Patient centred communication

Question 1

What is a patient-centred interview?

Answer 1

A patient centred interview:

• focuses on the patient’s needs in the interview
• makes history-taking and problem-solving more accurate
• promotes an active role for the patient in planning and carrying out treatment plans (Shared model)
• enables more efficient practice

Question 2

Why is it important to use patient centred interviews?

Answer 2

Patient centred interviews allow paitents to express their main concerns. This:

• Improves diagnostic efficiency
• Increases patient satisfaction
• Increases concordance with management plans
• Improves recovery
• Reduces the number of symptoms

Question 3

Why is it important to seek the patients’ specific requests

Answer 3

Specific requests may not be apparent from the presenting complaint

Patient satisfaction is improved if the patient is acknowledged

Patients look for a variety of information in primary care, a minority seek medication

Only a minory of patients voice all their agendas in the consultation

Question 4

What are four components that a doctor should do in a patient centred interview?

Answer 4

Allow patients to express their major concerns

Seek the patient’s specific requests

Facilitate the patient’s expression of their feeling

Gives the patient information

Question 5

Why is it important to provide patients with information in the consultation?

Answer 5

Doctors often over-estimate how much information is provided.

Patients that are coached in their understanding of chronic illness acheive improved physiological outcomes (diabetes, hypertension and peptic ulcer disease)

Question 6

Why is it important to teach communication skills?

Answer 6

It is a core clinical skill

It is a series of learned skills

Experience can be a poor teacher of communication skills

Communication can be taught

Changes resulting from communication skills training can be measured

Changes resulting from communication skills training can be retained

Question 7

What are the components of the Calgary Cambridge Model?

Answer 7

Five tasks:
Commencing the consultation
Gathering information
Physical examination
Explanation and planning
Closing the consultation

Two functions:
Building the relationship
Providing structure

Question 8

What are the categories of competence in the Leicester Assessment Package?

Answer 8

Interviewing/history taking
Physical examination
Patient management
Problem-solving
Behaviour/relationship with patients
Anticipatory care
Record-keeping

Question 9

What are the objectives for the start of the consultation?

Answer 9

Establishing a supportive environment and initial rapport

Developing an awareness of the patient’s emotional state

Identifying all the problems or issues that patient has come to discuss

Establishing a mutually agreed plan for the consultation with the patient

Developing a partnership with the patient

Question 10

Name four things that should be done to prepare for the consultation

Answer 10

put aside the last task

attend to personal needs and comfort

shift focus to consultation at hand

conclude these activities before greeting the patient

Question 11

State four things you can do to establish rapport with a patient

Answer 11

greet the patient, obtain patient’s name

introduce self, role, nature of interview

obtain consent

demonstrate interest and respect, attend to patient’s physical comfort

explain confidentiality

Question 12

How can you identify the reasons for the consultation from the patient?

Answer 12

use open questions
listen attentively without interruption
use pauses
facilitative the patient’s responses

non-verbal skills
pick up verbal and non-verbal cues
confirm list and screen for further problems
negotiate agenda taking both patient’s and doctor’s needs into account

Question 13

What are the objectives for gathering information from the patient

Answer 13

Exploring the patient’s problem to discover the biomedical perspective, patient’s perspective and background information.

Ensuring that information is accurate, complete and mutually understood

Ensuring patients feel listened to, and that their information and views are welcomed and valued

Continue to develop a supportive environment and collaborative relationship

Structuring the consultation to ensure information can be gathered efficiently, and enable the patient to be involved in the interview.

Question 14

What skills are needed to explore the patient’s problem in a consultation?

Answer 14

encourage patient to tell their story
use open and closed questioning techniques
listen attentively
facilitate patient’s responses
pick up verbal and non-verbal cues

clarify patient’s statements
summarise to verify own understanding
use concise, easily understood questions and comments
avoid or explain jargon
establish date and sequence of events
avoid multiple questions
avoid leading questions

Question 15

What in addition to the clinical information, should be actively gathered in the consultation?

Answer 15

Need to actively determine and explore patient’s ideas, concerns and expectations and encourage the patient to express their feelings.

Question 16

What are the objectives for building a relationship in the consultation?

Answer 16

Developing rapport so the patient feels understood, valued and supported

Establishing trust between doctor and patient, laying down the foundation of a therapeutic relationship

Encouraging an environment that maximises the consultation process

Enabling supportive counselling as an end in itself

Developing and maintaining a continuing relationship over time

Involving the patient so that s/he understands and is comfortable with participating

Reducing potential conflict between doctor and patient

Increasing the patient’s and doctor’s satisfaction with the consultation

Question 17

What are the skills required to build a good relationship with the patient in the consultation?

Answer 17

Non-verbal: use of notes, pick up patient’s nonverbal cues, demonstrate appropriate nonverbal behaviour.

Developing rapport: accept patient’s views and feelings as legitimate, use empathy, acknowledge patient’s views and feelings, provide support, deal sensitively with embarrasing and disturbing topics.

Involving the patient: share thinking with the patient, explain rationale, during physical examination explain and ask permission

Question 18

How can you provide structure to the consultation as a doctor?

Answer 18

Make the organisation clear: Signposting, summarise to confirm understanding

Pay attention to the flow of the consultation: structure the interview in a logical sequence, keep to time, keep the interview on task.

Question 19

What are the objectives for closing the consultation?

Answer 19

Confirming the established plan of care

Clarifying the next steps for both doctor and patient

Establishing contingency plans

Maximising patient adherence and health outcomes

Making efficient use of time in the consultation

Continuing to encourage patient to feel part of a collaborative process and to build the doctor -patient relationship for the future

Question 20

What skills are required to effectively close the consultation?

Answer 20

Forward planning: decide with the patient next steps are for patient and doctor, safety net (if anything should happen between now and then)

Ensuring appropriate point of closure: summarise, final check for any other questions.