Introducing clinical communication Flashcards
(25 cards)
Describe the changes in the doctor-patient relationship
Differences in the process of consultation- the way questions are asked, amount of time for talking, expectations, shared-decision making, no longer paternalistic, changes in language, patient-centred approach adopted. We have also moved away from a purely biomedical outlook of disease- we now think of how the illness effects them and their lives.
Define patient-centeredness
Providing care that is respectful and responsive to individual preferences, needs and values- ensuring that patient values guide all clinical decisions.
Basically, understanding that the patient is a unique human being- doctors need to encourage patient participation.
How do we achieve a patient centred approach.
Explore patients' perception of illness Work in partnership on treatment plan Empathetic approach to help the patient feel at ease Open Questions Active Listening Respond to verbal and non-verbal cues Do not make assumptions or judgements.
What are the advantages of patient-centred communication
Accurate and comprehensive information gathering
More efficient consultations
Patients are more satisfied and less anxious
Patients can recall better, understand more and act on advice given
Patients are more involved in decision making
Improved health outcomes.
What are the core elements of an introduction
Formal gathering 'Hello, Good Morning' Full name- role- elicit patient's name Acknowledge- nice to meet you State the purpose Gain consent Never say a 'quick chat'
Which questioning style should you use initially
open- avoid multiple and leading questions
‘How are you feeling today’ ‘Can you describe the pain’ Elaborate- ‘What do you mean by that’ ‘Could you tell me a bit more’
How to approach personal or lifestyle questions
Don’t seem invasive- ask: Could we talk a little bit more about your day to day life.
Describe the importance of transition statements
Hold the interview together- provide direction so that the patient knows what is coming next. ‘We have discussed why you have come to the hospital, what I would like to do now is to ask you some questions about your health in the past’.
How to discover what IDEAS the patient has
‘What do you think could be causing this’ ‘How may this have started’ ‘What do you think could be causing these symptoms’
How to discover what CONCERNS the patient may have
‘Are you worries about these symptoms’
How to discover what EXPECTATIONS the patient may have
‘What are you hoping to get out of the consultation’
‘What would be the best outcome for you’
How to gather information
Start with open-ended questions Invite them to tell their story chronologically Don't interrupt Pick up cues Paralanguage Clarify any jargon Incorporate ICE Interim Summary
How to close the consultation
Signal closure- with a summary
Ask if there is anything else that they would like to mention
See if the summary is accurate
Parting statement- wish them well
When should you move to close ended questions
When you need to restrict the answer to create a more specific focus.
When may interruptions be necessary
When the patient seems uneasy or tense- when the patient is diverging from the question -when there is an urgency
What are the taxonomy of clues
Expression of feelings
Their attempts to understand or explain the symptoms
Speech clues that underscore particular concerns of the patient
Personal stories that link the patient with medical conditions or risks
Behaviours suggestive of unresolved concerns or unmet expectations
How to probe topics sensitively
Recognise the difficulty that they will have- I can see this is difficult for you- do you want to go on. Normalise it- many patients find this topic difficult- do you have any problems
Survey for other problems
So far you have mentioned head aches and back pain- anything else.
important to establish these at the start so that you have time to talk about them.
Set the agenda
It may not be possible to talk about everything in one consultation- prioritise and let them know the areas that you want to focus on.
Clarify patient terms
They may speak colloquially or they may use medical terms incorrectly- establish exactly what they mean.
The importance of making interim summaries
Allow you to check and clarify what you have understood- they also show the patient that you have been listening. They also assess the accuracy of your understanding.
The importance of avoiding multiple questions
Patients are likely to only answer parts of them- meaning vital information will be missed.
The importance of avoiding leading questions
’ You don’t smoke do you’- may seem biased and judgemental- patient likely to agree with you.
How to display empathy
I can see that this is painful- it must be difficult managing this for all these years
You still seem worried
It is ok to be upset
It can be extremely difficult.
