INTRODUCTION TO BLOCK MEDICAL COMMUNICATION

Putu Sutisna

Communication imparting, conveying or exchanging of ideas, news, knowledge etc. There are several methods of communication.

Purposes of Communication
to form & maintain relationship to give information to convey feelings to persuade to solve problems to alleviate distress to make decisions (to give) reassurance

Ancient aim of a physician:

To cure sometimes, relieve often, comfort always

Communication in Medicine
Doctor patient/family Doctor doctor Doctor community

Main areas covered in Block MC

1. A.Taking medical history and review of body systems B. Giving information to patient C. Special approach to specific patient/situation 2. Paper presentation and discussion 3. Writing medical letters & notes, and CV 4. Scientific writing (5. Health education & health promotion for community at large)

BASIC CONCEPTS OF

COMMUNICATION WITH PATIENT AND FAMILY

Putu Sutisna

Doctor-Patient Communication:
Influencing Factors
Patient-related factors - Physical symptoms - Pathological factors related to illness - Previous experience of medical care - Current experience of med care

 Doctor-related factors -Training in communication skills - Self-confidence in ability to communicate - Personality - Physical factors (e.g. tiredness) - Psychological factors (e.g. anxiety) Interview setting requirements - Privacy - Comfortable surroundings - Appropriate seating arrangement

Guidelines for conducting interview with patient

A. Beginning 1. Greet patient by name, shake hand (?) 2. Ask patient to sit down 3. Introduce yourself 4. Explain purpose of interview 5. Say how much time available 6. Explain need to take notes

B. Main part of interview 1. Maintain +ve atmosphere, warm manner, eye contact 2. Use open questions, esp at beginning 3. Listen carefully 4. Be alert and responsive to verbal & non verbal cues 5. Facilitate patient verbally & non-verbally 6. Use closed questions when appropriate

7. Clarify what patient has told you 8. Encourage patient to be relevant C. Ending 1. Summarize what patient has told you 2. Ask if patient wants to add anything 3. Thank patient

 Key skills for communicating effectively with patient: Questioning Listening Facilitating

1. Questioning
Main purpose of interviewing patient: to obtain information about patients condition that is accurate, complete and relevant Good communication with patient alone contributes to correct diagnosis in about 80% of cases

 Open questions
should be used as much as possible to obtain great deal of information from patient Examples: Would you please tell me how you have been feeling in the past few days? I understand that you have had pain. Would you please tell me more about it? Can you tell me what brings it on?etc

 Closed questions
Give patient little choice in the way to answer Usually elicits little information, only yes or no. Examples: Have you been feeling unwell today? I see from your GPs notes that you have had chest pain. Do you still have the pain? Was it tight or dull pain? Did it go down your arm? Did it get worse when you exercised?

What are the advantages of open questions? More relevant information in given time Patient feels more involved Patient can express all concerns and anxieties about problems When to use close questions? Obtain specific information not yet given by patient In emergency cases

2. Listening
Features of active and effective listening: Gathering and retaining information accurately Understanding implications for patient of what is being said Responding verbal & non-verbal signals or cues Demonstrating you are paying attention and trying to understand

Non-verbal cues: Eye contact Posture Gestures Facial expressions Way voice is used

3. Facilitating
Part of effective listening. Aims to help patient to talk fully about problems. By verbal way Please go on and tell me more about your pain. Yes, I understandplease continue. Non verbal ways: Leaning slightly forward toward patient Making eye contact Nodding head at appropriate time

Pitfalls in communication! Asking too many or complicated questions Not allowing patient to tell story in own words Unnecessary interruption Failing to pick up important verbal & nonverbal cues

Communication with Family

How family can help?
Provide emotional & social support Provide practical support Provide understanding of beliefs about illness & treatment Provide information about family history Help avoid/overcome bad patient compliance Overcome difficulties arising from secrets Anticipate/address problems that may affect other family members

Conclusion
Dr Rene Laennec (1781-1826) Listen to your patient. They are giving you the diagnosis

THANK YOU