MRCPsych Communication Skills Module Week 1 – General Communication Skills

Module Aims Elicit from patients what is wrong. Summarise and reflect on the consultation. Provide information to patients in a way they can understand. Undertake a capacity assessment and seek patients consent.

Objectives – week 1 Demonstrate: treating patients with dignity. listening to patients. responding to patients’ concerns, preferences and questions. giving information to patients in a way they can understand. assessment of capacity.

Find somebody you do not know, make yourselves comfortable around the room and spend a couple of minutes finding out about their last holiday. Swap over.

Active Listening Skills 1 – Body Posture Square On Open Posture Lean Forward Eye Contact Relax Same height as patient Square 45 0r 90 degrees so can both look at floor in the middle, i.e. easier to break eye contact without actively doing this and therefore looking distracted or antisocial. Think about how close to sit re personal space. Lean slightly forward so patient can speak into ear if having difficulties disclosing something.

Active listening skills 2 – Matching, Pacing, Leading Patient’s behaviour You pace patient Patient resists lead You lead patient Better if patient not in a good place. Patient accepts lead You continue to lead

Active listening skills 3 Encouraging noises and gestures Echoing Use of silence Include nodding, smiling.

Active listening skills 4 - Summarising and Reflecting Paraphrasing Content only Reflecting Emotion only Empathic Responding Content + Emotion Advanced Empathy Drawing attention to a miss match between what is said and how it is said

The doctor talking… Identifying: Cues Ideas Concerns Expectations Open, closed and semi closed questions Softening/exaggerating Directing the consultation Semi closed e.g. when did it start? Softening – a lot of people find they drink when they are feel low is this something you have started? Exaggerating – how much alcohol do you drink in a week, 30 pints? Directing e.g. Can I just go back and explore the tummy pain further? There are two questions I need to ask which may seem strange

Giving Information Verbal/non verbal language Manageable chunks Engage the patient – 2 way process Check understanding Think about culture, lifestyle, pt’s communication Check capacity to consent

The Mental Capacity Act (2005)‏ Inability to make a decision P unable to make a decision if on the balance of probabilities unable to: Understand the information relevant to the decision to be made. Retain that information in their mind. Use or weigh up that information as part of the decision making process. Communicate their decision. Balance of probabilities means 51%. Beyond reasonable doubt is higher. Unable is different to unwilling. Unwilling does not mean they are unable but complicates the doctors’ life! Although belief test gone out the pt must embrace what the doctor says, e.g. Maybe you’re right dry but … or I hear what you say but…

Summary Demonstrate: treating patients with dignity. listening to patients. responding to patients’ concerns, preferences and questions. giving information to patients in a way they can understand. assessment of capacity.