1. Consultant in Family Medicine
COMMUNICATION SKILLS
DR. Yousif Elgizoli
Consultant in Family Medicine
MRCGP (UK),
JMHPE-MAASRTICHT

3. What is Communication?

4. Communication has been derived from the Latin word "communis", meaning to share.
Two-way process of reaching mutual understanding, in which participants not only exchange (encode-decode) information but also create and share meaning.
"sending, giving, or exchanging information and ideas.

5. Communication requires a sender, a message, and an intended recipient.
(cont)
Communication requires a sender, a message, and an intended recipient.

6. Most common ways to communicate
Visual Images
Speaking
Writing
Body Language

7. Purposes of Communication

8. To solve problems Reassurance To form and maintain
relationship
alleviate distress COMMUNICATION convey feelings
give information make decisions persuade

9. Benefits identify patients' problems more accurately:
Improve Pts understanding & Information retention
Increase adherence to treatment
Patients adjust better psychologically
Pts more satisfied with their care

10. Benefits
Doctors with good communication skills have greater job satisfaction and less work stress,
Delivery of high-quality health care.
(Roter 1987, Betakis 1991, Stewart 1995)

11. Communication skills - why bother?
Why learn communication skills?
Can you learn communication skills?
What is there to learn?
How is it taught?
Where next?

12. Why learn communication skills?
l reasons for the patient's attendance
l gathering information
l explanation and planning
l adherence to plans
l medico-legal
Enables us to become better doctors clinically
Improves patient care and disease outcomes

13. Can communication skills be taught?
communication is a clinical skill
it is a series of learnt skills
experience is a poor teacher
there is conclusive evidence that communication skills can be taught
and that communication skills teaching is retained

14. How to teach communication skills?
Observation
Video or audio playback
Well-intentioned feedback
Rehearsal
Active small group or 1:1 learning

15. Effective communication is essential to the practice of high quality medicine

16. Effect on Health Outcomes
The reduction of anxiety.
The reduction of psychological distress.
Pain relief.
Symptom resolution.
Mood improvement.
Reduction of high blood pressure.
(Stewart 1995).

17. “physicians were not listening enough to their complaints.”
“The main remarks made by patients in the PHC centers in Riyadh was that:
“physicians were not listening enough to their complaints.”
( Saeed 2001)

18. Setting:- Privacy, Avoid interruptions,
Comfortable lighting & temperature,
Arrangement of seats,
Distance,
Level.

19. Co-operation Confrontation. Conversation
Co-operation Confrontation Conversation Seating arrangements of doctor and patient

20. ACTIVE LISTENING…(cntd…)
Use Non-verbal Communication:
Smile,
Gestures,
Eye contact,
Your posture.

21. Techniques to improve listening skills
SUMMARIZE
Pull together the main points of a speaker
PARAPHRASE
Restate what was said in your own words
QUESTION
Challenge speaker to think further, clarifying both your and their understanding

22. Non-Verbal Communication
55%
Face and body: non-verbal communication or face and body language.
38%
voice dynamics:
tone + inflection + volume + accent + non-word sounds; and...

23. RECOGNIZING NON VERBAL COMMUNICATION
FACIAL EXPRESSION
GESTURES & POSTURES
VOCAL CHARACTRISTICS

24. RECOGNIZING NON VERBAL COMMUNICATION
PERSONAL APPREARENCE
TOUCH
TIME & SPACE

25. Example of body language
Folded arms and leg crossed away from you:
Rejection
Tapping fingers:
Impatience
Avoiding eye contact:
Untrustworthy

26. Example of body language
Sitting with legs crossed, foot kicking slightly:
Boredom
Biting nails:
Anxiety
Shoulder hunched, hands in pockets
Depression/Dejection

27. Effective
Communication
Skills
(Models)

28. Effective Communication Skills
Greet the person by their names.
Make eye contact ,introduce yourself warmly
Smile (ease the tension on either side)
Shake hands. Ask the person to sit down by indicating a chair.
establish a rapport by asking a simple
open- ended question ,
explain that you may need to take notes,

29. Effective Communication Skills
Aim to encourage emotional expression as this will often prove to be the most therapeutic aspect of the interaction.
If you think you are not getting through to the other person, resist the temptation to raise your voice.
Being positive

30. Effective Communication Skills
At the end:
Summarize
Give a chance to ask
Agree a time for a follow-up.
Thank and escort him to the door

31. in Communication with Pts
PITFALLS
in Communication with Pts

33. Blocking behavior Interrupting;
Offering advice and reassurance before the main problems have been identified;
Lack of concern;
Attending to physical aspects only;
Switching the topic.

