طبيب طـوارئ يفـقـد أنفه بعد ملاسنة خسر طبيب، في طوارئ مستشفى الملك خالد العام في حفر الباطن، أنفه عندما سدد له مراجع لكمة عنيفة تسبب في إصابته بكسر ونزيف دموي حاد، وذكرت التقارير أن شابا في مقتبل العمر حضر البارحة الأولى إلى قسم الإسعاف والطوارئ بغرض المراجعة والعلاج فدخل في ملاسنة حادة مع طبيب عام ثم سدد الضربة التي كسرت أنف خصمه، وأكد حدوث الواقعة المتحدث في الشؤون الصحية في محافظة حفر الباطن، فيصل محمد، الذي أوضح أن الطبيب المعتدى عليه تعرض إلى كسر في الأنف مع نزيف حينما اعتدى عليه مراجع بعد دقائق من مباشرته مهامه في قسم الطوارئ، وأشار المتحدث إلى أن إدارة المستشفى استدعت الشرطة التي اقتادت المعتدي إلى المركز لاستجلاء الحقيقة ومعرفة ظروف وملابسات الحدث. مواطن : من القهر من التعامل في المستشفيات كانك شحاذ يوم يقابلك الدكتور او الطوارئ لدرجة نفسك تموت ولا تروح مستشفي.. ليته كسر وجه كله.. ابراهيم : يستاهل والله ان بعض الدكاتره والممرضين يستاهل اكثر من كذا بس ايش نسوي ما بيدنا الا نصبر على تصرف بعض الممرضين والدكاتره اللي ما يعرفون يتعاملون مع المريض بالطريقه المثلى اولا المريض يجي مهموم تعبان وامله في الله ثم في هؤلاء الاطباء ولاكنه كثير ما يفاجأ ببرود من يأمل الخير فيهم اما في اهماله او عدم اهنمامهم به صرنا نكره الذهاب للطوارئ باهلنا او بأنفسنا وانا اتحدث عن طوارئ ((صامطه)) خاصه حسبي الله عن الاداره المسؤوله عنهم نفر مسكين : لم يفقد أنفه بعد كيف فقد أنفه.؟ ثم نصيحة للاطباء والممرضين السعوديين الله يرحم جد الفلبين قسما بالله ماشفت مثلهم رحمة وانسانية السعودية / السعودية بلاك بيري وتشكيرة ورفع حواجب (للبنات ) مشكلتنا متوحشين على الصعيد الانساني

COMMUNICATING WITH PATIENTS

OBJECTIVES To recognize the importance of communication and relationship-building in improving patient outcomes To learn questioning styles most effective in maximizing rapport, adherence and patient satisfaction Utilize active listening to facilitate information exchange and build relationship Identify effective communication skills for patients and families in distress

Why is effective communication important for your work?

The changing role of the pharmacist Movement from “traditional role” (emphasis on dispensing) to “health care provider role” Movement emphasizes actively identifying and resolving drug-related problems Pharmacist as partner with patient in achieving health goals

The power of effective communication Demonstrates interest and caring Improves relationships Saves time Helps to clarify situations Gives you an opportunity to learn Decreases stress Enhances your professional image Facilitates clear exchange of information  reduces risk of ADEs Builds trust and rapport  enhances patient adherence

Results: Improved patient outcomes Enhanced patient satisfaction

Three essential communication skills Building rapport and trust Effective questioning Active (or reflective) listening

How do you begin building rapport with patients and families?

Effective questioning: Beginning to build rapport Questioning continuum: Open-ended  Closed-Ended

Open-ended questions Examples: “How are you feeling?” “How can I help you today?” Doesn’t constrain patient’s reply Elicits patient’s perception of health goals and challenges Attentive questioning and listening builds partnership with patient and family

Moderately open-ended questions Example: “What do you think about the possibility of changing your medication?” Still allows patient to answer freely Helpful in eliciting patient’s thoughts and feelings regarding particular aspect of care

Moderately closed-ended questions Example: “Which of these specialists would be more convenient for you to see?” Relevant for more specific, problem-solving parts of patient interaction Elicits briefer, more focused responses

Closed-ended questions Example: “Have you ever had an allergic response to any medication?” Narrowest and most specific type of questioning Can be helpful in clarifying important parts of patient history Should be used in conjunction with open-ended questions

Ineffective questioning Not balancing closed-ended questions with open- ended Leading questions: “You didn’t have any side effects, did you?” “Why” questions: “Why did you skip that appointment?

