Communications 2 Flashcards
What happens in an eye examination?
Initial meeting
History and symptoms
Clinical investigation
Conclusion and summery
How many % are asymptomatic referrals?
> 15%
What type of asymptomatic referrals do you get?
POAG >50%
Diabetic retinopathy
Amblyopia
Naevi
What is good communication?
Increase patient understanding
Encourage good rapport with practitioner
Improves compliance
Enhances patient satisfaction
What is bad communication?
Leads to gross dissatisfaction
Going to another practice
Litigation
What may influence the interactions?
Patients health beliefs
- Family and friends
- school or workplace
- prev healthcare experience
- culture and religious beliefs
- internet
- verbal or non verbal behaviour
- prev experience of practitioner
What are pre conceived myths?
Does not understand instructions
What type of information are there?
Cognitive
Affective
What is cognitive information?
The stuff you need to know, ie patient wearing glasses, is there a family history of something
What is affective information?
Unspoken information- how nervous patient looks
What are common problems in interview?
failure to control the interview, premature and restricted focus lack of clarification lack of systemic interview procedure lack of precision failure to prepare patient lack of self awareness deficiencies in question style
What is the relevant information needed to be obtained?
Open V closed Direct V indirect Compound Leading Questionnaire Probing Facilitative Clarification Validation Confrontation
What is Open question?
More than one answer
What is closed Question ?
One answer
What is direct Open?
Why did the elephant cross the road?
What is direct closed?
Find X
What is indirect question?
Dont really sound like a question
What is compound question?
Can be quite confusing for the patient
What is leading question?
This lens makes it blurry doesnt it?
What is a questionnaire question?
Offers range of possibilities
Probing question?
To elicit precise information about symptoms
What is funnel question?
Start with open question
Narrow question down
Response
What is facilitative question?
Encourage remarks eg please continue
What is clarifying question?
Summarise history and symptoms
What is validating question ?
Normally an assumption from the effective information
What is confronting questions?
Occasionally may need to confront patient before continue eg you seem quite angry about your glasses why is this?
What are the measuring and investing type of techniques?
Memory
Ability to generalise
understanding of concepts
Ability to communicate
What complication can you find?
Concise and clear Specific to what you found Non verbal reinforcement Categorisation Primacy and recency effects Call for commitment Summary Body language
What if patient cant respond well?
Then direct questions to carer but ensure you include the patient
What disabilities can px have?
Cerebral palsy
Downs syndrome
Autism
How many people have learning disabilities?
1.2 million in UK Third are children 40% have eye problems 37% have hearing problems 50% receive no regular eyecare figure increases with age
What do you avoid at all cost?>
Sympathy, fear and hostility
Pathos or hopelessness
Over identification with patient or carer
Do not assume patient responses are wrong
Do not mistrust their state of mind
Orientation?
Pre arranged visit
Staff awareness
pre exam questionnaire
How many have hearing disabilities?
14% of population
8.7 million people
vast majority over 65 years
What do you do with elderly patients?
Consider memory problems, check mobility consideration
establish attitude
What tip do you consider for a silent patient ?
Warm, friendly manner
inverted funnel approach-initialy closed question
What tip do you consider for a talkative person?
Closed question
polite interruption
Be aware on non verbal behaviour and ensure you look like your listening
What tip would you consider for a nervous patient?
Warm, friendly manner
avoid jargon
closed question
What tip do you consider for a aggressive or angry patient?
Remain calm maintain good eye contact Open body posture acknowledge their feelings Direct address the problem if patient very aggressive leave door open
What tips do you consider for know all patients?
Directly acknowledge the situation in non confrontational manner
consider using more technical terms in this scenario
How do you tell someone the bad new?
Ensure privacy
Respect confidentiality
Good open body language
Good eye contact
What should you not do with a patient when telling them bad news?
Do not sympathise
Do not patronise
What should you do about a patient that will hear the bad news?
Ask what patient already knows
listen to how patient tells you
What is aligning ?
Start at the level of the patient understanding and use same vocabulary
What is educating?
Give info in small chunks. keep language clear and simple. check that the patient understands what you are telling them
How do you respond to the patients reaction?
Acknowledge all reactions and feelings
Be empathic
Deal with crying and other strong emotions
How do you close?
Summarise the main points
Ask if the patient has any questions
