COMMUNICATION SKILLS

W HAT IS C OMMUNICATION ?

Communication has been derived from the Latin word "communis", meaning to share. Two-way process of reaching mutual understanding, in which participants not only exchange (encode-decode) information but also create and share meaning. "sending, giving, or exchanging information and ideas.

( CONT ) Communication requires a sender, a message, and an intended recipient.message

M OST COMMON WAYS TO COMMUNICATE Speaking Visual Images Writing Body Language

P URPOSES OF C OMMUNICATION

To solve problems Reassurance To form and maintain relationship alleviate distress COMMUNICATION convey feelings give information make decisions persuade

C RITICAL SUCCESS FACTOR FOR LIFE The majority of our perceived ability comes from how we communicate 70% How we communicate it 30% What we know Source: CGAP Direct

C OMPONENTS OF CLINICAL COMPETENCE  Knowledge base  Diagnostic skills and problem solving  Physical exam skills  Communication skills

C OMMUNICATION SKILLS - WHY BOTHER ? Why learn communication skills? Any benefits? Can you learn communication skills? What is there to learn? How is it taught? Where next?

T HINK, P AIR & S HARE Benefits??

E VIDENCE B ASED R ATIONALE  Enhancing communication leads to better outcome:  Increased: understanding & recall Adherence Symptoms relief Physiological outcomes Patient safety Patient satisfaction Doctor satisfaction  Decreased: Costs Complaints and malpractice litigations

E VIDENCE B ASED R ATIONALE  Enhancing communication leads to more effective consultation for Dr& Pt Accuracy Efficiency Supportiveness Relationship characterized by a partnership  Improving communication leads to better coordination of care( within practice team, with pts/ family, etc)

B ENEFITS Doctors with good communication skills have greater job satisfaction and less work stress, Delivery of high-quality health care. (Roter 1987, Betakis 1991, Stewart 1995)

T HE T ORONTO CONSENSUS STATEMENT “stressed that the main complaint of patients is related to “communication problems and not to clinical competency.” (Simpson 1991)

“The main remarks made by patients in the PHC centers in Riyadh was that: “physicians were not listening enough to their complaints.” ( Saeed 2001)

C AN COMMUNICATION SKILLS BE TAUGHT ? communication is a clinical skill it is a series of learnt skills experience is a poor teacher there is conclusive evidence that communication skills can be taught and that communication skills teaching is retained

H OW TO TEACH COMMUNICATION SKILLS ?  Observation  Video or audio playback  Well-intentioned feedback  Rehearsal  Active small group or 1:1 learning

E FFECTIVE COMMUNICATION IS ESSENTIAL TO THE PRACTICE OF HIGH QUALITY MEDICINE

COMMUNICATION PROCESS

THINK ARTICULATE INFLUENCE COMMUNICATE

FEEDBACK

DESIRED ACTION

Sender Receive r Message

COMPONENTS OF COMMUNICATION Sender –Encoder Thought, or an idea to be sent to the receiver in true meanings Sender –Encoder Thought, or an idea to be sent to the receiver in true meanings Message Medium Verbal, Non-verbal Message Medium Verbal, Non-verbal Receiver - Decoder Thought or the idea of sender received in right perception Receiver - Decoder Thought or the idea of sender received in right perception FEEDBACK Verbal, Non-verbal FEEDBACK Verbal, Non-verbal CONTEXT Stimuli NOISE C o m p o n e n t s o f C o m m u n i c a t i o n

S ETTING :- Privacy, Avoid interruptions, Comfortable lighting & temperature, Arrangement of seats, Distance, Level.

C O - OPERATION C ONFRONTATION C ONVERSATION S EATING ARRANGEMENTS OF DOCTOR AND PATIENT

T WO BASIC TYPES OF QUESTIONS 1. Closed questions: Get a one-word response and inhibit thought. Questions begin with who, when and which 2. Open-ended questions: Invite unique thought, reflection or an explanation. Questions begin with how, what and how (not why!).

P ROBING Q UESTIONS Use to:-  Clarify: What do you mean by that?  Justify: What makes you think that?  Check accuracy: You definitely took 3 tablets a day?

Q UESTIONS TO BE AVOIDED  Complex Questions: “Did your vomiting start yesterday or today & have you had diarrhoea?”  Leading Questions: “ you don’t sleep well, do you?”

