Communication Difficulties (Mohr) Flashcards
Communication Dynamics
Non-Verbal Communication – 80/20
- Delivery of message - intentionality
- Receipt of message - sensitivity
Effective Verbal Communication
- Delivering a message
- –Direct, clear, specific
- –Jargon
- – Pacing
Receipt of a message
- -Listening actively; reflect
- Confirm accuracy
Managing emotions
Sitting with, accepting, emotional reactions
Labeling the emotion, passive permission
Managing anxiety
Communication Pitfalls
Mind-reading Overloading Defensiveness Strong emotions Leading questions Ignoring nonverbal cues Interrupting information delivery
Common Physician Pitfalls
Avoid standing over your patients Staring at a clipboard, computer or the chart Avoid Mindreading – if you sense inconsistent messages, ask the patient Ignoring nonverbal cues - address them directly Unintentional nonverbal cues - Unsure of self - Busy (pager, interruptions, etc..) - Reaction to patient concerns/comments
General rules for difficult interactions
Appreciate communication is a dynamic process
Recognize the feeling of being ‘stuck’ in an interview
Appreciate that there is a breakdown in the process and address the process
Be aware that seeking medical care is anxiety provoking and often brings out the worst in people
Understand that people are often trying to fulfill a need through their interactions with the medical system
Recognition of that need makes managing them easier; visualize it
Sometimes that need is simply anxiety management; other times it’s a greater need
Appreciate that its not about you!
Difficult Patient-Clinician Interactions – six styles
Dependent and demanding patients Orderly and controlled patients Dramatizing or manipulative patients Long-suffering or masochistic patients Guarded or paranoid patients Superior patients
Dependent and demanding patients
Initial interactions are very positive (you are the only person who understands them)
An increase in attention and care is requested
Efforts by the physician and office staff are never enough and do not satisfy the patient
Patient withdraws and/or blames the physician for inadequate care
Managing demanding patients
Overtly set limits on frequency and mode of communication (phone calls, e-mail, etc..)
Avoid making promises that you cannot keep (I’ll talk with the insurance company)
Emphasize the patient’s responsibility in their own health care
Remind the patient of the time constraints
Minimize credit for remission of illness as it inevitably brings about blame for onset of illness
Orderly and controlled patients
Very conscientious and knowledgeable about medical care
Much detail and thoroughness regarding their approach to their health care
They use information and knowledge as a way to maintain control
They need to sense of control to manage their anxiety
Managing orderly patients
Be systematic in the clinical interview; state what you are doing and why
Explain topics of discussion in detail
Don’t leave loose ends
Summarize often
Avoid statements that are vague or unfounded
Dramatic or Manipulative Patients
Penchant for dramatic statements (‘the worst ever’, ‘the longest I’ve ever seen..’)
Strong need to be heard and validated
Wants to be acknowledged by the physician as being in pain, as suffering or as special
May comment on the physicians person (appearance, affect, etc..)
Managing Dramatic Patients
Allow the patient to tell his/her story
Be gentle yet firm; keep boundaries in mind
Utilize good listening skills; convey that the story has been heard
Keep comments descriptive rather than judgmental (‘I see this happening’ rather than ‘Why do you keep…?’)
Redirect personal comments back to the patient
Long-suffering or Masochistic Patients
Reject help as they explain their concerns/symptoms
Nothing seems to work, or has worked in the past
Much reported self sacrificing to help others
When one areas is resolved often times another problem appears
Cannot accept hope or possibilities
Managing long-suffering patients
Set realistic goals (“well, lets try this and see what happens” not “let’s try this and see if it works”)
Avoid optimistic statements or seeking out the strengths or possibilities
Reflect the patients perspective
They often like the idea of ‘helping’ the provider by allowing the provider to treat them
Good for physicians in training
Guarded, Paranoid Patients
Mistrusting of the health care field in general
Will often tell stories of medical errors in their past
Physicians often feel defensive with these patients
Express frustration and blame medical incompetence when they can’t get what they want
