M2: Principles of communication (More G2K on Trans) Flashcards
(105 cards)
1
Q
imparting of information between a sender and a receiver
A
Communication
2
Q
3 reasons why good communication
is important:
A
- To provide better healthcare for patients
- To address the needs or concerns of the patient effectively
- Have a positive effect on the patient’s physical condition
3
Q
7 characteristics of the
interviewer that patients prefer: (G2K)
A
- Warm and sympathetic
- Easy to talk to
- Introduces themselves
- Self-confident
- Does not repeat themselves
- Listens to them and responds to verbal cues
- Asks questions that were easily understood and
were precise
4
Q
FREQUENT COMPLAINTS
OF DISSATISFIED PATIENTS
A
- Not listening
- Not given information
- Lack of concern to the patient
5
Q
Difficulties medical students encountered during interviewing their patient included (G2K)
A
- Not enough information
- Forgot to ask influence of the patient’s problem
- Fail to observe verbal cues
- Bored during interview
6
Q
The following are the most effective ways/methods for learning communication skills:
A
- Set the goal of the training
- Teacher acts first
- Students follow by practice
- Students receive feedback
- Students discuss their performance with a tutor
7
Q
Factors by which people cope with illness in different ways are the following:
A
(PUSEL)
- Personality
- Upbringing
- Social class
- Ethnicity
- Life experiences
8
Q
5 Patient related factors
A
(CAPPP)
- Current experience
- Anxiety
- Physical symptoms
- Psychological factors
- Previous experience
9
Q
Ideal distance between seating arrangements
A
1.25 to 2.75 meters (4 to 9 feet).
10
Q
How to interview bed ridden patients
A
- Don’t stand over them as much as possible
2. Get a chair and sit the same level as them
11
Q
Verbal cue that may signify problem areas when talking to your patient
A
“Slips of the tongue”
12
Q
It sometimes surfaces as a last, desperate attempt to
communicate because, with a hand on door, escape is readily accessible if the physician’s reaction is unfavorable.
A
HAND-ON-DOORKNOB SYNDROME
13
Q
Because of fear of rejection or humiliation, the patient may test the physician with minor complaints before mentioning the real reason for the visit
A
HAND-ON-DOORKNOB SYNDROME
14
Q
It is a good practice to ask the patient routinely at the
end of the visit (G2K)
A
“Is there anything we have not covered
or anything else you would like to ask me?”
15
Q
voice effect that accompanies or modifies talking and often communicates meaning
A
Paralanguage
16
Q
These 8 are conveyed by qualities of voice
A
- Urgency,
- sincerity,
- confidence,
- hesitation,
- thoughtfulness,
- happiness
- sadness,
- apprehension
17
Q
action that can reverse the meaning of words.
A
Tone of voice
18
Q
3 vocal messages
A
- Emotional quality
- Tone of Voice
- Length of pauses
19
Q
is a common example of a contradiction
between vocal and verbal messages
A
Sarcasm
20
Q
the study of nonverbal gestures, or body
movements, and their meaning as a form of
communication
A
Kinesics
21
Q
5 body languages
A
- Posture
- Head motion
- Facial expression
- Eye contact
- Gestures
22
Q
The tense person sits ___
A
erect with a fairly rigid posture
23
Q
person who is moderately relaxed has a ____ sitting position
A
forward lean of approximately 20 degrees and a side lean of up to 10 degrees.
24
Q
Higher patient satisfaction is associated with a _____ sitting position
A
physician’s forward body lean and rotation of the torso to-ward the patient.
25
A very relaxed position (usually too relaxed for
| physicians interacting with patients) is a _____
back- ward lean (i.e., recline) of 20 degrees and a side- ways lean of more than 10 degrees.
26
found that “the patient also responds more favorably to the physician who relaxes his chin in his hands and gazes directly at the patient,
Larsen and Smith
27
Rapport is improved if the physician does not _____
Intimidate the patient
28
When good rapport exists between two people, each
| will be _____ the other’s movements
MIRRORING
29
When listening to a patient, the physician should show interest and concern by an attentive position, which is best illustrated by _____
sitting forward in the chair with an interested, attentive facial expression and the head slightly tilted.
30
are least affected by
these cultural disguises and are the most consistently
dependable indicators of emotion.
