Introducing clinical communication

Question 1

Describe the changes in the doctor-patient relationship

Answer 1

Differences in the process of consultation- the way questions are asked, amount of time for talking, expectations, shared-decision making, no longer paternalistic, changes in language, patient-centred approach adopted. We have also moved away from a purely biomedical outlook of disease- we now think of how the illness effects them and their lives.

Question 2

Define patient-centeredness

Answer 2

Providing care that is respectful and responsive to individual preferences, needs and values- ensuring that patient values guide all clinical decisions.
Basically, understanding that the patient is a unique human being- doctors need to encourage patient participation.

Question 3

How do we achieve a patient centred approach.

Answer 3

Explore patients' perception of illness
Work in partnership on treatment plan
Empathetic approach to help the patient feel at ease
Open Questions
Active Listening
Respond to verbal and non-verbal cues
Do not make assumptions or judgements.

Question 4

What are the advantages of patient-centred communication

Answer 4

Accurate and comprehensive information gathering
More efficient consultations
Patients are more satisfied and less anxious
Patients can recall better, understand more and act on advice given
Patients are more involved in decision making
Improved health outcomes.

Question 5

What are the core elements of an introduction

Answer 5

Formal gathering 'Hello, Good Morning'
Full name- role- elicit patient's name
Acknowledge- nice to meet you
State the purpose
Gain consent
Never say a 'quick chat'

Question 6

Which questioning style should you use initially

Answer 6

open- avoid multiple and leading questions
‘How are you feeling today’ ‘Can you describe the pain’ Elaborate- ‘What do you mean by that’ ‘Could you tell me a bit more’

Question 7

How to approach personal or lifestyle questions

Answer 7

Don’t seem invasive- ask: Could we talk a little bit more about your day to day life.

Question 8

Describe the importance of transition statements

Answer 8

Hold the interview together- provide direction so that the patient knows what is coming next. ‘We have discussed why you have come to the hospital, what I would like to do now is to ask you some questions about your health in the past’.

Question 9

How to discover what IDEAS the patient has

Answer 9

‘What do you think could be causing this’ ‘How may this have started’ ‘What do you think could be causing these symptoms’

Question 10

How to discover what CONCERNS the patient may have

Answer 10

‘Are you worries about these symptoms’

Question 11

How to discover what EXPECTATIONS the patient may have

Answer 11

‘What are you hoping to get out of the consultation’

‘What would be the best outcome for you’

Question 12

How to gather information

Answer 12

Start with open-ended questions
Invite them to tell their story chronologically
Don't interrupt
Pick up cues
Paralanguage
Clarify any jargon
Incorporate ICE
Interim Summary

Question 13

How to close the consultation

Answer 13

Signal closure- with a summary
Ask if there is anything else that they would like to mention
See if the summary is accurate
Parting statement- wish them well

Question 14

When should you move to close ended questions

Answer 14

When you need to restrict the answer to create a more specific focus.

Question 15

When may interruptions be necessary

Answer 15

When the patient seems uneasy or tense- when the patient is diverging from the question -when there is an urgency

Question 16

What are the taxonomy of clues

Answer 16

Expression of feelings
Their attempts to understand or explain the symptoms
Speech clues that underscore particular concerns of the patient
Personal stories that link the patient with medical conditions or risks
Behaviours suggestive of unresolved concerns or unmet expectations

Question 17

How to probe topics sensitively

Answer 17

Recognise the difficulty that they will have- I can see this is difficult for you- do you want to go on. Normalise it- many patients find this topic difficult- do you have any problems

Question 18

Survey for other problems

Answer 18

So far you have mentioned head aches and back pain- anything else.
important to establish these at the start so that you have time to talk about them.

Question 19

Set the agenda

Answer 19

It may not be possible to talk about everything in one consultation- prioritise and let them know the areas that you want to focus on.

Question 20

Clarify patient terms

Answer 20

They may speak colloquially or they may use medical terms incorrectly- establish exactly what they mean.

Question 21

The importance of making interim summaries

Answer 21

Allow you to check and clarify what you have understood- they also show the patient that you have been listening. They also assess the accuracy of your understanding.

Question 22

The importance of avoiding multiple questions

Answer 22

Patients are likely to only answer parts of them- meaning vital information will be missed.

Question 23

The importance of avoiding leading questions

Answer 23

’ You don’t smoke do you’- may seem biased and judgemental- patient likely to agree with you.

Question 24

How to display empathy

Answer 24

I can see that this is painful- it must be difficult managing this for all these years
You still seem worried
It is ok to be upset
It can be extremely difficult.

Question 25

Basic opening questions

Answer 25

Can you tell me what brought you here today.
What made you decide to come to see the doctor
Can you tell me the main thing you think is wrong
Can you tell me about