DR. SALAH R EL-FAQIH The Concept of Communication Skills in Medicine

What is Communication ● Is the act by which information is shared between humans ● It is the process by which we relate and interact with other people. ● It is a mutual process between 2 sides (Dialogue) not a one sided monologue. ● It includes listening & understanding with passion & respect as well as expressing views & ideas and passing information to others in a clear manner.

COMMUNICATION THEORY ● Communication is a learned skill or a series of learned skills which is based on 3 pillars: Accuracy Efficiency Supportiveness All combined contribute to effective communication

Communication: Why? ● Effective communication is the basis of mutual understanding & trust. ● Poor communication causes a lot of misunderstanding & hinders work & productivity.

Types of communication

Verbal Communication Speaking to the person  Look straight in the eye  make eye-ball contact  Show respect Clear message  Relevant  Use understandable language  Support by illustrations if needed Good listener  Allow them to understand the message and reply  Listen carefully  Make a dialogue ant not one way instruction

Communication & Medicine ● Historically the emphasis was on the biomedical model in medical training which places more value on technical proficiency than on communication skills. ● Recently learning communication skills & evidence based practice become integral part of modern medicine training. ● In healthcare institutions,effective communication is essential for patient safety

From the doctors What is required ● Support patients in caring for themselves to improve and maintain their health ● Work in partnership with patients ● Listen to patients and respond to their concerns and preferences. ● Give patients information in way they can understand ● Taking patient’s views into consideration when assessing their condition ● Respond to patients questions, keep them informed & share information. ● Support patients to self care ● Treat patients politely and considerately ● You must make sure, wherever practical, that arrangements are made to meet patient’s language and communication needs. ● Respect patients rights to confidentiality ● You must be considerate to relatives, carers and partners be sensitive and provide information and support.

continue-From the doctors What is required ● Communicate effectively with colleagues within and outside the team ● Make sure your patients and colleagues understand your role and responsibilities in the team and who is responsible for each aspect of patient care ● You must treat your colleagues fairly and with respect ● When referring a patient you must provide all relevant information about the patient.

Do doctors need communication? ● Doctors need to learn essentials of good communication more than other professionals because patients are humans with sensitive needs. ● Doctors cannot practice medicine without effective communication skills. ● Poor communication causes a lot of medico-legal and ethical problems.

Communication: With whom? ● Patients & care-givers ● Nurses & auxiliary staff ● Colleagues ● Administrators ● Evidence in court ● Reporting research findings ● Talking to the media ● Public & legislature

Communication: How? The medical interview is the usual communication encounter between the doctor and the patient. It can be classified according to the purpose of the interview into 4 types:  History taking  Breaking bad news  Consultations  Obtaining informed consent

Effective communication ● Ensures good working relationship ● Increases patients satisfaction ● Increases patients understanding of illness & management ● Improves patients compliance with treatment ● Reduce medico-legal problems ● Reduce uncertainty

Principles of effective communication ● Ensures an interaction rather than a direct transmission process (telling someone what to do or only listening is not enough). ● Demonstrates involvement as well as flexibility in relation to different individuals and contexts.

Principles of effective communication ● Requires planning and thinking in terms of outcomes. ● Follows the helical model ( i.e. what I say influences what you say in a spiral fashion and coming back around the spiral of communication at a little different level each time is essential). ● Shows empathy & learn how to handle emotional outbreaks.

COMMUNICATE AS A TEAM ● patient ● family ● physician ● other health care providers ● psychologist ● nurse ● social worker ● dietician

Communication with peers ● Mutual trust & respect ● Exchange information ● Ask your seniors ● Do your share of work

Communication & Medical care ● Good communication should be established between the patient, the family and the treating multidisciplinary team. ● patient & family should be encouraged to participate and verbalize in the ward round discussion about:  Offered medical care & treatment  Rehabilitation  Follow- up/re-admission plans  Doubts & worries.

Communication & Medical care ● Proper information to patient and family regarding services available and how they can utilize them. ● Information should be made available on:  Health Education/ Counseling & Psychiatry.  Endocrine, Metabolic, Neurology & nephrology.  Cardiology, Respiratory, GIT & hematology.  Nutrition, Immunization & ambulatory care.  Infections & infection control.  Clinical pharmacy & therapeutics.  Hygiene and Safety.

Communication skills: Some techniques ● Develope fluent dialogue with the patient ● Use silence effectively, allowing patients enough time to express thoughts or feelings ● Actively encourage the patient through use of supportive words or comments ● Dialogue with patients is enhanced by effective use of non-verbal behaviour ● Use open, exploratory questions – inviting patient to become actively involved ● Adjusted language as appropriate, to suit particular needs of the situation

Listening vs Hearing ● Hearing - a passive activity; no effort ● Listening - requires  active involvement, attention  interpretation of message  understanding  takes time and effort

Listen with Attention ● focus on patient or relative and give physical attention ● suitable environment - remove distractions and interruptions, make speaker feel comfortable ● eye contact ● use positive body language

Barriers to effective communication ● Personal attitudes ● Language ● Time management ● Working environment ● Ignorance ● Human failings (tiredness, stress) ● Inconsistency in providing information

The Art of Consultation ● Gauging the correct amount and type of information to give to each individual patient. ● Providing explanations that the patient can remember and understand & which relate to the patient’s illness framework. ● Using an interactive approach to ensure a shared understanding of the problem with the patient. ● Involving the patient and collaborative planning increase the patient’s commitment and adherence to plans made. ● Continuing to build a relationship and provide a supportive attitude.

Initiating the Consultation ● Establishing a supportive environment. ● Developing an awareness of the patient’s emotional state. ● Identifying as far as possible all the problems or issues that the patient has come to discuss. ● Establishing an agreed agenda or plan for the consultation. ● Enabling the patient to become part of a collaborative process.

Closing the interview ● Confirming the established plan of care. ● Clarifying next steps for both doctor and patient. ● Establishing contingency plans. ● Maximizing patient adherence and health outcomes. ● Making efficient use of time in the consultation. ● Continuing to allow the patient to feel part of a collaborative process and to build the doctor-patient relationship for the future.

Consultation Framwork

Doctors-Patients Relationship ● Developing rapport to enable the patient to feel understood, valued and supported. ● Encouraging an environment that maximizes accurate and efficient information gathering, planning & and explanation. ● Enabling supportive counseling as an end in itself.

Doctors-Patients Relationship/2 ● Involving the patient so that he/she understands and is comfortable with the process of the consultation. ● Increasing both the physician’s and the patients’ satisfaction with the consultation. ● Developing and maintaining a continuing relationship of trust & respect over time.

Conclusion ●Communication between the patients, family and heath team play a vital role in the compliance to outpatient clinic visits and in-patient care programs. ●Good communication is essential for proper doctor- patient relationship and help avoids problems of misunderstanding. ●Effective communication is the key to success in professional career. ●Effective communication is essential to the practice of high quality medicine