Verbal communication Jana Heřmanová

Communication is a core clinical skill 4 parts of clinical competence Professional knowledge Communication skills Physical examination Problem solving

What is communication about? Content – What doctors communicate; question and answers, treatment methods they discuss with patients Process – How they do it; the way of communication, verbal and nonverbal communication, building the relationship with patients, structure of the information Perception – What do they think and feel; the way of thinking, problem solving/decision making, what do they think about the patient, what do they feel about themselves, biases, attitudes, intentions…

Theoretical principles Patient-centered medicine – Empathy – Authenticity/congruence – Unconditional regard – Bio/psycho/social/spiritual Authonomy of the person Reflective practice

Tasks of communication Initiating interview – Earn trust: greet the patient, introduce yourself, show interest, ensure comfort – Find out the reason for the visit: the first question, attentive listening, screening/clarifying – Agenda setting

Communication skills Eye contact Facial expression Listening Screening Balancing open and closed questions Empathic reflection Reacting to verbal and nonverbal clues Summarizing Information giving – What does the patient know – Clustering, spacing – Feedback Communication media

What does attentive listening mean? Listening with your ears, eyes, heart, your whole person Use of touch while listening – when to do it and when not

Barriers to attentive listening Compulsion to “do” Bias toward client Judgmental attitude Focusing on the facts Overly sympathetic (more sympathy than empathy) Inappropriate interrupting The environment

Empathy What it is Being able to understand the inner world of the patient Being able to acknowledge patient’s feelings – It sounds like… – You look… – I sense… – You seem… What it is not Sympathy - being sorry for the patient Cliches and giving advice Interpretation Parroting

Communication media Face to face (awareness of the environment, body language) Telephone communication Written communication (charting, referrals, transfer notes, discharge summaries) Electronic documentation and communication Presentation of case studies, results, conferences etc.

Communication beyond the patient Relatives and other accompanying persons Interpreters, patient advocates Professional colleagues Other members of the healthcare team

Special situations Age Cultural and social differences Handling emotions, difficult questions Clinical specialties – psychiatry, emergency Education, informed consent Handling unscertainty – prognosis, expert patient, no medical explanation of symptoms Sensitive issues – dying, bereavement, sex, conditions with stigma Handicapped patients