2. Professional skills part one 2008-2009 By Dr. Aziza Rajab Dr. Hashim Fida Assistant professor Assistant professor Head of Nursing dep. Family & community health King Abdul Aziz University king Abdul Aziz University

3. Professional skills -1 part one contents 1. What is communication, role of com. theory, types, components, process, why com. in healthcare and medicine, principle of effective com. 2. Principles of accurate perception 3. Understanding self concept 4. verbal and non verbal com./ body language 5. Listening and thinking in communication 6. Empathy, sympathy & empowerment of patients 7. Interpersonal relationship and self disclosure. 8. Doctor – patient relationship and How to build rapport 9. Principles of interviewing patients

4. Lecture 1 What is communication theory, process, models, types, components why com. in healthcare and medicine principle of effective com. Barrier ’ s to effective communication By Dr. Aziza Rajab Dr. Hashim Fida Assistant professor Assistant professor Head of Nursing department Family & community health King Abdul Aziz University king Abdul Aziz University

5. Objectives What is communication skills What is communication skills Communication theory Communication theory Communication essential components Communication essential components Communication models Communication models Steps of communication process Steps of communication process Communication types Communication types Communication why Communication why Principles of effective communication Principles of effective communication Barrier ’ s to effective communication Barrier ’ s to effective communication

6. What is communication? The simultaneous sharing and creating of meaning through human symbolic action. The simultaneous sharing and creating of meaning through human symbolic action. Is the act by which information is shared between humans. Such encounters may cover: Is the act by which information is shared between humans. Such encounters may cover: Desires Desires Needs Needs Perceptions Perceptions Knowledge Knowledge Affective states. Affective states. Communication 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. It may involve conventional or non-conventional signals. It may take linguistic or non-linguistic forms. It may occur through spoken or other modes.

7. COMMUNICATION THEORY Communication is a learned skill or a series of learned skills which is based on 3 pillars:   Accuracy   Efficiency   Supportiveness all combine to contribute to effectiveness of communication Experience is a poor teacher: it needs observation with well intentioned, constructive, detailed and descriptive feedback plus rehearsal to effect change. Communication is an art and like other arts it is a learned skill

8. What are the essential components of an effective communication ? Source / sender of information Source / sender of information Message ( knowledge, feelings, thoughts) Message ( knowledge, feelings, thoughts) Interference / interrupters of com. Interference / interrupters of com. Channel / media in and by which massage is delivered Channel / media in and by which massage is delivered Receiver Receiver Feedback Feedback Environment / context com. occurs Environment / context com. occurs

10. What are the models of communication? Linear Linear Interactive Interactive Transactional Transactional Can Communication be intentional or unintentional? is communication a process? Yes, it ’ s a series of actions that has no beginning or end and is constantly changing.

14. Linear

15. Interactive

16. Transactional

17. What is the steps of a communication process? Encoding: process by which the source translates thoughts or feelings in words, sounds, and physical expressions, which together make up the actual message. Encoding: process by which the source translates thoughts or feelings in words, sounds, and physical expressions, which together make up the actual message. Interaction: exchange of communications take turns sending& receiving messages Interaction: exchange of communications take turns sending& receiving messages Message: the stimulus that is produced by the source Message: the stimulus that is produced by the source Interference: anything that changes the meaning of an intended message, could be internal & psychological or external & physical Interference: anything that changes the meaning of an intended message, could be internal & psychological or external & physical Channel: the rout by which messages flow between senders and receivers (person or people who analyze and interprets the message) Channel: the rout by which messages flow between senders and receivers (person or people who analyze and interprets the message) Decoding: the process of translating a message into the thoughts, feelings that were communicated Decoding: the process of translating a message into the thoughts, feelings that were communicated Feed back: the response to a message that the receiver send to the source or sender ( increase our perception, accuracy and confident, help in learning about ourselves, adjust to others, maximize connection with other, serves as monitor of communication process) Feed back: the response to a message that the receiver send to the source or sender ( increase our perception, accuracy and confident, help in learning about ourselves, adjust to others, maximize connection with other, serves as monitor of communication process) Environment: the surrounding in which communication occurs Environment: the surrounding in which communication occurs Context: the circumstances or situation in which communication occurs Context: the circumstances or situation in which communication occurs

20. What are the types of communication? Intrapersonal communication: the process of understanding information within oneself. includes diverse internal activities, such as critical thinking, decision making, problem solving, conflict resolution, planning, stress and time management, developing, maintaining and evaluating relationships. Intrapersonal communication: the process of understanding information within oneself. includes diverse internal activities, such as critical thinking, decision making, problem solving, conflict resolution, planning, stress and time management, developing, maintaining and evaluating relationships. Interpersonal communication: also called dyadic communication: which is the informal exchange of information between two or more people such as Interpersonal communication: also called dyadic communication: which is the informal exchange of information between two or more people such as Interview : a careful planned and executed question and answer session designed to exchange desired information between two parties Interview : a careful planned and executed question and answer session designed to exchange desired information between two parties Group communication: an exchange of information among a relatively small number of persons, five to seven who share a common purpose or task such as, solving a problem, making a decision, reviewing a policy or sharing information. Group communication: an exchange of information among a relatively small number of persons, five to seven who share a common purpose or task such as, solving a problem, making a decision, reviewing a policy or sharing information. Public communication:Transmission of a message from one person who speaks to a number of individuals who listen. Public communication:Transmission of a message from one person who speaks to a number of individuals who listen. Mediated communication: Any communication transmitted by the use of technology means, such as radio, television, telephone or the internet,it may be one to one communication. Mediated communication: Any communication transmitted by the use of technology means, such as radio, television, telephone or the internet,it may be one to one communication. Mass communication: Communicating with or to a large number of people, such as lectures, election speeches. Mass communication: Communicating with or to a large number of people, such as lectures, election speeches.

21. 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 the corner stones of modern medicine.

22. Why communication? Communication is essential For all daily life competent interactions Communication is essential For all daily life competent interactions For better career development For better career development To Increase satisfaction and knowledge To Increase satisfaction and knowledge To decrease anxiety and distress To decrease anxiety and distress facilitate decision-making and coping facilitate decision-making and coping assists in accurate history taking and diagnosis assists in accurate history taking and diagnosis Effective communication is the basis of mutual understanding & trust. & hinders work & productivity. Poor communication causes a lot of misunderstanding & hinders work & productivity.

