week 12b Flashcards
(1. Approaches to Treatment Decision-Making)
three main models of treatment decision-making
- Professional choice (doctor decides)
- Shared choice (to achieve concordance)
- Consumer choice (patient decides)
➢ In reality there is a mixture of these three, while the professional choice is more likely to be observed in emergencies
(1. Approaches to Treatment Decision-Making)
Shared choice
➢ Patients may not always prefer to have a shared choice
➢ This is happening when patients are in crisis – they prefer
decision to be made for them (i.e. cancer)
➢ Even if they do not wish to participate in any decision making they usually want to be informed about their
condition
Doctors’ Communication
Skills
➢ In medical consultations patients are often dissatisfied
with the way their clinicians
communicate
➢ In the last two decades modern medical curricula pay
particular attention to doctors’ communication skills
➢ Studies show that good communication skills are associated with patients’ satisfaction and better medical adherence
(2. Doctors’ Communication Skills)
Basic communication skills for history taking
➢ Initiate the consultations ➢ Consent and confidentiality ➢ Use of closed and open questions ➢ Check patients’ perspective ➢ Empathise (recognise, accept, validate) ➢ Signpost ➢ Check patient’s understanding ➢ Summarise ➢ Close the consultation
(Communication Skills)
➢ Use of closed and open questions
➢Closed questions: question that lead to given answers
➢Open questions: which allow patient to narrate
(Communication Skills)
➢ Check patients’ perspective
➢Check what the patient think by using an open question
(Communication Skills)
➢ Empathise (RAV)
➢Recognise (pick up the cues)
➢Accept (non-judgemental), Acknowledge (confirm that the emotion is there)
➢Validate (confirm that the emotion is valid)
(Communication Skills)
➢ Signpost
➢Prepare the patient of the area your are exploring next
(Communication Skills)
➢ Check patient’s understanding
➢ You can ask the patient how they understand medical terms, conditions, management etc
➢ You can ask the patient if everything is clear
➢ You can ask the patient to summarise what you have told
them
(Communication Skills)
➢ Summarise and Close the consultation
➢ Summarise so to make sure that you have understood well
➢ Close the consultation by mentioning what are you going to do with the information and by thanking the patient
Basic communication skills for information giving
➢ Avoid jargon, use simple language
➢ Organise the information, do not jump from one issue to another
➢ Give the information in small chunks
➢ Do not scare the patient, start with something positive
➢ Check patient’s understanding
Andreas Christodoulou is 52 years old and visits his GP, Dr Joseph Michael, for routine check-ups. Andreas is
afraid of mentioning that he has been having blurred vision in the last month. At the clinic Dr Michael tells Andreas that blood tests have to be performed and asks
Andreas if he has had any other issues to mention. When Andreas mentions that he has been having blurred
vision, Dr Michael tells Andreas that he has to do an MRI. Andreas is scared and puzzled: “Dr, how serious is it?”
➢ Based on sociological principles, how would you
classify the consultation (decision-making for
treatment)? Why?
Professional choice (doctor decides), the doctor does not check the patient’s perspective
➢ What communication skills has the doctor
demonstrated (or not demonstrated)?
The doctor has not demonstrated the basic skills for
history taking, such as consent, confidentiality, open
questions, empathy, signposting and closing. The doctor scared the patient and did not try to tell
patient something positive
Summary
➢ Decision-making for treatment may take various forms
➢ Patients do not always want to take part in the decision-making of their treatment especially when they are seriously ill
➢ Good doctor communication skills are associated with
patient satisfaction and adherence to therapy
