1. MRCPsych Communication Skills Module
Week 1 – General Communication Skills

2. 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.

3. 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.

4. 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.

5. 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.

6. 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

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

8. 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

9. 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

10. 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

11. 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…

12. 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.