1. COMMUNICATION SKILLS & DOCTOR-PATIENT RELATIONSHIP DR Tabassum Alvi Assistant Professor Psychiatry/Behavioura Sciences Majmaah University 15 TH OCTOBER, 2014

2. What and why

3. Oh my Sustainer! Open my heart and Make my task easy for me And loosen the knot from my tongue So that they might understand my Speech Surah Taha (16:25-29--Al Quran

4. MAPSOFOURMINDMAPSOFOURMIND

5. OUTLINE Objectives Definition 7 Cs Types Doctor patient relationship Fundamental elements Partnership with patient Improving communication

6. OBJECTIVES At the end of session students should be able to 01. Explain the basic principles of communication skills 02. Discuss the role doctor patient relationship in clinical care

7. DEFINITION “The imparting or exchange of information by speaking, writing or using any other medium” APT (2002), vol. 8, p. 166

8. Communication Model Context ( stimuli ) Sender Thought Process What, When, Why, Whom, where & How Encoder Message (Medium) Verbal & Non Verbal Receiver Thought process Taking meaning out & Plan to respond decoder

9. 7 Cs 1.Clear 2.Concise 3.Concrete 4.Correct 5.Coherent 6.Complete 7.Courteous

10. TYPES Verbal Nonverbal Written

11. WHAT IS MORE IMPORTANT?

12. Verbal Symbol Based Non verbal Gesture Based Types of communication Largely Learnt Consciously Controlled Higher Risk of Deception Largely Innate Partial Control Relatively Uncontaminated

13. WHY IN MEDICINE? Communication error leads to 60% to 70% of preventable hospital deaths (The Joint Commission on Accreditation of Healthcare Organizations)

14. DOCTOR-PATIENT RELATIONSHIP

15. FUNDAMENTAL ELEMENTS Right to receive information Right to make decisions Right to courtesy, respect, responsiveness, and timely attention Right to confidentiality Right to continuity of health care Right to have available adequate health care (Issued June 1992 based on the report "Fundamental Elements of the Patient-Physician Relationship)Fundamental Elements of the Patient-Physician Relationship

16. PARTNERSHIP WITH PATIENT Polite and considerate Treat patients as individuals(holistic model) Treat patients fairly Work in partnership with patients regarding: Condition, its likely to progression and the options for treatment, including associated risks and uncertainties The progress of their care, and your role and responsibilities in the team Who is responsible for each aspect of patient care

17. PARTNERSHIP WITH PATIENT You must support patients in caring for themselves Not pursue a sexual or improper emotional relationship with a current patient Be aware of risk involved in social media (http://www.gmc-uk.org/guidance/good_medical_practice/partnerships.asp)http://www.gmc-uk.org/guidance/good_medical_practice/partnerships.asp

18. IMPROVING COMMUNICATION Call by name Not just the illness! Minimize distractions Engage in active listening Concrete feedback Culturally responsive care

19. Sit squarely in front of patient Attentive posture Nodding Active questions and answer. Use Para linguistics Eye contact Matching facial expression Level of seating Environment ACTIVE LISTENING

20. IMPROVING COMMUNICATION Assessing your own biases Expect resistance to change Highlight the positives Don’t just write an order Clarify before you end interview Pain is not always physical!

21. Listen for emotions Avoid jumping to conclusions Observe the congruence between the verbal and non-verbal Practice listening Limit your own talking Be patient Concentrate Guidelines to Effective Listening

26. The Essential Questions What is wrong with me? Is there a risk of the illness spreading to those around me or passing it to my off-springs? Is there an effective treatment for my problem? Is the treatment safe / are there any serious side effects or dangerous effects of the treatment (drugs, interventions, surgery etc), effects on sex, appetite, sleep, weight etc…… Alternative treatments Alternative treatments available? How long will I take to recover? Is there any abstinence? Information Care

27. Patient’s knowledge and expectations must be assessed prior to and after the communication of significant information to see what and how much has been retained. Evidence Based Facts should be provided. Positive and negative effects of medicine expressed. Avoid false hopes. Discuss prognosis of disease in range. Summarize Check for information retained. Basic steps in informational care

28. Assignment Write a learning agreement showing how principles of interpersonal skills can be applied to daily activities

29. THANK YOU