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

24. Effective communication does what? Ensures good working relationship Increases patients satisfaction Increases patients understanding of illness & management Improves patients compliance with treatment

25. Principles of effective communication Ensures an interaction rather than a direct transmission process (telling someone what to do or only listening is not enough). Reduces uncertainty. Demonstrates flexibility in relating to different individuals and contexts). 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.

26. Barriers to effective communication Personal ( lack of confidence, shyness, internal conversation, self talk, lack of objectivity, cultural differences, discomfort in sensitive situations, values believes, attitudes, feeling tiredness, stress) Language, Ignorance, Lack of Time management, Inconsistency in providing information Working environment (crowded, noisy, music playing, lack of privacy, telephone call, presence of assistants) Patient barriers( their negative perception about the desies and condition, less trust in knowledge and capabilities of health providers, think you are not interested in them, address them as cases, sense of inferiority) Administrative and financial barriers ( management strategies, economical support, number of staff, availability of recourses, policy and administrative decisions).

27. Communication Training why? to acquire knowledge of the basic features of verbal and non-verbal communication. to learn how to take a medical history from patients & relatives. to know about illness behavior, physician and patient roles, and relevant cultural beliefs. to learn how to draw up a plan for an interview, open and close interviews, explain the purpose and summary.

28. Communication Training why? Cont. to know how to communicate with patients who have a learning disability. to gain further experience of doctor- patient communication with different types of patient (e.g. male, female, different social and ethnic groups, school age children & elderly people). to learn the basic principles of clinical problem solving.

30. Lecture 2 Understanding Perception the nature of perception, perceptual differences, improving perceptional competencies and perception checkingBy Dr. Aziza Rajab Dr. Hashim Fida Assistant professor Assistant professor Head of Nursing department Family & community health King Abdul Aziz University king Abdul Aziz University Head of Nursing department Family & community health King Abdul Aziz University king Abdul Aziz University

31. Perception and Communication

32. Perception I know that you believe you understand what you think I said, but, I am not sure you realize that what you heard is not what I meant. I know that you believe you understand what you think I said, but, I am not sure you realize that what you heard is not what I meant.

33. Preview Perception defined Perception defined Influences of perception Influences of perception Four stages of perception Four stages of perception Pitfalls to accurate perception Pitfalls to accurate perception

34. The Role of Perception in Communication Perception Perception process through which people select, organize, and interpret sensory input to give meaning and order to the world around them process through which people select, organize, and interpret sensory input to give meaning and order to the world around them

35. Perception Defined The process by which we become aware of objects and events in the external world. The process by which we become aware of objects and events in the external world. The process of making sense of the world around us. The process of making sense of the world around us. Many people ignore the fact that all of us are different and that these differences equip us to view the world from our very own vantage points. Usually we spend more energy defending our own position than understanding others. Many people ignore the fact that all of us are different and that these differences equip us to view the world from our very own vantage points. Usually we spend more energy defending our own position than understanding others. Where does the triangle begin?

37. The Role of Perception in Communication Biases Biases systematic tendencies to use information about others in ways that can result in inaccurate perceptions systematic tendencies to use information about others in ways that can result in inaccurate perceptions

38. The Role of Perception in Communication Stereotypes Stereotypes often inaccurate beliefs about the characteristics of particular groups of people often inaccurate beliefs about the characteristics of particular groups of people can interfere with the encoding and decoding of messages can interfere with the encoding and decoding of messages

39. Influences on Perception Physiological (biological, neurological) Influences Physiological (biological, neurological) Influences Senses, age, health, fatigue, hunger, biological cycles Senses, age, health, fatigue, hunger, biological cycles Social Influences Social Influences Cultural Differences Cultural Differences Nonverbal behaviors, odors, speech, silence, space Nonverbal behaviors, odors, speech, silence, space Social Roles Social Roles Sex roles, gender roles, occupational roles Sex roles, gender roles, occupational roles Self-Concept Self-Concept Self-esteem, locus of control, attribution (attaching meaning to behavior) Self-esteem, locus of control, attribution (attaching meaning to behavior)

40. Perception Perception is the process of making sense of the world around us Perception is the process of making sense of the world around us Also called informational or cognitive processing Also called informational or cognitive processing Perception is influenced by two factors: Perception is influenced by two factors: Biological/Neurological — How we are hardwired Biological/Neurological — How we are hardwired Universal to all humans Universal to all humans Social — The different social influences in our lives Social — The different social influences in our lives Differs in all humans (men vs. women; US vs. Japan; 12 th vs. 21 st Century) Differs in all humans (men vs. women; US vs. Japan; 12 th vs. 21 st Century) It is important we understand this process if we are to become smart, competent communicators It is important we understand this process if we are to become smart, competent communicators It is the “ thing ” that happens before we even open our mouths It is the “ thing ” that happens before we even open our mouths

41. There are four stages of perception

42. Stage 1: Selection Life is a process of selecting information/data Life is a process of selecting information/data We are confronted with millions of pieces of stimuli each day (1,500 advertisements alone) We are confronted with millions of pieces of stimuli each day (1,500 advertisements alone) Factors That Influence Our Selection Factors That Influence Our Selection A. Interest (College Basketball, Movies, Music) A. Interest (College Basketball, Movies, Music) B. Need (lectures, traffic lights, buying 1 st car) B. Need (lectures, traffic lights, buying 1 st car) C. Aesthetics (noise, movement, color) C. Aesthetics (noise, movement, color) What advertisers, marketers, & designers do What advertisers, marketers, & designers do D. Biology (sensation seeking, ADHD, circadian rhythms) D. Biology (sensation seeking, ADHD, circadian rhythms)

