Communication skills

Question 1

Active listening

Answer 1

A more dynamic process requiring focused concentration and attention, enabling the listener to interpret the information received and understand its meaning.

Question 2

The 4 main components of active listening

Answer 2

1) Nonverbal behaviour- yours and the patients
2) Faciliatory response- includes eye contact, nodding, encouragement, paraphrasing and interpreting. Its encouraging the patient to tell their story.
3) Allowing the patient time to response- pausing allows the patient to thinks and process
4) Picking up verbal and non-verbal cues

Question 3

What are non-verbal and verbal cues

Answer 3

Clues to what the patient is feeling or thinking about. Watch for mismatch between verbal and non-verbal cues, the non-verbal cues probably tell the true story

Question 4

Verbal cues

Answer 4

Can include expression of feeling even when indirect, symptoms described with vivid intensity, attempts to explain symptoms, description of unnamed disease or loaded questions, repetition of statement or idea and sharing a personal story indicating link to medical condition or risk.

Question 5

Non-verbal cues

Answer 5

Changes in non-verbal behaviour; for example, posture, facial expression, eye behaviour, “welling up”, body movements or tension, tone of voice. Behavioural clues may also indicate unidentified concerns or unmet needs; for example, presence of another family member, “by the way” statements at the end of consultation, interrupting physician or reluctance to accept recommendations.

Question 6

How to respond to cues

Answer 6

Best to respond straight away but don’t make any assumptions, useful to repeat words they have said.

Question 7

What type of questions to ask in a consultation

Answer 7

Don’t ask too many closed questions or questions which are long and complicated. The question should not bias the answer given. Follow the open to closed question cone so that you can fully understand the area of interest then narrow down on the specific problem and symptoms

Question 8

Open questions

Answer 8

Cannot be answered by yes or no, so the patient has to provide more detail. They introduce an area to be explored. Sets a pattern of patient participation. Can help to explore the disease-illness framework

Question 9

Closed questions

Answer 9

Questions seeking a specific answer, useful in determining specific symptoms and diagnosis. Not useful in initial exploration.

Question 10

Clarifying questions

Answer 10

Used to check out statements which are vague or need amplification (eg. could you explain what you mean by…?)

Question 11

Probing questions

Answer 11

Used to look in more depth (eg. can you tell me more about the ….? How did that make you feel?)

Question 12

Statements as questions

Answer 12

Eg. tell me about it from the beginning; tell me about your headaches

Question 13

Skills that can help you structure a doctor-patient consultation

Answer 13

Summarising- gives you time to think and keeps the patient on track
Signposting- to progress from one section to another using transitional statements, gives opportunity to return to issues not dealt with
Sequencing- structure interview in logical sequence
Timing- needed to keep interview on track

Question 14

Internal summary

Answer 14

Summarises an initial line of enquiry before moving on to another one. Encourage the patient to correct misinterpretations and add more information when needed.

Question 15

End summary

Answer 15

Helps close the consultation and address what has been achieved in the interview

Question 16

Why is patient perspective important

Answer 16

The patient is more likely to be accurately diagnosed, less litigation against the doctor. The patient will be more involved and informed. Don’t try and fix everything at once the patient may just want to vent

Question 17

What’s included in the patient perspective

Answer 17

• Ideas: What does the patient think the problem is?
• Concerns: What does the patient fear the problem is or may be? Can you tell me what’s worrying you the most?
• Expectations: What does the patient think is going to happen? Helps with shared decision making.
• Thoughts
• Impact: What has the impact of illness been on the patient?
• Effects: What effects has the illness had on their life?
• Feelings

Question 18

Constructive feedback

Answer 18

Providing information to someone about their performance in order to improve future performances, allows mistakes to be corrected and effective performances to be recognised and built on.

Question 19

Pendleton’s rules of giving constructive feedback

Answer 19

• Clarify any points of understanding or facts.
• Ask the person performing skill what they did well and why.
• Invite the “patient”, rest of the group and tutor to discuss what they observed being done well and why.
• Ask the person performing skill to say what went less well and what they would do differently next time.
• Invite the “patient”, rest of the group and tutor to discuss what went less well and make constructive suggestions for how things could be done differently.
• Always end on a positive note and agree an action plan to improve.

Question 20

What to do when giving feedback

Answer 20

• Be positive about the others performance.
• Focus on what you observed not personal attributes, own the feedback you give “I noticed that” instead of “you where”
• Be specific (not general) and descriptive (not judgemental)
• Be constructive– give alternative approaches when thinking about what didn’t work so well.
• Be sensitive to how the recipients of feedback may feel.