Flashcards in Person Centred Communication in Primary Care Deck (54)
Why is effective communication essential to high quality medicine?
Complaints about communication skills feature heavily in a large percentage of claims against doctors ("my doctor won't listen", "my doctor never explains anything to me")
Research shows that in improves patient satisfaction, recall, understanding, concordance and outcomes of care
What are the 4 essential components of clinical competence?
What 3 broad types of skills are needed for successful medical interviewing?
What are content skills?
What doctors communicate- the substance of their questions and responses, the information they gather and give; the treatments
What are perceptual skills?
What they are thinking and feeling - their internal decision making, clinical reasoning; their awareeness of their own biases, atitudes and distractions.
What are process skills?
How they do it- the way doctors communicate with patients; how they go aboyt discovering the history or providing information; the verbal and non-verbal skills they use; the way they structure and organise communication
What physical factors influence a consulatation?
Site and environment
Adequacy of medical records
How can site and environment influence a consultation?
Attendence at a roadside accident in the dark, cold and pouring rain, with bystanders milling around and sometimes offering advice is obviously a different scenario to the doctor managing this same problem in the emergency department of a major hospital
How can the adequacy of medical records influence a consultation?
Many patients have continuing health problems.
An adequate record of the history of the illness, patient background, drugs in current use, etc, will avoid the need to waste time in reviewing such matters whenever the patient attends
How can time constraints influence a consultation?
A time is usually allocated to each appointment which in itself is determined by many factors.
there is usually an upper limit of time available and in certain cases this will significantly influence the consultation
How may patient status influence a consultation?
New patient or known patient, new problem or old problem
What personal factors can influence a consultation?
Backgrounds and origins
Knowledge and skills
How may age influence a consultation?
As a general rule younger doctors are sought after by younger patients and older doctors by older patients, with of course considerable overlap.
How may sex influence a consultation?
Similar attitude with age differences.
A barrier may exist to effective communicatoin if a patient is forced to consult a doctor of the opposite sex when the reverse is preferred
how may backgrounds and origins influence a consultation?
in particular social class and ethnic factors.
There may be considerable language difficulties in both these instances which could adversely affect outcome
How may knowledge and skills influence a consultation?
This is an important factor to the doctor but to a lesser extent with the patient.
Consider the position of the doctor when he or she is a patient
How may beliefs influence a consultation?
Everyone has thier own health beliefs about all sorts of aspects affecting illness and disease (e.g. vitamin taking, ideas about weather affecting illness, bizarre theories about cause of disease, etc)
Beliefs may be influences by your medical training: most patients do not have that luxury.
health beliefs are often influenced by the media, other people, past experiences, and are often not medically accurate
How may the illness influence a consultation?
A consultation in which is patient is to be told that he has a terminal illness will be much more difficult to conduct than one where only a minor illness is present
What are the 3 styles of doctor/patient relationships in medical interviewing have been described by Szasz and Hollender?
Authoritarian or paternalistic relationship
Mutual participation relationship
What is a authoritarian or paternalistic doctor/patient relationship?
The physician uses all of the authority inherent in his status and the patient feels no autonomy.
He tries hard to please the doctor and does not actively participate in his own treatment
What is a guidance/co-operation doctor/patient relationship?
The physician still exercises much authority and the patient is obedient, but has a greater feeling of autonomy and participates somewhat more actively in the relationship
What is a mutual participation doctor/patient relationship?
This is the most desirable for the more complex diagnostic interview, as it is for the management of patients suffering from a chronic illness.
Here the patient feels some responsibility for a successful outcome which involes both active participation and a feeling of relatively greater personal autonomy.
This is created by appropriate moderation of the doctor's use of his authority.
In such a relationship, the widest range of relevant diagnostic information tends to emerge and the most successful outcome of treatment is likely to occur
The medical consultation typically involves up to 3 separate activities.
What are they?
Doctor examing the patient
What is the open ended question?
Essential in initiating the interview.
A question such as, "what kind of troubles have you been having?" may start to elicit an account of the problems and worries that a patient has
What do we mean by listening in a consultation?
Vital to the quality of communication are active listening skills.
This means asking questions thta follow on logically from what the patient has told you, encouraging them to talk by nodding, making eye contact, etc, plus picking up on the patients body language (i.e. nervousness, eye filling with tears)
What so we mean by silence in a consultation?
While the patient is communicating freely the doctors behaviour of choice is an interested attentive and relaxed silence. An attentive facial expression and posture tells the patient non-verbally that s/he has an interested listener.
Silence can also encourage communication. If the petient falls silent the interviewer should consider being silent him- or herself for at least a brief time (a few seconds- not a long uncomfortable gap!) If one senses that the patient is holding back and that his/her non-verbal behaviour reflects tension or discomfort, one's silence is likely to be appropriate
What is facilitation in a consultation?
Facilitation encourages communication by using manner, gesture or words that do not specify the kind of information that is sought.
It suggests that the doctor is interested, and encourages the patient to continue.
Silence and facilitation tend to go hand in hand - an interested, attentive manner is of course facilitating.
Change of facial expression or posture displaying greater interest or attention is facilitation
What are the different types of questions?
What are the advantages and disadvantages of questions in a consultation?
When the doctor asks a question of the patient s/he tends to take control of the interview and so directs it along the lines of his/her own thinking or hypothesis generation.
Although this is quite valid, the use of questions too early in an interview still confines the amount of information the patient may give.
More importantly it may completely disrupt the true priorities of the patients concern and prevent the doctor from finding out other reasons for the patient's attendence than those contained within the patient's opening statement