I MPORTANT OF L ISTENING :- 80 % TOP EXECUTIVES BELIVES IT AS MOST IMPORTANT SKILL STRENGTHENS ORGANIZATIONAL RELATIONSHIPS CREATES OPPORTUNITIES OF INNOVATION

TYPES OF LISTENING CRITICAL LISTENING UNDERSTAND & EVALUATE THE MEANING LOGIC OF ARGUMENT STREANTH OF EVIDENCE INTENTIONS & MOTIVES VALIDITY OF CONCLUSION

EMPATHIC LISTENING UNDERSTAND FEELINGS,NEEDS, WANTS AVOID JUMPING WITH ADVICE UNTILL NOT ASKED FOR. APPREACIATE HIS/HER FEELINGS & UNDERSTAND THE SITUATION

ACTIVE LISTENING AVOID OR TURN OFF ANY BIASES OR FILTERS TO TRUALY HEAR & UNDERSTAND THE SPEAKERS MESSAGE ENCOURAGE SPEAKERS WITH POSITIVE BODY LAUNGUAGE Passive Listening??

ACTIVE LISTENING LISTENING/RECEIVING / RESPONDING PHYSICALLY HEARING THE MESSAGE & ACKNOWLEDGING IT

Use Non-verbal Communication: Smile, Gestures, Eye contact, Your posture. ACTIVE LISTENING…(con)

Give Feedback Remember that what someone says and what we hear can be amazingly different. Repeat back or summarize to ensure that you understand. Restate what you think you heard and ask, "Have I understood you correctly?" ACTIVE LISTENING…(con)

T ECHNIQUES TO IMPROVE LISTENING SKILLS PARAPHRASE Restate what was said in your own wordsPARAPHRASE SUMMARIZE Pull together the main points of a speakerSUMMARIZE QUESTION Challenge speaker to think further, clarifying both your and their understandingQUESTION

P RACTICE P ARAPHRASING Paraphrasing is simply restating what another person has said in your own words.  Use phrases such as:  In other words…  I gather that…  If I understand what you are saying…  What I hear you saying is…  Pardon my interruption, but let me see if I understand you correctly…

BARRIERS IN EFFECTIVE COMMUNICATION SELECTIVE LISTENING DEFENSIVE LISTENING LACK OF COMMON BACKGROUND

N ON -V ERBAL C OMMUNICATION 38% voice dynamics: tone + inflection + volume + accent + non-word sounds; and... 55% Face and body: non-verbal communication or face and body language.

N ON - V ERBAL C OMMUNICATION Visual: expression, eye contact, eye movement Listening: carefully, actively, memory Kinesthetic: Posture, distance, mobility, muscle tone, hand movement, etc

RECOGNIZING NON VERBAL COMMUNICATION FACIAL EXPRESSION GESTURES & POSTURES VOCAL CHARACTRISTICS

RECOGNIZING NON VERBAL COMMUNICATION PERSONAL APPREARENCE TOUCH TIME & SPACE

E XAMPLE OF BODY LANGUAGE Folded arms and leg crossed away from you: Rejection Tapping fingers: Impatience Avoiding eye contact: Untrustworthy

E XAMPLE OF BODY LANGUAGE Sitting with legs crossed, foot kicking slightly: Boredom Biting nails: Anxiety Shoulder hunched, hands in pockets Depression/Dejection

Communication Skills (Models) Effective

E FFECTIVE C OMMUNICATION S KILLS  Greet the person by their names.  Make eye contact,introduce yourself warmly  Smile (ease the tension on either side)  Shake hands. Ask the person to sit down by indicating a chair.  establish a rapport by asking a simple open- ended question,  explain that you may need to take notes,

E FFECTIVE C OMMUNICATION S KILLS Aim to encourage emotional expression as this will often prove to be the most therapeutic aspect of the interaction. If you think you are not getting through to the other person, resist the temptation to raise your voice. Being positive

E FFECTIVE C OMMUNICATION S KILLS At the end: Summarize Give a chance to ask Agree a time for a follow-up. Thank and escort him to the door

IN C OMMUNICATION WITH P TS PITFALLS

B LOCKING BEHAVIOR Interrupting; Offering advice and reassurance before the main problems have been identified; Lack of concern; Attending to physical aspects only; Switching the topic.

LEARNING C OMMUNICATION SKILLS Practice Rehersal Recording Refelection Feedback

T AKE H OME M ESSAGE To Be a Good Doctor/Teacher we Have to Be a GOOD COMUNICATOR