47. Stage 2: Organization We put our “ selected ” data in cognitive “ folders ” We put our “ selected ” data in cognitive “ folders ” Also called: Schemata's or Cognitive Frameworks Also called: Schemata's or Cognitive Frameworks Three Principles of Organization: Three Principles of Organization: A) Binary Opposition (all things in pairs) A) Binary Opposition (all things in pairs) male/female, short/tall, white/black, good/bad male/female, short/tall, white/black, good/bad B) Already formed social categories B) Already formed social categories 101 students, sorority sisters, UK basketball players, Italians 101 students, sorority sisters, UK basketball players, Italians C) We also organize by similarities C) We also organize by similarities size (big buildings), color (things that are purple), space (things from Hawaii), smell (things that make us hungry), function (computer, phone, TV, DVD, VCR, CD player, pager, palm) size (big buildings), color (things that are purple), space (things from Hawaii), smell (things that make us hungry), function (computer, phone, TV, DVD, VCR, CD player, pager, palm)

51. How many Fs?

61. A Duck... Or a Rabbit?

63. Stage 3 Interpretation/Comprehension Next, we have to Evaluate the data in our folders Next, we have to Evaluate the data in our folders Larger files (more complete and accurate) Larger files (more complete and accurate) Smaller files (simplistic and underdeveloped) Smaller files (simplistic and underdeveloped) Our Comfort Zone: Our Comfort Zone: Not Comfortable with New or Small Folders Not Comfortable with New or Small Folders We like our old, Big Folders (Basketball) and avoid our small, underdeveloped folders We like our old, Big Folders (Basketball) and avoid our small, underdeveloped folders College Forces Us To Make New Folders College Forces Us To Make New Folders

65. Young, or old?

67. Native American... Or Eskimo?

68. Which line is longer? A B

69. Perfect Circle?

70. 1 2 345

71. 1 2 345

75. Count the black dots...

80. Ladder up … or down?

81. Which way is water flowing?

87. Stage 4 Retention and Memory We Don ’ t Retain All We Select! We Don ’ t Retain All We Select! Photographic Memory & Hypnosis (still not perfect) Photographic Memory & Hypnosis (still not perfect) Factors That Influence Long- term Memory Factors That Influence Long- term Memory A) Recency of Time (today vs. 10 years from now) A) Recency of Time (today vs. 10 years from now) B) Frequency of Use (628-2254, names, TV channels) B) Frequency of Use (628-2254, names, TV channels) C) Importance (test information, PIN number, anniversary) C) Importance (test information, PIN number, anniversary) D) Emotional Connection (1 st wedding) D) Emotional Connection (1 st wedding)

90. Pitfalls to Perception As much as we wish our minds (and the process of perception) were perfect, they are not As much as we wish our minds (and the process of perception) were perfect, they are not Ask the police at a crime scene reflecting on “ what went wrong ” Ask the police at a crime scene reflecting on “ what went wrong ” Some of our mistakes, however, are due to our “ biological brain ” playing tricks on us (below the level of consciousness) Some of our mistakes, however, are due to our “ biological brain ” playing tricks on us (below the level of consciousness) If we know what they are, we can prevent them! If we know what they are, we can prevent them!

91. There are 5 major “ biological ” pitfalls:

92. 1) Impressions of Others A) First Impressions of others A) First Impressions of others 1st impressions overwhelm 2nd & 3rd 1st impressions overwhelm 2nd & 3rd They tend to taint the rest of the interaction (for the better or worse) They tend to taint the rest of the interaction (for the better or worse) Start strong is what matters!! Start strong is what matters!! B) Negative Impressions of others B) Negative Impressions of others When people are aware of both positive and negative qualities, we tend to be more influenced by the negative When people are aware of both positive and negative qualities, we tend to be more influenced by the negative “ Bob is handsome, hardworking, intelligent and honest. He ’ s also conceited ” “ Bob is handsome, hardworking, intelligent and honest. He ’ s also conceited ” Did you keep Bob ’ s negative quality in perspective? 4 to 1 ratio! Did you keep Bob ’ s negative quality in perspective? 4 to 1 ratio!

93. 2) Halo & Devil Effect A) We select the first (positive or negative) “ obvious ” or “ dominant ” characteristic of a person A) We select the first (positive or negative) “ obvious ” or “ dominant ” characteristic of a person Physical appearance, weight, personality, wealth, clothing, regional accent, race, large nose, glasses, nice shoes, etc. Physical appearance, weight, personality, wealth, clothing, regional accent, race, large nose, glasses, nice shoes, etc. B) We then assign “ accompanying ” positive or negative traits to that person ( that they have not earned ) B) We then assign “ accompanying ” positive or negative traits to that person ( that they have not earned ) Halo--Attractive People: smart, happy, rich, honest Halo--Attractive People: smart, happy, rich, honest Devil--Unattractive People: dumb, poor, dishonest Devil--Unattractive People: dumb, poor, dishonest C) Problem: We unfairly punish some while rewarding others simply due to one dominant trait we happen to notice C) Problem: We unfairly punish some while rewarding others simply due to one dominant trait we happen to notice

94. 3) Selective Processes The mind likes consistency, simplicity, & balance. Any information that could “ disrupt the peace ” is seen as dangerous. Ergo, the brain tries to restore balance: The mind likes consistency, simplicity, & balance. Any information that could “ disrupt the peace ” is seen as dangerous. Ergo, the brain tries to restore balance: A. Selective Exposure A. Selective Exposure We attend to messages that are in accord with our already-held attitudes (conservative talk radio) We attend to messages that are in accord with our already-held attitudes (conservative talk radio) And avoid dissonance from other ideas And avoid dissonance from other ideas B. Selective Retention B. Selective Retention We remember what is consistent with pre- existing attitudes and interests We remember what is consistent with pre- existing attitudes and interests C. Selective Perception C. Selective Perception We mentally recast messages so that they are inline with our beliefs and attitudes We mentally recast messages so that they are inline with our beliefs and attitudes Classic Study by Allport and Postman in 1945 Classic Study by Allport and Postman in 1945

