1. Communication and The Consultation
Dr Sarah Hands

2. Objectives for the Session
Confirm the importance of developing good patient communication.
Look at some different consultation models
Have a chance to practice communication skills
Look at a video using COT

3. Communication Theory
“Communication is the process by which information is transmitted and received”
‘Process’ is a means to an end
‘Information’ includes factual + other + NVC
‘Received’ crucial verb as transmitting is only half the story
“The meaning of the communication is the response that you get”

4. Communication Is Cyclical
YOUR EXTERNAL BEHAVIOUR
MY INTERNAL RESPONSE
YOUR INTERNAL RESPONSE
MY EXTERNAL BEHAVIOUR

5. Human Expressiveness
Body language 55%
Voice tonality 38%
Words 7%

6. What are their moods?

7. Five Styles of Listening
Ignoring
Pretending to listen
Selective listening
Attentive – reflective listening
Empathic listening – with intention to really understand

8. Listening Is a Three- Stage Process
You hear what is said – all Vs & NVCs
You understand what you heard – reflect, paraphrase summarise check understanding
You interpret what you understood - you are then ready to respond

9. Think About…… Barriers to effective communication: Within the doctor
Within the patient
Within the environment

10. Barriers to Communication: Listener (Doctor)
Mental state
Poor listener – easily distracted
Negative previous experience
Pursuing own agenda
Over-controlling
Personal prejudices

11. Barriers to Communication: Speaker (Patient)
Mental state
Hidden agenda
Lack of motivation
Sensory impairment & language difficulties
Easily distracted
Negative previous experience
Personal prejudices

12. Barriers to Communication: Environment
External noise and interruptions
Time factors – late busy, time constrained

13. Patient Agenda Beliefs Hopes and fears Hidden problems Expectations
Presenting problems
Secondary problems, perceived problems and perceived effects

14. Doctor Agenda Information gathering and fact collecting
Analysing, further questioning clarifying
Interpreting and verifying
Sharing understanding

15. Characteristics of Empathic Listener
Sets up meeting well – knowledge of patient
Gives speaker 100% attention – relaxed, eye contact, tone
Avoids half-hearing and jumping to conclusions
Delays thinking of a response
Does not interrupt with next point
Tests own understanding – summarising, paraphrasing
Tries to understand problem from other perspective

16. Consultation Structure Overview
Content – questions, information, management
Process – questioning, Vs and NVCs, relationship
Attention to thoughts and feelings – decisions, problem solving, awareness of self

17. Doctor-Patient Relationships
Sociological – behaviour value determined
Anthropological – What happened, why now, why me, what if I did nothing?
Transactional – Parent/adult/child
Psychological – patient psychology determines outcome
Verbal – follows doctor-initiated sequence*
Non-verbal – response to mutual cues
Balint – physical & psychological co-exist

18. Byrne and Long (1976) Original verbal model
Phase 1 – Dr establishes relationship with patient
Phase 2 – Dr attempts to discover reason for attendance
Phase 3 – Dr conducts exam verbal/physical/both
Phase 4 – Dr or Dr + patient or patient consider the condition
Phase 5 – Dr & occasionally patient detail further treatment or investigation
Phase 6 – consultation terminated usually by Dr

19. Pendleton Framework (1984) Basis for RCGP COT
1. Discover reason for patient’s attendance
2. Define the clinical problem(s)
3. Address the patient’s problem(s)
4. Explain the problem(s) to the patient
5. Make effective use of the consultation
Resources
Relationship
Health Promotion

20. Consultation Observation Tool
Discover reasons patient attendance
1. Appropriate encouragement, 2. Response to cues, 3. Use of context, 4. Health understanding explored
Define clinical problems
5. Sufficient information, 6. Appropriate examination Working diagnosis
Explain problem to patient
8. Appropriate language, 9. Confirm understanding
Address patient problems
10. Management appropriate, 11. Patient involved in decision management
Make effective use of consultation
12. Use of resources e.g. time, 13. Follow up arrangement

21. Consultation Exercises
Different Agenda Exercise
Empathic Listening Exercise
Using COT to look at and score a video