Session 2: Communication skills and the doctor-patient relationship

Question 1

List the 6 key competencies in the CanMEDs Physician Competency Framework.

Answer 1

1. Professional
2. Communicator
3. Collaborator
4. Leader and manager
5. Health advocate
6. Scholar

Question 2

What is an ethical therapeutic relationship in healthcare?

Answer 2

• Communication improves patients’ health and medical care
• Patients feel valued, understood & motivated to cooperate.
• Based on core ethics prescribed by HPCSA
• Respect, beneficence, non-maleficence, confidentiality,
  informed consent, privacy, compassion, tolerance,
  autonomy & human rights
• Failure to demonstrate these = patient complaints

Question 3

Name and describe three types of communication skills in healthcare.

Answer 3

1. CONTENT SKILLS
   - What HCP communicate
   - Substance of Q&A
   - Information
   - Treatments discussed
2. PROCESS SKILLS
   - How they do it
   - Verbal/non-verbal skills
   - Relationship
   - Structure of communication
3. PERCEPTUAL SKILLS
   - What they think/feel(internal decisions)
   - Problem solving/reasoning
   - Attitudes
   - Personal capacity(Compassion, respect)
   - Self-awareness/ self-confidence
   - Own biases/distractions

Question 4

What is patient-centered care?

Answer 4

• A relationship where patients are treated as partners in a two-way relationship
• Are respected for their individual values and concerns
• Involved in decision-making.

Question 5

Discuss the 3 aims of communication in health care.

Answer 5

1. Fundamental to medical practice
   * information gathering, diagnosis, and treatment, patient healthcare & health team interactions
2. International requirement in medical education
   * communication skills are important and patients expect good communication
   * define, teach and evaluate communication skills for doctors in training
3. Foundation of a doctor-patient relationship
   * always honour patient’s trust, do not abuse power & treat them with politeness and consideration
   * give out information in an understandable way
   * respect right to be involved in own healthcare

Question 6

List the 7 benefits of effective communication for the patient.

Answer 6

1. Increased satisfaction
2. Greater symptom resolution
3. Lower referral rates
4. Improved functional status
5. Enhanced health outcomes
6. Increasing compliance
7. Reduce anxiety, stress and vulnerability

Question 7

List the 5 benefits of effective communication for the physician (doctor).

Answer 7

1. Increased job satisfaction
2. Increased efficacy
3. Reduced malpractice
4. Increased well-being
5. Reduced stress and burnout

Question 8

List the 3 benefits of effective communication for medical care.

Answer 8

1. Improved diagnostic accuracy
2. Better doctor-patient relationships
3. Reduced errors

Question 9

Overview of 6 essential communication skills in a medical encounter.

Answer 9

1. Open the discussion
2. Gather information
3. Understand the patient’s perspective
4. Share information
5. Reach an agreement on problems and plans
6. Provide closure

Question 10

What are the 4 barriers to effective communication?

Answer 10

1. Patient health status
2. Diversity
3. Logistics
4. Doctor’s fears

Question 11

List the 5 patient health status factors that act as a communication barrier.

Answer 11

1. speech ability or language articulation
2. altered mental state
3. medication effects
4. cerebrovascular event
5. psychologic or emotional distress

Question 12

Name the factors that affect diversity as a communication barrier.

Answer 12

*race, gender, culture, language, values, personality, temperement

Question 13

Name the 4 logistics factors as a communication barrier

Answer 13

1. time constraints
2. not meeting face to face
3. venue, e.g. noisy background, interruptions, personal space
4. PPE

Question 14

List 5 the doctor’s fears as a communication barrier.

Answer 14

1. litigation
2. abuse
3. unrealistic patient expectation
4. burden of work
5. social media

Question 15

Describe verbal and non-verbal communication with examples.

Answer 15

Verbal: includes usage of words, speech and language patterns + voice, e.g volume, tone, speed, emotion.

Non-verbal: includes eye contact, facial expressions, body position, personal space, appearance/clothing, behaviour/physical contact, as well as gestures or the use of objects.

Question 16

Define relationship skills in the context of the therapeutic relationship.

Answer 16

Includes self-awareness and sensitivity to the needs of others, as well as the capacity for critical self-reflection.

Question 17

Discuss the 4 essential components to listening well.

Answer 17

1. Give 100% attention
   * suspend other activities, don’t judge, focus
2. Respond
   * verbal or non-verbal proves you received the message
3. Prove understanding
   * restate, question, don’t jump to conclusions
4. Prove respect
   * empathize, communicate at an appropriate level

Question 18

How to deal with diversity in communication with each other.

Answer 18

• Diversity may lead to conflict, misunderstanding, and distrust
• English may not be everyone’s primary language
• Culture is not obvious
• Cultural competence requires a good understanding of others and self

Question 19

How can communication be addressed in crises?

Answer 19

• Information must be delivered in small amounts
• Remain updated w/ trustworthy sources
• Patients and doctors fears compromised communication

Question 20

Addressing communication while wearing PPE.

Answer 20

• Can be intimidating/non-recognizable
• Establishing trust may be difficult
• Behave calmy and communicate clearly
• Children may be fearful