Hematopoitic system.  General none specific systems History taking Past medical history : Chronic illnesses ,other diseases. Operations and interventions. Injuries. Admissions and reason. Blood transfusion. Immunizations. History taking Medications and allergies : Any recent medications. Previous medications. Long term medications( cardiovascular ,neurological , steroids ,hormones ). Over the counter medications , aspirin ,NSAIDs, vitamins , CCP ,herbal preparations. If known allergies to medications ,other preparations and dressings etc. History taking Family history No of children. Chronic diseases in the family. Any familial or congenital diseases. Cause of death of close family members if known. Social history Occupation ,present and past ,exposure to hazards. Home circumstances ,type of residence ,sanitary conditions ,number of rooms , animal contact ,pets. Smoking , active and passive, if using tobacco in other forms , if ex smoker , for how long? Alcohol intake and substance misuse. Travel. Hobbies and activities. Social relations. History taking Psychiatric history if appropriate. Case summary.