Download Communication Skills 2011

Communication and
The Consultation
Dr Sarah Hands
Objectives for the Session
• Confirm the importance of developing
good patient communication.
• Look at some different consultation
models
• Have a chance to practice
communication skills
• Look at a video using COT
Communication Theory
• “Communication is the process by which
information is transmitted and received”
• ‘Process’ is a means to an end
• ‘Information’ includes factual + other + NVC
• ‘Received’ crucial verb as transmitting is only
half the story
• “The meaning of the communication is the
response that you get”
Communication Is Cyclical
YOUR EXTERNAL BEHAVIOUR
YOUR INTERNAL RESPONSE
MY INTERNAL RESPONSE
MY EXTERNAL BEHAVIOUR
Human Expressiveness
• Body language 55%
• Voice tonality 38%
• Words 7%
What are their moods?
Five Styles of Listening
1.
2.
3.
4.
5.
Ignoring
Pretending to listen
Selective listening
Attentive – reflective listening
Empathic listening – with intention to really
understand
Listening Is a Three- Stage
Process
1. You hear what is said – all Vs & NVCs
2. You understand what you heard – reflect,
paraphrase summarise check understanding
3. You interpret what you understood - you
are then ready to respond
Think About……
Barriers to effective communication:
• Within the doctor
• Within the patient
• Within the environment
Barriers to Communication:
Listener (Doctor)
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Mental state
Poor listener – easily distracted
Negative previous experience
Pursuing own agenda
Over-controlling
Personal prejudices
Barriers to Communication:
Speaker (Patient)
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Mental state
Hidden agenda
Lack of motivation
Sensory impairment & language difficulties
Easily distracted
Negative previous experience
Personal prejudices
Barriers to Communication:
Environment
• External noise and interruptions
• Time factors – late busy, time constrained
Patient Agenda
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Beliefs
Hopes and fears
Hidden problems
Expectations
Presenting problems
Secondary problems, perceived problems
and perceived effects
Doctor Agenda
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Information gathering and fact collecting
Analysing, further questioning clarifying
Interpreting and verifying
Sharing understanding
Characteristics of Empathic Listener
• Sets up meeting well – knowledge of patient
• Gives speaker 100% attention – relaxed, eye contact,
tone
• Avoids half-hearing and jumping to conclusions
• Delays thinking of a response
• Does not interrupt with next point
• Tests own understanding – summarising,
paraphrasing
• Tries to understand problem from other perspective
Consultation Structure Overview
• Content – questions, information,
management
• Process – questioning, Vs and NVCs,
relationship
• Attention to thoughts and feelings –
decisions, problem solving, awareness of self
Doctor-Patient Relationships
• Sociological – behaviour value determined
• Anthropological – What happened, why now,
why me, what if I did nothing?
• Transactional – Parent/adult/child
• Psychological – patient psychology
determines outcome
• Verbal – follows doctor-initiated sequence*
• Non-verbal – response to mutual cues
• Balint – physical & psychological co-exist
Byrne and Long (1976)
Original verbal model
• Phase 1 – Dr establishes relationship with patient
• Phase 2 – Dr attempts to discover reason for
attendance
• Phase 3 – Dr conducts exam verbal/physical/both
• Phase 4 – Dr or Dr + patient or patient consider the
condition
• Phase 5 – Dr & occasionally patient detail further
treatment or investigation
• Phase 6 – consultation terminated usually by Dr
Pendleton Framework (1984)
Basis for RCGP COT
1. Discover reason for patient’s attendance
2. Define the clinical problem(s)
3. Address the patient’s problem(s)
4. Explain the problem(s) to the patient
5. Make effective use of the consultation
– Resources
– Relationship
– Health Promotion
Consultation Observation Tool
•
Discover reasons patient attendance
– 1. Appropriate encouragement, 2. Response to cues, 3. Use
of context, 4. Health understanding explored
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Define clinical problems
– 5. Sufficient information, 6. Appropriate examination
7. Working diagnosis
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Explain problem to patient
– 8. Appropriate language, 9. Confirm understanding
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Address patient problems
– 10. Management appropriate, 11. Patient involved in
decision management
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Make effective use of consultation
– 12. Use of resources e.g. time, 13. Follow up arrangement
Consultation Exercises
• Different Agenda Exercise
• Empathic Listening Exercise
• Using COT to look at and score a video