Communication and The Consultation Dr Sarah Hands

Objectives for the Session Confirm the importance of developing good patient communication. Look at some different consultation models Have a chance to practice communication skills Look at a video using COT

Communication Theory “Communication is the process by which information is transmitted and received” ‘Process’ is a means to an end ‘Information’ includes factual + other + NVC ‘Received’ crucial verb as transmitting is only half the story “The meaning of the communication is the response that you get”

Communication Is Cyclical YOUR EXTERNAL BEHAVIOUR MY INTERNAL RESPONSE YOUR INTERNAL RESPONSE MY EXTERNAL BEHAVIOUR

Human Expressiveness Body language 55% Voice tonality 38% Words 7%

What are their moods?

Five Styles of Listening Ignoring Pretending to listen Selective listening Attentive – reflective listening Empathic listening – with intention to really understand

Listening Is a Three- Stage Process You hear what is said – all Vs & NVCs You understand what you heard – reflect, paraphrase summarise check understanding You interpret what you understood - you are then ready to respond

Think About…… Barriers to effective communication: Within the doctor Within the patient Within the environment

Barriers to Communication: Listener (Doctor) Mental state Poor listener – easily distracted Negative previous experience Pursuing own agenda Over-controlling Personal prejudices

Barriers to Communication: Speaker (Patient) Mental state Hidden agenda Lack of motivation Sensory impairment & language difficulties Easily distracted Negative previous experience Personal prejudices

Barriers to Communication: Environment External noise and interruptions Time factors – late busy, time constrained

Patient Agenda Beliefs Hopes and fears Hidden problems Expectations Presenting problems Secondary problems, perceived problems and perceived effects

Doctor Agenda Information gathering and fact collecting Analysing, further questioning clarifying Interpreting and verifying Sharing understanding

Characteristics of Empathic Listener Sets up meeting well – knowledge of patient Gives speaker 100% attention – relaxed, eye contact, tone Avoids half-hearing and jumping to conclusions Delays thinking of a response Does not interrupt with next point Tests own understanding – summarising, paraphrasing Tries to understand problem from other perspective

Consultation Structure Overview Content – questions, information, management Process – questioning, Vs and NVCs, relationship Attention to thoughts and feelings – decisions, problem solving, awareness of self

Doctor-Patient Relationships Sociological – behaviour value determined Anthropological – What happened, why now, why me, what if I did nothing? Transactional – Parent/adult/child Psychological – patient psychology determines outcome Verbal – follows doctor-initiated sequence* Non-verbal – response to mutual cues Balint – physical & psychological co-exist

Byrne and Long (1976) Original verbal model Phase 1 – Dr establishes relationship with patient Phase 2 – Dr attempts to discover reason for attendance Phase 3 – Dr conducts exam verbal/physical/both Phase 4 – Dr or Dr + patient or patient consider the condition Phase 5 – Dr & occasionally patient detail further treatment or investigation Phase 6 – consultation terminated usually by Dr

Pendleton Framework (1984) Basis for RCGP COT 1. Discover reason for patient’s attendance 2. Define the clinical problem(s) 3. Address the patient’s problem(s) 4. Explain the problem(s) to the patient 5. Make effective use of the consultation Resources Relationship Health Promotion

Consultation Observation Tool Discover reasons patient attendance 1. Appropriate encouragement, 2. Response to cues, 3. Use of context, 4. Health understanding explored Define clinical problems 5. Sufficient information, 6. Appropriate examination 7. Working diagnosis Explain problem to patient 8. Appropriate language, 9. Confirm understanding Address patient problems 10. Management appropriate, 11. Patient involved in decision management Make effective use of consultation 12. Use of resources e.g. time, 13. Follow up arrangement

Consultation Exercises Different Agenda Exercise Empathic Listening Exercise Using COT to look at and score a video