95. 4) Primary (first things) & Recency (last things) Theory The mind privileges things that come first and last in a set, list, or encounter The mind privileges things that come first and last in a set, list, or encounter Job Interviews (never get stuck in the middle) Job Interviews (never get stuck in the middle) Beauty Pageants & Talent Contests e.g. Greek Sing (statistics show bookends are more likely win) Beauty Pageants & Talent Contests e.g. Greek Sing (statistics show bookends are more likely win) Spelling Lists (the top & bottom are easy) Spelling Lists (the top & bottom are easy) Movies (intros & conclusions stay with us) Movies (intros & conclusions stay with us) Human Encounters (see pitfall #1) Human Encounters (see pitfall #1)

96. 5) Self-Serving Bias (AKA Fundamental Attribution Error) We alter our interpretations to favor ourselves & to “ cheat ” others: We alter our interpretations to favor ourselves & to “ cheat ” others: Your Test Grade: Your Test Grade: When we do well, it is because of internal factors When we do well, it is because of internal factors I worked hard--I ’ m smart I worked hard--I ’ m smart When we do poorly, it is because of external factors When we do poorly, it is because of external factors Your professor hates you Your professor hates you Others Test Grade: Others Test Grade: When others do well, it is because of external factors When others do well, it is because of external factors They got lucky--They were given special treatment They got lucky--They were given special treatment When others do bad, it is because of internal factors When others do bad, it is because of internal factors They are stupid and lazy They are stupid and lazy

97. Summary Perception defined Perception defined Influences of perception Influences of perception Four stages of perception Four stages of perception Pitfalls to accurate perception Pitfalls to accurate perception

99. Lecture 3 Self Concept relation between self concept / needs and self esteem, theories, definitions, influences on self concept, factors that enhances self concepts. By Dr. Hashim Fida Dr. Aziza Rajab Assistant professor Assistant professor Family & community health Head of Nursing department Family & community health Head of Nursing department King Abdul Aziz University king Abdul Aziz University

100. Self-Concept/Self-Esteem Cause or Effect?

101. THE SELF EARLY THEORISTS OF ‘THE SELF’ William James, Charles Cooley SELF-CONCEPT & SELF-ESTEEM Pelham & Swann (1989) Gender differences? Self-objectification theory

102. EARLY THEORISTS OF THE ‘SELF’

103. WILLIAM JAMES (1842--1910) “Principles of Psychology” Duality of Self: Self as object than can be observed I have property X “me” Self as agent doing the observing Self as the perceiver “I” Related to consciousness: the “I” does the perceiving, feeling,

104. CHARLES COOLEY (1864-1929) “Human Nature and the Social Order” The Social Self: Self can’t be understood in isolation--must be studied in interaction with others Self is not an inherent property of human nature but rather a socially-constructed entity: our sense of self is built upon the life-long experience of seeing ourselves through the eyes of others (“looking-glass self”)

105. Self-Concept A Composite of all Self-Definitions A Composite of all Self-Definitions Cognitions, Beliefs, Images, Emotions Cognitions, Beliefs, Images, Emotions Explanation of who we are Explanation of who we are In a constant state of CHANGE In a constant state of CHANGE Partitioned into separate identities Partitioned into separate identities Sports, Academic, Social, etc. Sports, Academic, Social, etc. Moderate Correlation to Academic Achievement Moderate Correlation to Academic Achievement

106. Self-Esteem An emotional reaction to who you are An emotional reaction to who you are A subsection of the Self-Concept A subsection of the Self-Concept Affection/Disaffection of ourselves Affection/Disaffection of ourselves Tied to performance in valued activities Tied to performance in valued activities Children have higher Self-Esteem Children have higher Self-Esteem Teenage females have moderate-low Self- Esteem Teenage females have moderate-low Self- Esteem Moderate Correlation to Achievement Moderate Correlation to Achievement

107. Classroom Techniques Maintain an atmosphere of TRUST. Maintain an atmosphere of TRUST. Help to recognize & process emotion Help to recognize & process emotion “ You ’ re feeling _______. ” “ You ’ re feeling _______. ” Predict how others might feel Predict how others might feel Be honest with your emotion Be honest with your emotion Cultural Awareness (Thai smiles) Cultural Awareness (Thai smiles)

108. Recap Our Self- Concept Self-Esteem Self-Image Our Self-Concept is made up of our self-esteem and our self-image

109. Definitions SELF-CONCEPT SELF-CONCEPT The sum total of the ways in which we think about ourselves The sum total of the ways in which we think about ourselves SELF ESTEEM - How highly we think about our abilities and our self. SELF IMAGE - How we view our self based on others reactions to us.

110. Self-concept SC is an organized cognitive set of traits, opinions, attitudes, notions, beliefs and other mental contents that an individual has about him/her-self.

111. Why study the self in social psych? Social factors influence how we think about ourselves. Social factors influence how we think about ourselves. We learn about ourselves by comparing ourselves with other people. We learn about ourselves by comparing ourselves with other people. Our self-views shift with our social surroundings. Our self-views shift with our social surroundings. The way people think and feel about themselves influences their social behavior. The way people think and feel about themselves influences their social behavior.

112. Self-concept areas(SDQ III) Mathematics Mathematics Verbal Verbal Academic Academic Problem solving/Creativity Problem solving/Creativity Physical abilities Physical abilities Physical appearance Physical appearance Relations with opposite sex peers Relations with opposite sex peers Relations with parents Relations with parents Religion/Spirit. Religion/Spirit. Honesty/Reliability Honesty/Reliability Emotional stability/Security Emotional stability/Security General self-concept General self-concept

114. A Positive Self-Concept A positive self-concept helps us in life – how we behave and act with others. A positive self-concept generally makes us feel happier.

115. Influences to Self-Concept Self-Concept Age Appearance Gender Culture Emotional Maturity Education Relationships Sexual Orientation Life Experiences

116. Age Self-concept changes as we get older. YOUNG CHILDREN: OLDER CHILDREN: ADOLESCENTS: ADULTS: ELDERLY: Younger children are limited to descriptions of themselves, like boy/girl, size etc. Older children can provide much more detailed descriptions; hair and eye colour, address, shoe size etc. Self concept can be explained in terms of beliefs, likes and dislikes, relationships. Adults can explain themselves in terms of quality of life and their personality. Older adults may have developed even more self knowledge and developed ‘wisdom’.

