Case Study

Question 1

What are three broad types of skill might you, as a GP, use during the consultation?

Answer 1

1. Content Skills
2. Perceptual Skills
3. Process Skills

Question 2

What are Content Skills?

Answer 2

What doctors communicate:

1. The substance of their questions and responses
2. The information they gather and give
3. The treatments

Question 3

What are Perceptual Skills?

Answer 3

What the doctor is thinking and feeling:

1. Their internal decision making and clinical reasoning
2. Their awareness of their own biases, attitudes, and distractions

Question 4

What are Process Skills?

Answer 4

How the doctors do it:

1. The ways the doctors communicate with patients
2. How they go about discovering the history / providing information
3. The verbal and non-verbal skills they use
4. The way they structure and organize a consultation

Question 5

What are the two factors which can affect the consultation?

Answer 5

1. Personal Factors

2. Physical Factors

Question 6

What are some examples of Physical Factors, which can affect the consultation?

Answer 6

1. Site and Environment
2. Adequacy of Medical Records
3. Time Constraints
4. Patient Status

Question 7

What kind of questions can be used to elicit more information from a history?

Answer 7

1. Open-ended questions
2. Direct questions
3. Closed questions
4. Leading questions
5. Reflected questions

Question 8

What are Open-Ended questions?

Answer 8

Questions which do not elicit an answer but invite the patient to tell a story

Question 9

What are Direct questions?

Answer 9

Questions asking specifically about an item

Question 10

What are Closed questions?

Answer 10

Questions that can only be yes or no

Question 11

What are Leading questions?

Answer 11

A question which presumes the answer and is best avoided

Question 12

What are Reflected questions?

Answer 12

A question that allows a doctor to avoid answering a direct question from a patient

Question 13

When is listening and silence used by a clinician?

Answer 13

1. To encourage communication when a patient is talking freely
2. To show you are listening
3. To encourage communication when a patient appears to be holding back

Question 14

what does silence tend to go hand in hand with?

Answer 14

Facilitation

Question 15

What is facilitation?

Answer 15

This is the encouragement of communication by using manner, gesture or words which do not specify the kind of information which is sought

Question 16

When might confrontation by used?

Answer 16

When the patient is not speaking freely and clearly

Question 17

How does the clinician present the confrontation?

Answer 17

By describing to the patient something striking about their verbal/non-verbal behavior. e.g. “You look sad”

Question 18

What does support and reassurance allow for?

Answer 18

An atmosphere in which the patient is encouraged to communicate

Question 19

What is meant by non-verbal communication?

Answer 19

Body language

Question 20

What are the percentages of the breakdown of verbal vs non-verbal behavior?

Answer 20

Verbal - 7%
Tone of Voice - 38%
Non-verbal behavior - 55%

Question 21

What are some types of non-verbal communication?

Answer 21

1. Instinctive
2. Learned
3. From training (training courses)
4. Clinical

Question 22

What is meant by instinctive non-verbal communications?

Answer 22

Crying, expressions of pain, laughter etc.

Question 23

What causes learned non-verbal communication?

Answer 23

This happens from experience - body language is acquired at an early age and is dependent on culture / family experience

Question 24

What is meant by clinical non-verbal communication?

Answer 24

The doctor learning to recognize certain clinical syndromes from pain, abnormal movement etc.