MEDICAL COMMUNICATION SKILL The benefits of good communication: Good communication: builds trust between patient and doctor;

; may help the patient disclose information; enhances patient satisfaction; involves the patient more fully in health decision making; helps the patient make better health decisions; leads to more realistic patient expectations; produces more effective practice; and reduces the risk of errors and mishaps. Essential element of Medical Communication 1. 2. 3. 4. 5. 6. 7. Build a relationship Open the discussion Gather Information Understand the patients perspective Share information Reach agreement on problems and plan Provide closure

1. Build a Relationship Mnemonic P E A R L S : P..partnership, acknowledges that the physician and the patient are in this together E..empathy, expresses understanding to the patient A..apology, acknowledges that the phycisian is sorry the patient had to wait, that a laboratory test had to be repeated, etc R..respect, acknowledges the patients suffering, difficulties, etc L..legitimization, acknowledges that many patient are angry, frustrated, depressed, etc S..support, acknowledges that the physician will not abandon the patient. Fundamental communication task Strong Therapeutic Effective relationship (idea, feelings, and values of both) Also relevant for work with the patient, family and other support system Is an ongoing task within and across

. Open the discussion Physicians first greeting. Physician show personal concern by offering a handshake and warm smile. Put the patient at ease in what could otherwise to be unfamiliar, if not frightening environment.

3. Gather Information Shifting from a physician-centered to patient-centered interview style Physician interrupt patients an average of 18 seconds after the patient begins to speak. Patient rarely continued to express all their true concern once they were interrupt

No more than 150 seconds was needed to express all their concern at the beginning or the interview Two words . What else?

Five Communication Pattern : Narrowly biomedical Expanded biomedical Biopsychosocial Psychosocial Consumerist.

. Understand the Patients Perspective Explore contextual factors (e.g., family, culture, gender, age, socioeconomic status, spiritually) Explore beliefs, concern, and expectation about health and illness Acknowledge and respond to to the patients ideas, feeling, and values

5. Share Information Use language the patient can understand Check for understanding Encourage questions

6. Reach Agreement on Problems and Plan

7. Provide Closure Special Medical Communication Bad News Mnemonic S P I K E S protocol for breaking bad news. S..etting and listening skills P..erception by patient of condition and seriousness I..nvitation from patient to give information K..nowledge - giving medical facts E..xplore emotions and empathize as patient responds S..trategy and Summary End-of-life communication Bad News Old Patient Family caregivers Ask whether the patient has other issues or concern Summarize and affirm agreement with the plan of action Discuss follow up

Old Patient Create Hope Family Caregivers Understand that illnes and disability are a family affair. Let the patient know Working Memory Capacity Diminish Hearing and Vision lost Reflective listening

 EMPHATY

Be sensitive about place talking to caregivers about difficulty subjects. Not appropriate in waiting room and corridors.

Of all the element involved in effective communication: the most powerful 1880, psychologist Theodore Lipps: einfuhlung (in-feeling) To describe: emotional appreciation of anothers feeling Being a psychiatric or mental health expert is not necessary for using emphatetic communication The only requirement is an awareness of opportunities for emphaty as they arise during the interview with the patient In emphaty, we borrow anothers feelings to observe, feel, and understand them - - but to take them onto ourselves By being a participant-observer, we came to understand how the other person feels EMPHATY versus SYMPHATY? Key skill used to built doctor patient-relationship Empathic processes affect how the physician (observer) thinks, feels (intrapersonal outcomes), and behaves (interpersonal outcomes) with the patient (target) The process of understanding a persons subjective experience Balance curiosity to leading to a deeper understanding of another human being The capacity to understand another person experience from within that person s frame of reference The ability to put oneself in anothers shoes Begins to look something like: Touch the patient on the arm Look them in the eye

If the patient stop talking, repeat the last word that they said to show you are listening and interested. Doing so without also developing a genuine interest in the resulting connection can lead to an empty charade Effectively teaching useful approaches to physician-patient relationship

Active Listening Mnemonic S O L E R , positive non-verbals that can be used to indicatephysician are listening supportively. Ssitting square on to the patient with an Oopen position L leaning slightly forward with Eeye contact in a R relaxed posture