118. Appearance By the age of 10 or 12 we begin to compare ourselves to others. If we think we look good we have a positive self-image The important thing is we feel positive about the way we look. We can easily develop a negative self image and this can lead to a lack of confidence or to feel depressed about our relationships with other people.

119. How does how we dress affect our self- concept?

120. Gender Very early in life we know if we are a boy or a girl. How does this affect our self-concept and our lives? There are different social expectations of men and women Girls tend to do much better at school than boys, but boys do better at higher education. Why is this? Gender affects the type of employment we go for. Women are more likely to interrupt their careers to look after children.

121. Culture Different people have different customs and different ways of thinking. Your family or community may have different beliefs and expectations from other families and communities. These influences affect the way we think and are called ‘cultural influences’. Different cultures have different views of what is normal or right and wrong and these are our norms.

122. Cultural Influences and Norms Most British people wont eat frog’s legs, snails or horse meat. Parents who do not smoke will discourage their children from smoking. People from ethnic minority groups are more likely to live in an extended family.

123. What you think of as important, or right or wrong, will be influenced by the norms of the people around you. Your self-esteem will be influenced by cultural beliefs about what is right or wrong.

124. Objectives Recap self-concept and continue on factors that can influence it. Recap self-concept and continue on factors that can influence it.

125. Affect on Self-Concept. It can be difficult to be positive about yourself if you receive negative signals about a big part of your life. It can be difficult to be positive about yourself if you receive negative signals about a big part of your life.

126. Education Self-concept is strongly influenced by school. Self-concept is strongly influenced by school. You spend more than half your waking time at school, doing homework or doing school things. You spend more than half your waking time at school, doing homework or doing school things.

127. Education influences our self- concept You mix with other people and compare yourself to them Success or failure at school has an affect on self esteem Learn theories and ideas that help you to understand your life and that of others Friendships boost self esteem as it shows people want to be your friend The expectations of teachers influence your success or failure. Students expected to do well often perform better than those not. This is a self fulfilling prophecy. AGREE OR DISAGREE?

128. Relationships with others Write the following list of people on the back of the handout. Write the following list of people on the back of the handout. Mother or step-mother Mother or step-mother Father or step-father Father or step-father Brothers and sisters Brothers and sisters Best friend Best friend Teacher Teacher

129. Relationships ’ Effects Write one way in which each of these people have affected you or taught you something. Write one way in which each of these people have affected you or taught you something. Which relationship affected you the most? Which relationship affected you the most?

130. Forms of relationships Family relationships Family relationships Work relationships Work relationships Friendly relationships Friendly relationships Depending on the amount of time we spend with these people and the value we place on their opinions determines the extent that they affect our self-concept.

131. Group Task In groups of no more than 4 choose one of the factors that influence our self- concept and produce an A3 poster that contains the following information: In groups of no more than 4 choose one of the factors that influence our self- concept and produce an A3 poster that contains the following information: A title of the influencing factor (i.e. AGE) A title of the influencing factor (i.e. AGE) A definition of self-concept, self-esteem and self-image A definition of self-concept, self-esteem and self-image An outline of how the factor influences our self-concept. An outline of how the factor influences our self-concept. Choose from: Age, Appearance, Gender, Culture, Education, Relationships,. Choose from: Age, Appearance, Gender, Culture, Education, Relationships,.

132. Example AGE Self-Concept: xxxx Self Esteem: xxxx Self Image: xxxx Childhood Older Children AdolescenceAdults Elderly

133. Extension Questions When you have completed your poster and are fully prepared to present it to the class answer the following questions: When you have completed your poster and are fully prepared to present it to the class answer the following questions: 1. How might a very young child describe their self-concept? 1. How might a very young child describe their self-concept? 2. How can the way we dress affect our self- concept? 2. How can the way we dress affect our self- concept? 3. Write about a time when your own self image was affected. Why did this happen? 3. Write about a time when your own self image was affected. Why did this happen?

135. lecture 4 Verbal and non verbal communication, and body language the importance of elements of language, how to use language effectively, assertiveness, definitions, types, functions and techniques of using non verbal communication and body language In medicine By Dr. Aziza Rajab Dr. Hashim Fida Assistant professor Assistant professor Head of Nursing dep. Family & community health King Abdul Aziz University king Abdul Aziz University

136. What is verbal communication ?

137. what are the different Types of possible Reponses in the health field? what are the different Types of possible Reponses in the health field? Assertive response: - initiate com. In trust, confident atmosphere - initiate com. In trust, confident atmosphere - direct expression of ideas, opinions, desires - direct expression of ideas, opinions, desires - Stand up for oneself yet respect others - Stand up for oneself yet respect others Non assertive response: - Fear for rejection, need for approval, every body should like me and approve of what I do - Over concern to others needs & rights I should please all Passive response: wait other to start, avoid conflict, low self esteem, victimize themselves, Aggressive response: win in short term – lose on long run, always in conflict, hostile, say their feelings and thoughts

138. How to be assertive? What is assertiveness? Clearly communicating your needs and expectation with respect to others and with no or minimal compromises or damaging relationship. What are assertive techniques? Provide and invite feed back Provide and invite feed back Setting limits Setting limits Making request Making request Being persistent Being persistent Ignoring provocation and focussing on problem in hand Ignoring provocation and focussing on problem in hand Responding to criticism without losing temper, objectivity, and mutual respect Responding to criticism without losing temper, objectivity, and mutual respect

139. What is non verbal communication ? 1. Body language ( includes all behaviors that used to communicate messages such as facial expression, posture, appearance( skin color, body size, shape,, space, time, touch distance, furniture lay out, grooming, makeup, clothing, eye glasses, eye contact, smile.. 2. Tone of voice, volume, silence. 3. Written communications

144. What are the Characteristics of non verbal com. Occurs constantly Occurs constantly More believable than verbal & powerful & interdependent with verbal com. More believable than verbal & powerful & interdependent with verbal com. It is a primary mean of communication It is a primary mean of communication Depend and relate to culture and context greatly Depend and relate to culture and context greatly Ambiguous, and ever changing Ambiguous, and ever changing Carries most of the meaning of the message 93% specially the feeling and attitude Carries most of the meaning of the message 93% specially the feeling and attitude Frequent source of misunderstandings Frequent source of misunderstandings Do not follow a universal rules, not a language Do not follow a universal rules, not a language Spontaneous and unintentional Spontaneous and unintentional Can be learned Can be learned Critical in building trust relationship Critical in building trust relationship