The eyebrows, eyes, and forehead
31
can be a physician’s most effective weapon for
breaking down resistance or apprehension, especially in
children or young adults.
A smile
32
Micro-expressions last only about
one-fifth (1/5) of a
| second
33
can easily be missed if physician is
| not carefully observant of the patient.
Micro-expressions
34
2 Instances when micro-expressions occur are when
| emotions are concealed by:
1. Repression (unwittingly)
| 2. Suppression (deliberately)
35
The briefest expression
Surprise
36
Facial expression for Fear
Upper eyelids raised
37
Facial expression for Disgust
Nose wrinkled
38
Facial expression for Anger
Jaw thrust forward
39
Facial expression for Determination
Lips pressed
40
Facial expression for Sadness
Eyebrows drawn up or lip corners down
41
In most cultures, 60% to 70% of the time, good rap-port is enhanced when
Eye contact is made
42
90% of gaze will be in a
triangular area between eyes
| and mouth
43
Pupils ___ when person sees something pleasant, and ____ when unpleasant.
Dilate, contract
44
is the best method for conveying sincerity; it is the most appropriate technique used when listening to another person.
Frequent eye contact
45
shown when patient’s eyes blink frequently or dart back and forth
Anxiety
46
shown when patient maintains eye contact only one-fourth as long as non-depressed patients
Depression
47
The following are cues for patients with abdominal pain
| caused by organic disease
1. They are more likely to keep eyes open during
palpation of the abdomen than those with nonspecific
pain.
2. Patient with genuine abdominal tenderness may
apprehensively watch the physician’s hand as it
approaches the tender area.
48
distinguished when hands are fidgety and grasping, when they shake when holding a pain, twitch,
or braced unnaturally.
Anxiety
49
tightly-locked fingers that can
| be an effort to mask anxiety
White-knuckle pose
50
when speaker joins her/his hands, with
| fingers extended and fingertips touching
Steepling
51
index finger along the lips or extended along the cheek
“The thinker” position
52
a defensive gesture that can indicate disagreement with another’s view
Crossed arms
53
common leg position of comfort
Crossed legs
54
gestures that can be an attempt to (establish
| rapport) and good interpersonal relations
Preening
55
the frequent clearing
| of the throat even when no phlegm/mucus is present
Respiratory avoidance response
56
a reflection of the fact that a (split) is being
| forced between inner thoughts and outward action
Nose flick
57
when what patient says
| does not match his/her facial expression or gestures
Verbal-nonverbal mismatch
58
Example of Verbal-nonverbal mismatch
Asymmetric facial expressions and a prolonged smile
59
Enable one to obtain information and allow patients
| to tell their own story
Open questions
60
Reasons why open questions are more preferable
1. More relevant information can be obtained
2. Patients feel more involved in the interview.
3. Patients can express themselves
61
Questioning that Give patients little choice
Specific or closed questions
62
Type of interview conducted as if the interviewer and
| interviewee were close friends or relatives
Cambridge style
63
during a consultation indicates to the
| patient what you want to discuss next.
Signposting
64
is a powerful therapeutic tool during interview
Empathy
65
7 How to demonstrate empathy
(EMPATHY)
1. Eye contact
2. Muscle of facial expression
3. Posture
4. Affect
5. Tone of voice
6. Hearing the whole patient
7. Your response
66
imparting ideas or thoughts through verbal and
| nonverbal means
Communication
67
Clinical competence includes
1. Medical technical knowledge
2. Physical examination
3. Medical problem solving
68
categories of skills
1. Content skill
2. Process Skill
3. Perceptual skill
69
(Skills develop) on what doctors like you do. The (substance) of the questions you ask and the answers you receive
Content Skills
70
Skills develop on (how doctors like you to do it)
Ex:
• How you ask questions
• How well you listen
Process Skills
71
What doctors like you are thinking and feeling, or the (awareness of your own decision making) and other thought. It also Processes, (awareness) of, and response to your own attitudes and emotions during an interview
Perceptual Skills
72
for the well-conceived,
| well-delivered message
Shot-put (unilateral) approach
73
for interaction, feed-back,
| relationship, confirmation, common ground
Frisbee (bilateral) approach
74
5 FRAMEWORK OF THE CALGARY CAMBRIDGE GUIDE
1. Initiate
2. Gather info
3. Build relationship
4. Explain
5. Close
75
In the 1970s, there were a series of studies on
| medical students during their clerkship in psychiatry. Before training, students experienced difficulties in
obtaining histories from patients.
