Week 6: Communication

Question 1

List some attending behaviours?

Answer 1

- Attending behaviour vs non-attending behaviour
		○ Facial expression
		○ Body language
		○ Vocal tone
	- S.O.L.E.R. 
		○ Squarely faced
		○ Open body posture
		○ Leaning forward
		○ Eye contact
Relax

Question 2

What are some factors for building rapport?

Answer 2

• Posture
  
  • Eye contact
  • Body language
  • Vocal qualities
  • Verbal tracking
    Silence

Question 3

What are the 5 Phases of the consultation?

Answer 3

1. Introduction
2. Case history
3. Data collection
4. Contracting
5. Termination

Question 4

What are some things that should be done during the introduction?

Answer 4

Meeting, greeting and seating.
If necessary establishing confidentiality or its limitaions
Beginnings of data collections (Demographics, observations (age, stature, complexion, BMI, head tilt, facial symmetry) )

Question 5

What are some things that should be addressed during the case history?

Answer 5

- CC (chief complaint) 
			§ Exploring questions
			§ Listen for reason for the visit, things they are unhappy about (they talk, you listen) 
			§ Use FOLDARQ - for symptoms of significance
				- F - frequency
				- O - onset
				- L - location
				- D - duration
				- A - Associated symptoms
				- R - Relief
				- Q - quality - is the pain sharp
		- Other symptoms
		- Ocular symptoms
			§ Distance or near vision effected
			§ HA
			§ Sore eyes
			§ Flashes/floaters
			§ Double vision
			§ Word swim/ trouble tracking
			§ Current or previous spectacle/CL
			§ Previous infection, injury, surgery, other treatments
			§ Time of last examination
		-  Medical history/general health 
			§ Diagnosed general health conditions
				Diabetes, hypertension, hyperthyroidism, etc
				medications
		- Family history 
			§ Eye conditions e.g. glaucoma, macular degeneration, strabismus
			§ General health concerns
		- Vocation/hobbies 
			§ Hours of screen time 
			§ Type of work 
Sport (e.g. shooting)

Question 6

What should be done during the Data collection?

Answer 6

This is guided by your case history, at this point you have formed some suspected diagnosis’s. In the data collection you will be gathering evidence, for or against that diagnosis . It’s a combination of routine and priority assessments.

Question 7

What should be done during Contracting?

Answer 7

a. Making a summary of the findings
i. Any sensitive issues/diagnoses to deliver?
ii. Will your presentation of findings further build rapport/confidence or reduce it?
iii. Have you considered the patients perspective?
b. Formulating and discussing
c. Handling questions
Establishing a “contract” or plan of action

Question 8

What should be done during Termination?

Answer 8

5. Termination
   a. Verbal vs non-verbal cues
   i. “the last test for today”
   ii. Standing and moving towards the door
   b. Clarify administrative details and ensure all questions addressed
   i. Do you have any other questions for me before we leave the room?
   c. Arranging next appointment
   d. Parting ways
   Friendly polite and professional

Question 9

What are the letter for SOAPE?

Answer 9

S - subjective - what the patient reports to you
O - objective - your data/testing and observations
A - analysis - what is your diagnosis? There are often multiple issues at play
P - Plan - what action will you take? What recommendations will you make?
E - education - how will you communicate this with the patient?

Question 10

What are the steps for Conceptualising the problem?

Answer 10

1. Clarification
   ○ “Do you mean that..” “Are you saying that…”
   ○ Checks accuracy and mutual understanding
   
   2. Paraphrase
      
      • Helps patient to focus on content of their message
      • Highlights facts over feelings
   3. Reflection
      
      • Rephrasing the patients feelings about the content
      • Acknowledge patients feeling, to both parties
      • Helps patient discriminate accurately among feelings
   4. Summary
      
      • Ties together multiple elements
      • Identify common theme or pattern
      • Allows review of progress

Question 11

What are the reequired steps for Empathy?

Answer 11

• Listening
  - Listen with an ear to understand, not correct - even if we want to challenge what they are saying
  
  • Understanding
    
    • Trying to conceptualise what it might be like to be that person, what they might be feeling
  • Communications
    To increase our understanding, and to communicate our empathy to the patient

Question 12

What are the limitation to empathy?

Answer 12

• Not able to understand (cannot share their point of view)
  
  • You identify too strongly (different feelings about similar experiences)
  • Not able to share (out of your range of experience)
    Difference in personal values (racism, religious, bias, breastfeeding)

Question 13

How can you achieve a patient centred exam?

Answer 13

• Exploring the patients experience of vision loss/change
  - Exploring the patients knowledge/understanding of their condition
  - Allowing the patient to express their beliefs about their pathology
  - Allowing the patient to express their concerns
  Treating the patient as a partner/collaborator when discussion treatment and options

Question 14

What are the steps for delivering Bad news?

Answer 14

Give the information

Check the patients understanding of the information

Identify the patients main concerns

elicit the patients resources and give realistics hopes

Question 15

Which examination technique may require touch?

Answer 15

• Tonometry
  - Opthalmoscopy
  - Contact lenses
  Biomicroscope examination

Question 16

What are the steps for physical touch during an exam?

Answer 16

• Always seek consent
  - Ensures patient comfort
  - Gives them warning they will feel something
  Be careful not to put yourself in compromising positions