145. What are the Functions of non verbal com. Complements the verbal communication Complements the verbal communication Regulating and controlling the information in verbal communication Regulating and controlling the information in verbal communication Deceiving the verbal incorrect information Deceiving the verbal incorrect information Substituting the verbal communication Substituting the verbal communication Interpreting the verbal communication Interpreting the verbal communication Improving the message of verbal communication Improving the message of verbal communication

147. Lecture 5 connecting listening and thinking in communicating with patient By Dr. Aziza Rajab Dr. Hashim Fida Assistant professor Assistant professor Head of Nursing dep. Family & community health King Abdul Aziz University king Abdul Aziz University

148. What is listening ? The process of receiving, constructing meaning from and responding to spoken or nonverbal messages. The process of receiving, constructing meaning from and responding to spoken or nonverbal messages. Giving feedback is an important part of being an effective listener. Giving feedback is an important part of being an effective listener.

149. Stages of effective listening Hearing Hearing Understanding. Understanding. Remembering. Remembering. Interpreting. Interpreting. Evaluating. Evaluating. Responding. Responding.

151. The functions of listening Obtain information. Obtain information. Evaluate. Evaluate. Empathy. Empathy. Enjoyment. Enjoyment.

152. HURIER model Developed by listening scholar Judi Brownell.

153. Barriers to effective listening The topic or the speaker is uninteresting. The topic or the speaker is uninteresting. Criticizing the speaker instead of the message. Criticizing the speaker instead of the message. Concentrating on details,not main ideas. Concentrating on details,not main ideas. Avoiding difficult listening situations. Avoiding difficult listening situations. Tolerating or failing to adjust to distractions. Tolerating or failing to adjust to distractions. Faking attention. Faking attention.

154. Competent Listeners Be prepared to listen. Be prepared to listen. Behave like a good listener. Behave like a good listener. Take good notes. Take good notes. Ask question to clarify information. Ask question to clarify information.

156. Lecture 6 interpersonal communication and self disclosure By Dr. Aziza Rajab Dr. Hashim Fida Assistant professor Assistant professor Head of Nursing dep. Family & community health King Abdul Aziz University king Abdul Aziz University

157. What do we mean by interpersonal communication ? It is the process of sending and receiving information or communication with another person

158. What is the function of interpersonal communication ? Gaining information Gaining information Learn to interact with others Learn to interact with others Assess personal needs Assess personal needs Help us better learn and understand others Help us better learn and understand others

159. Phases of interpersonal relationship Entry phase. Entry phase. Personal phase. Personal phase. Exit phase. Exit phase.

160. Interpersonal communication needs are based on the following theories: 1. Uncertainty Reduction Theory (A theory suggesting that when we meet others to whom we are attracted, our need to know about them tends to make us draw inferences from observable physical data. 2. Predicted Outcome Value Theory (A theory that suggests that people connect with others because they believe that rewards or positive outcomes will result. 3. Social Exchange Theory (A theory based on the assumption that people consciously & deliberately weigh the costs & rewards associated with a relationship or interaction.

161. 4.Reward (Anything that we perceive as beneficial to our self- interest. 5.Costs (Negative rewards,things that we perceive to be not beneficial to our self-interests. 6. Orientation Theory (A theory that provides insight into our motivation to communicate. 7. Schutz ’ s theory of need for - affection (lovable) referred as personal, under personal, or over personal) - inclusion referred as social, under social, or over social. - Controlreferred as abdicrats, autocrats, or democrats. 4.Reward (Anything that we perceive as beneficial to our self- interest. 5.Costs (Negative rewards,things that we perceive to be not beneficial to our self-interests. 6. Orientation Theory (A theory that provides insight into our motivation to communicate. 7. Schutz ’ s theory of need for - affection (lovable) referred as personal, under personal, or over personal) - inclusion referred as social, under social, or over social. - Controlreferred as abdicrats, autocrats, or democrats.

162. What is self disclosure Voluntary sharing of information about the self that another person is not likely to know.

163. Benefits of self disclosure The principal benefit of self-disclosure should be personal growth (self- understanding and self-improvement). The principal benefit of self-disclosure should be personal growth (self- understanding and self-improvement). Encourages development of interpersonal relationships. Encourages development of interpersonal relationships.

164. Stages of self -disclosure Self – presentation. Self – presentation. Relationship building. Relationship building. Catharsis. Catharsis.

165. Johari Window Model A graphic model describing human interaction during relationships in four different levels of knowledge.

166. Social Penetration Model Dept h Breadth Depth

167. Facts about self-disclosure 1. Increases with intimacy. 2. Increases with reward. 3. Increases to reduce uncertainty. 4. Is a reciprocal. 5. Gender: -women disclose more than men. -women disclose more than men. -women disclose more with the close person, while men disclose more with the person they trust. -women disclose more with the close person, while men disclose more with the person they trust.

168. Effective self-disclosure The situation and factors about the other person should be considered before communication. The situation and factors about the other person should be considered before communication. Accept personal complexity. Accept personal complexity. Be flexible and sense when to communicate. Be flexible and sense when to communicate. Do not change values,but change the ways of communicating them. Do not change values,but change the ways of communicating them. Choose the language. Choose the language.

169. Appropriate self-disclosure Reasoned. Reasoned. Two way process. Two way process. Appropriate to the person and the situation. Appropriate to the person and the situation. Consider diversity: individual, group and culture. Consider diversity: individual, group and culture. Be positive. Be positive.