Continuing to build rapport through active listening

What is active listening? It requires: A focus on the person or caregiver Understanding what the person said Demonstrating that understanding

Ways we communicate how well we’re listening Verbal clues: Tone of voice Interruptions Acknowledgment of what patient has said Nonverbal clues: Body posture Gestures Repetitive motion

Barriers to listening Faking attention Prejudging the speaker Waiting to speak Rehearsing counterarguments in our head Failing to ask when we don’t understand

Listening responses Less effective: Judging Advising Quizzing Placating Distracting More effective: Paraphrasing content Empathic reflective response

Effective listening responses Identify the feelings and ask yourself, “What would I be feeling?” Put the feeling into words Tie the feelings to thoughts

Aids to active listening “What I hear you saying is…” “It seems like you’re feeling…” “Tell me more about…” “I can tell this is important to you …”

When patients and/or family members are distressed

Reasons people get upset: Their expectations have not been met They are ill, tired, stressed or frustrated They feel that no one will listen to them They feel they have been treated with indifference or rudeness

What do upset people want? To be taken seriously To be treated with respect To feel listened to A truthful answer A response that isn’t dismissive or insulting

“People don’t care what you know until they know that you care.” --Cavett Robert

After the encounter Review how it went: What worked? What didn’t? Did this visit further the health goals for this patient? What might I do differently next time

Keys to effective interactions Express respect Listen, understand and address the real feelings behind the person’s words Collaborate and brainstorm new ideas once patient and family members feel heard and trust you as a partner in care

Strategies for establishing the pharmacist-patient relationship: Introduce self to the patient during the encounter Outline for the patient what will occur during the encounter Demonstrate empathy or caring attitude so that the patient feels at ease Discuss with the patient the amount time needed for the encounter Discuss the expected outcome of the encounter Use feedback strategies throughout the encounter to ensure patient’s understanding Ensure sufficient time for patient to ask questions towards the end of the encounter Resolve a drug therapy problem in a timely manner Follow up with patient

Indian health service counseling model Three prime questions to ask patients who are receiving a new prescription: What did your doctor tell you the medication is for? How did the doctor tell you to take it? What did the doctor tell you to expect? Final verification or asking the patient for feedback Just to make sure that I didn’t leave anything out, please tell me how you are going to take your medication? Show and tell strategy when a patient is receiving a refill What do you take the medication for? How do you take it? What kind of problems are you having?

Tips for good patient interviews Greet the patient and introduce yourself Explain the interview process Direct the patient to the consultation area Explain why you need to collect the information, what you will do with it, and that it will be treated confidentially Indicate how long the interview will last Use words/manners that convey professionalism Pay attention to body language Ask open-ended questions. Begin with broad questions and then get more specific

Use active listening skills and demonstrate empathy Ask the patient to restate any unclear information and use paraphrasing feedback strategies to ensure that you understood Communicate at an appropriate educational level and avoid medical jargon

Targeted methods for achieving the objectives of a patient education session:

Communicating information to physicians: Keep patient focused Provide the physician with any meaningful background information Clearly and concisely outline the problem the patient is experiencing with the drug therapy Propose a solution (pharmacist’s intervention) If face to face, request physician feedback for the solution

 Kristi Eckardt. “Talk to Me!” Communicating Effectively with Patients and Families. ASCP Midyear Meeting, April 26, 2006  Randy P. McDonough and Marialice S. Bennett. Improving Communication Skills of Pharmacy Students Through Effective Precepting. Am J Pharm Educ June 15; 70(3): 58. References: