1. Patient Communication “The Dance We Do” Brian E. Wood, D.O. Associate Professor and Chair, Department of Neuropsychiatry and Behavioral Sciences Edward Via Virginia College of Osteopathic Medicine brwood6@vcom.vt.edu

2. Communication a process by which information is exchanged between individuals through a common system of symbols, signs, or behavior exchange of information personal rapport Meriam-Webster Online Dictionary

3. Why Communicate? To include someone in interaction To impart to someone something you want them to understand. To attempt to understand something about others. Innate human drive to seek others. – Fascination with the existence of other life – Personification in fantasy/literature, etc.

5. Biology of Communication Very complex interplay of physiological functions controlled by the:

6. The Missing Link Brain functioning and communication are directly linked. The brain, when working properly, uses many complex mechanisms of communication to “connect” with other organisms. One of the predominant mechanisms is language but there are others. – Posture, physical presence – Gestures and mannerisms – Appearance and expression

7. Mental Status Exam Observation of brain functioning is the goal Complications/limitations – Attempting to derive information about brain functioning through observation of behavior and responses to tasks, etc. – Looking at brain functioning through overlay of learned responses, behavior, dynamics, etc. Examination remains science with art – Not unlike any other medical examination (ex. Auscultation)

8. Characteristics of Patient Communication Mental Status (functioning of the CNS) is integrally involved There are two parties – You – The patient There is a constant two way street – Communication to and from the patient There is a dynamic interplay

9. Language Language encompasses many complex processes. Not just speech Expressive language – Written – Verbal – Prosidy Receptive language – Written – Verbal – Prosidy

10. Non-verbal communication Patient appearance – Anxious ? – Distracted? Does the non-verbal communication conflict with verbal ? – Often when patients have barriers to verbal communication (ambivalence, social barriers, etc.), we see mixed messages from verbal and non-verbal sources.

11. Eliciting Information Eliciting information from only verbal sources – Content or fact oriented – Very limited scope to patient communication – Close ended factual information gathering Eliciting information from multiple sources – Much more complete view of patient status – Content (static) plus Process (dynamic) information – Open ended

12. Patient Interview Design Should incorporate ways of getting both content and process information. Open ended questions for sensitivity. Close ended questions for specificity. Information In Information Out Open Ended Process Close Ended Content

13. Patient Interview Content – Factual (ex.) History of illnesses Current living arrangements – Close ended – Provided directly or indirectly. Process – Interaction based (ex.) Rapoirte Openess to examiner – Open ended – Based on observation of patient and environmental interactions.

14. Effects of CNS Abnormalities Can abnormalities in brain functioning affect content of information? What brain functions might be involved? – Fairly direct relationships. Can abnormalities in brain functioning affect process information? Which brain functions? – Much more complex issues – May be subtle but very significant

15. Mental Status Abnormalities and their Effects Content – Factual errors – Distortion of information (ex. Negativistic thinking) Process – Inability to establish relationship with examiner. – Inability to filter extraneous environmental cues – Inability to understand (capacity)

16. Factual Errors and Distortions May introduce error into elements of history and thus diagnostic decisions. May be dependent on multiple factors including patient functioning and environment. Usually requires corroborating source of information.

17. Inability to Interact with Examiner. May result in complete inability to acquire reliable factual information. Be aware of your interactions and how the patient is interpreting them. May require treatment of the patient and/or adjustment of examiner technique in order to engage patient in therapeutic interaction.

18. Capacity Ability to engage in some sort of cognitive process Many different types or areas of capacity – Capacity to understand – Capacity to manage affairs – Capacity to give informed consent Not an “all or nothing phenomenon”