171. Lecture 7 empathy, sympathy and empowerment By Dr. Aziza Rajab Dr. Hashim Fida Assistant professor Assistant professor Head of Nursing dep. Family & community health King Abdul Aziz University king Abdul Aziz University King Abdul Aziz University king Abdul Aziz University

172. What are the importance of empathy and sympathy? Can not build rapport or gain trust without showing those feelings Can not build rapport or gain trust without showing those feelings Back bone for establishing and solidifying helping relationship Back bone for establishing and solidifying helping relationship Help in developing mutual understanding Help in developing mutual understanding Guide us to build appropriate perceptions Guide us to build appropriate perceptions Help us to understand the message Help us to understand the message

173. how to differentiate between empathy and sympathy? Sympathy is to identify and communicate that you understand the patients feelings. Sympathy is to identify and communicate that you understand the patients feelings. ( e.g. I understand what you are saying, I know how you are feeling) Empathy is to share his/her feelings ( e.g. I do feel exactly what you feel ) Empathy is to share his/her feelings ( e.g. I do feel exactly what you feel )

174. What is empowerment? Empowerment is helping others to trust themselves, to identify, know, and believe in them selves and their abilities Empowerment is helping others to trust themselves, to identify, know, and believe in them selves and their abilities Enable others to act independently for him/her self, choose and decide for them selves. Enable others to act independently for him/her self, choose and decide for them selves. Enhancing people ’ s creativity, cooperation, inspiration, and productivity. Enhancing people ’ s creativity, cooperation, inspiration, and productivity.

175. How to be sympathetic ? Try to listen effectively, Try to listen effectively, try to understand and perceive things as they are try to understand and perceive things as they are Try to accept the feelings and point of views without changing them, stop them, or judge them, Try to accept the feelings and point of views without changing them, stop them, or judge them, try to pay attention try to pay attention Try to be consistent Try to be consistent Try to reflect on the patients feeling verbally by summarizing, paraphrasing to show your caring attitude to patient Try to reflect on the patients feeling verbally by summarizing, paraphrasing to show your caring attitude to patient Try to be genuine and sincere in your relation with patient Try to be genuine and sincere in your relation with patient Try to Respect and accept patient feelings Try to Respect and accept patient feelings Try to set limits ( I don ’ t have time now but we will talk next visit) Try to set limits ( I don ’ t have time now but we will talk next visit)

176. What are the type of empathic responses that we should avoid? 1. Judging response: to evaluate another ’ s feelings: Tell patients in various ways that they should not feel discouraged or frustrated, they shouldn ’ t worry,they shouldn ’ t question their treatment by other health professionals. Any message from you that indicate you think patient is wrong or bad, will make patient think and feel that you are not worth his trust and he cant build confidence for a helping relationship.

177. 2. Advising response: we can offer quick solution to another person ’ s concern with or without correct perception to his exact needs The best source of solution to the problem is always within the patient him/her self. Rely on other for advise may keep patients dependent this is against the empowerment idea we talked earlier When there are times when patients are not capable of coping or understanding or deciding for a solution to their problem, you should walk them and direct them to the solution without dictating it to them. It has to be and show that it is coming from them not you.

178. 3. Reassuring response: telling patients who is facing surgery do not worry, every thing will be fine, you will turn out just fine. It may seems to be helpful but it is conveying that the person should not feel upset, scared of the procedure, and concerned about the outcomes. You should tell the patient with exact words what is the procedure steps briefly in understood words, explain the risk in an honest words, state the expected outcomes, and the assurance part has to be in the part how practices, competent you are, how careful you will be, and how common this procedure is, and that his fear is very normal to feel.

179. 4. Distracting response: changing the subject, or cutting off patient ’ s talk or feeling just because we don ’ t know how to response to them We might direct the communication to topics we feel comfortable with such as medication regimens and so forth These responses tend to convey to patients that we are not listening, or we don ’ t want to listen.

181. Lecture 8 Doctor-patient Relationship building a rapport with patients ? By Dr. Aziza Rajab Dr. Hashim Fida Assistant professor Assistant professor Head of Nursing department Family & community health King Abdul Aziz University king Abdul Aziz University

182. Doctors ’ Mission Doctors ’ primary goals are: To treat and cure where possible To treat and cure where possible To bring relief in suffering To bring relief in suffering To help the patient cope with illness, disability and death. To help the patient cope with illness, disability and death.

183. Doctor- patient relationship The doctor – patient relationship is built on : The doctor – patient relationship is built on : 1. Honesty 2. Confidentiality 3. Trust and reliability

184. How to enhance doctor- patient 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. Using the verbal responses and non verbal behaviors appropriately Involving the patient so that he/she understands and is comfortable with the process of interview and the consultation. Increasing both the physician’s and the patients’ satisfaction with the communication. Developing and maintaining a continuing relationship of trust & respect over time.

187. Why doctors Communicate? Gain Mutual trust & respect Exchange information Ask your seniors Do your share of work Interview and consult patients Conduct Seminar & workshops

188. with whom doctors Ccommunicate? patient patient family family physician physician health care administrators health care administrators Media Media psychologist psychologist nurse nurse social worker social worker Dietician Dietician Pharmacist Pharmacist others others

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

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

191. We need to communicate to build a trust relationship with whom ? Patients & care-givers Nurses & auxiliary staff Colleagues Administrators Evidence in court Reporting research findings Talking to the media Public at large

192. How can doctors build a positive rapport with their patients ?

193. What is rapport? Rapport is the ability to connect, the ability to trust, the ability to express feeling and thoughts, the ability to understand, the ability to accept the other as is without judgment, and the ability to exchange information honestly and freely during formal or informal interviews. It is the process of creating a goodwill between the interviewer and the interviewee.

194. How can we build a rapport? Using therapeutic communication techniques Using therapeutic communication techniques Use the non verbal body language ( time, space, touch, smile, eye contact, dress, distance, location, expressions, grooming), and the verbal ( the way we talk and address each other, the tone, voice, words used), and the formality levels should be used appropriately as needed to enhance connectivity. Use the non verbal body language ( time, space, touch, smile, eye contact, dress, distance, location, expressions, grooming), and the verbal ( the way we talk and address each other, the tone, voice, words used), and the formality levels should be used appropriately as needed to enhance connectivity. Avoid being judgmental, labeling, and criticizing Avoid being judgmental, labeling, and criticizing Empower patients and lower their feeling of powerlessness, helplessness, dependability. Empower patients and lower their feeling of powerlessness, helplessness, dependability. Show sympathy and empathy as needed. Show sympathy and empathy as needed.