76
2 Results for students who received feedback training with regards to communicating with patients are as follows:
1. Feedback group = 3x accurate info on patient problem
| 2. Feedback group = given high ratings
77
3 Results for doctors who received video feedback training as students showed the following:
1. More empathetic.
2. More self assured
3. Better communication skills
78
4 Factors that contribute to anxiety
1. Unfamiliar environment
2. Loss of personal space
3. Separation from family and friends
4. Loss of independency
79
6 Doctor related factors in communicating
1. Training in communication
2. Self-confidence
3. Personality
4. Physical factors (e.g. tiredness)
5. Psychological factors (e.g. anxiety)
6. Preoccupation
80
is extremely important (since it explains why patients believe they need the physician’s
help).
The chief complaint
81
These 4 are primarily transmitted verbally during consultations.
1. Symptoms,
2. past medical history,
3. family medical history
4. psychosocial data
82
Patients who do not mention a concern and who withhold requests are _______
Less satisfied with their care and less improved on their symptoms
83
Korsch and Negrete (1972) found that some of the longest interviews between physician and patient were caused by
failures in communication
84
Examples of paralanguage
1. Velocity of speech
2. Tone and volume
3. Sighs and grunts
4. Pauses
5. Inflections
85
There is a _____ duration in which two people who meet will scan each other’s face before gazing
downward.
3 second
86
What do locked ankles signify?
Defensiveness
87
Anger may be seen when feet are....
placed widely apart in
| a position of stability
88
Sadness is seen when feet are.....
Moving in slow circular pattern
89
Examples of preening
→ Male pulling up socks, adjusting a tie, or combing hair
→ Female adjusting clothing or using a mirror to
review makeup
90
Respiratory avoidance response means
indication of disgust or rejection
91
Nose Rubbing means
Lying or struggle to appear calm
92
9 Indications of lying (G2K)
1. Nose rub
2. pulling earlobe
3. rub eye
4. scratch neck side
5. cover mouth with hand
6. Micro expression
7. Using arm and hand less
8. Defensiveness
9. Changing posture abruptly
93
when the patient answers “fine” to the question “how are things between you and your husband” while looking sad and avoiding eye contact. This gesture signifies
Verbal-nonverbal-mismatch
94
3 behaviors about asking questions that
| studies of medical students and doctors have found
→ Too many questions = not giving chance
→ Too complicated/confusing questions
→ Ignoring questions that patients may ask
95
“ How you have
| been feeling in the past few days?” is an example of what kind of question?
Open ended question
96
3 Disadvantage of open question
1. Too Long interview
2. Irrelevant info
3. Difficult in recording
97
“Have you been feeling unwell today?” is an example of what question?
Closed question
98
3 Disadvantage of close style of questioning
→ Info is restricted to the question
→ The interview is controlled by the interviewer
→ The interviewee has little opportunity to express themselves
99
Guidelines in an interview
1. Set atmosphere
2. Facilitate the patient
3. Use open Q (Beginning)
4. Use close Q (when appropriate
5. Listen carefully
6. Clarify
7. Be alert for cues
8. Encourage relevancy
100
“What you’ve just told me about your job is interesting, but I’d like to hear more about the headaches you’ve been having. It would
help me to know more about the circumstances that
bring on your chest pain.” Is an example of
Relevancy
101
What to do when the situation is silent
1. Observe the patient
2. Reflect
3. Plan
4. Dont rush
102
“And now I would like to ask you a few more questions
| about…” and “Thank you for discussing your problems with me and now I would like to examine you.” are examples of
SIGNPOSTING
103
a powerful means of communication and Expresses a range of emotions including tender-ness,
love, and anger
Touch
104
5 Essentials needed to learn skills and change behavior are as follows
1. Systematic presentation of skills
2. Observation
3. Detailed feedback
4. Practice
5. Reiterate
105
4 GOALS OF MEDICAL COMMUNICATION
1. Collaboration
2. Increase accuracy and efficiency
3. Enhancing patient and physician satisfaction
4. Improving health outcomes