195. How do I know that there is a positive rapport between me and the other party? When the interviewer and the interviewee share a similar world view or situational view When the interviewer and the interviewee share a similar world view or situational view When we are not jugging the person but rather trying to understand them more When we are not jugging the person but rather trying to understand them more When we are able to express and communicate our thoughts and feeling without fear or criticism to the other person When we are able to express and communicate our thoughts and feeling without fear or criticism to the other person When we mutually are understood correctly. When we mutually are understood correctly.

196. What are the doctors attitude and behaviors that can damage a helping relationship and obstruct you from building rapport? 1. Stereotyping: seeing a patient as a person with stereotype behavior, then,most probably you as a doctor will fail to listen without judgment, and your judgmental thoughts will reflect in your behavior & words, and patient will not build trust, there won ’ t be no rapport. we must see patient as an individual and accept him/her as is we must see patient as an individual and accept him/her as is

197. 2.. Depersonalizing :if we focus our communication on specific problems and cases only, without taking the patient and his culture, background, thoughts& feeling in account, then we are really not understanding the person as a whole, and trying to implement solutions that are inapplicable because we don ’ t have enough connectivity with patient to comprehend the big picture about his/her circumstances.

198. 3.Controling : doctors usually try to run the show when it comes to diagnose and treat patients, they rely on what they know more to decide for care, rather than trying to understand more from the patient about his feelings and thoughts about the disease it self and their preferences of the treatment. Increased levels of patients participation and control over the health care interventions, usually empowers patients, and gives positive results that includes improved health, less complications & general quality of life positive outcomes.

199. Lack of communication and poor doctor- patient relationship : why? Clinicians focus often on relieving patients' bodily pain, less often on their emotional distress, seldom on their suffering. Some of them view suffering as beyond their professional responsibilities. If clinicians feel unable to, or simply do not want to, address the powerful issue of patient suffering, it is appropriate to refer the patient to another professional on the healthcare team who is more comfortable in this area.

201. Lecture 9 How to Interview Patient By Dr. Aziza Rajab Dr. Hashim Fida Assistant professor Assistant professor Head of Nursing dep. Family & community health King Abdul Aziz University king Abdul Aziz University

202. What is an interview? Professional Interview in the medical field is an interpersonal communication method and process to gather or/ and exchange information by using therapeutic communication techniques. It is one of the most common methods used in patients assessment

203. with whom and why to do Interview ? 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

204. What are the steps of the interview? 1. Determine the purpose of the interview ( job interview, patient assessment, … ) ( job interview, patient assessment, … ) 1. Determine the objectives of the interview 2. Pre- research the topic and the person 3. Prepare the questions and the context 4. Organize the interview (opening, body, and closing) 5. Record and document the interview

205. What are the differences between formal and informal interview? In the Informal interview: there is small social talks at the beginning to get self comfortable, oriented, and prepare to be ready for the real sensitive issues. In the Informal interview: there is small social talks at the beginning to get self comfortable, oriented, and prepare to be ready for the real sensitive issues. In the formal interview: the interviewer takes more direct, focused, serious, and in-depth elaborative approach to patients concerns and complains. In the formal interview: the interviewer takes more direct, focused, serious, and in-depth elaborative approach to patients concerns and complains.

206. What are the Components of effective interview? 1. Differentiate between therapeutic and non therapeutic communications 2. Establish rapport 3. Prepare the environment, choose right time, get client comfortably situated 4. Listen instead of just hearing 5. Differentiate between empathy sympathy 6. Avoid being superficial and routines, Get to the sensitive issues

207. How therapeutic comm. Is different than social comm. Therapeutic communication characteristics unlike the social interactions, must be : 1. Goal oriented, planned, and focused on specific objectives. 2. Leagal accountability and responsibility for the given information. 3. Credibility of information and good reputation of the informer. 4. Mutual understanding between all parties involved in the communication.

208. Strategies to conduct an interview? 1-Use open ended questions always that makes the person think and elaborate on the question, and encourage the patient to tell their own story, specially in the start, such as: What exactly happened, how do you feel about it, why do you think this is the problem, can you explain to me this, can you talk more on this … What exactly happened, how do you feel about it, why do you think this is the problem, can you explain to me this, can you talk more on this … (this will be time consuming at the beginning of the interview and hard to control, but that is ok because you want to build trust and understand your patient well( (this will be time consuming at the beginning of the interview and hard to control, but that is ok because you want to build trust and understand your patient well(

209. Strategies to conduct an interview? Cont. 2. Lower patients defensiveness by: - Asking proper type of questions such as the what? and how? - Minimize the why question, it makes patients feel that they need to give justifications always and that might intimidate them, and make them feel guilt and responsible for what ever situation they are facing - Use silence to allow patient to finish answering before asking next question and to avoid feeling of being interrogated

210. Strategies to conduct an interview? Cont. 3. Use closed ended questions appropriately only when you need to establish factual details quickly such as :does it hurt you when you cough? The yes and no answer gives you the exact information that you need for understanding the problem, but they often will not allow patients concerns and anxieties to be expressed.

211. Strategies to conduct an interview? Cont. 4- use probing questions for clarification and verification of information: ( e.g. for clarification: exactly what do you mean by that? ) ( e.g. for clarification: exactly what do you mean by that? ) ( e.g. for verification : did I hear you say that you do not take your medication at all?)

212. Strategies to conduct an interview? Cont. 5. Do not Use and avoid leading questions such as ( e.g. I think your pain increases at night ?) They specify the answer you expect to get, there is no advantage of using it. 6- always listen and use silence and touch whenever needed to express sympathy and keep building trust 7- accept and respect patients

213. Strategies to conduct an interview? Cont. 8- summarize : always summarize to patients what has been discussed in brief and points ( e.g. so we can conclude from our session today that you agreed to control your diabetes by measuring blood sugar twice a day, eat seven small meals instead of three big ones, and walk at least half an hour daily, right? Is there something else?)

214. Critical thinking questions 1. What are the most important concepts doctors need to take in consideration in building a helping relationship with patients? 2. What are the main obstacles in building a rapport in any interpersonal relationship?