34. LEARNING Communication SKILLS
Practice
Rehersal
Recording
Refelection
Feedback

35. To Be a Good Doctor/Teacher we Have to Be a
Take Home Message
To Be a Good Doctor/Teacher we Have to Be a
GOOD COMUNICATOR

36. The consultation

37. DEFINITION

38. Definition
The occasion when, a person who is ill, or believes himself to be ill, seeks the advice of a doctor whom he trust.
(Wright & Macadam)

39. CONSULTATION IN HOSPITAL
CONSULTATION IN PHC
Vs.
CONSULTATION IN HOSPITAL

40. Sara is 38 years old lady, complaining of 2 weeks history of headache.
How are you going to conduct this consultation?

41. Characteristics of Hospital Model
It is doctor centred and disease oriented.
A diagnosis must be arrived at "objectively" before treatment.
It takes long time
No consideration of the psychosocial dimensions explanation, health education, health promotion and treatment by reassurance

42. PHC Model of Consultation (Bio-psychological Model)

43. Characteristics of PHC Consultation Model
Patient – centred
Holistic approach (Bio-psycho – social)
Prevention & Health education
Treatment by reassurance
Appropriate use of time & resources

45. Models of consultation

46. Stott and Davis (1979)

47. Roger Neighbor

48. NEIGHBOUR’S 5 CHECKPOINTS
(Roger Neighbour “The Inner Consultation”) 1. CONNECTING SUMMARISING HANDING OVER SAFETY NETTING. 5. HOUSEKEEPING.

49. NEIGHBOUR’S 5 CHECKPOINTS
1. CONNECTING. Achieving rapport & empathy. 2. SUMMARISING. Demonstrate to patient you understand why he’s come, hopes, feeling, concerns & expectations. 3. HANDING OVER. Has the patient accepted the management plan we have agreed? Negotiating, influencing & gift-wrapping.

50. “The Inner Consultation” (Continued)
4. SAFETY NETTING. Predicting what could happen – what if? Or have I anticipated all likely outcomes? 5. HOUSEKEEPING. Clearance of any emotional responses to patients we have seen or to those we are about to see. Am I in good condition for the next patient.

51. Schofield, Tate and Havelock (1984)
PENDLETON’S MODEL
Schofield, Tate and Havelock (1984)

52. Seven Tasks:
1. To define the reasons for the Patient’s attendance, including:
(i) The nature and history of the problems; (ii) Their aetiology; (iii) The Patient’s ideas, concerns & expectations; (iv) The effects of the problems. 2. To consider other problems:
(I) Continuing problems; (ii) At risk factors.

53. 3. To choose with the Patient. An appropriate. action for each problem
3. To choose with the Patient. An appropriate action for each problem. 4. To achieve a shared understanding of the problems with the patient. 5. To involve the Patient in the management and encourage him to accept appropriate responsibility. 6. To use time and resources appropriately. 7. To establish or maintain a relationship with the Patient which helps to achieve the other tasks.

54. Doctor-centred / Patient-centred
Doctor is the expert and the Pt. just to cooperate.
Focus only on the physical aspects
Tightly controlled the interview
Qs. are mainly of ‘closed’ type
Biomedical disease framework
 Lack for patients to express their ICE.
Much less controlling style
Encourage and facilitate pt. participation
Fostering a relationship of ‘mutuality’.
Greater use of ‘open’ questions
more time to active listening
Responding to Pt. cues
Considered Pt. ICE

56. Performance Criteria?

57. Your name is Ahmad a 35-Ys- old, working as a bus driver in near school, 3 days ago after you hold a heavy tire, you felt a LBP
 The pain is down the back and not goes down, it is stabbing in nature, aggravated by leaning forward and stiff in the morning, it is ease by lying in a bed
  Your concern today is that, it could be a disc prolapse because you have an elder brother who had a prolapse last Year, your expectation is that your doctor to ask for MRI to be reassured, give you a potent pain killer (injection) and also to offer you a sick leave.

58. A- DISCOVER THE REASONS FOR THE PATIENT'S ATTENDANCE1-
Encourage
2-Respond to signals (Cues)
3-Psych-social
4- ICE

59. B- DEFINE THE CLINICAL PROBLEM(S)
5- Red Flags
6- Examination
7- Working Diagnosis

60. C- EXPLAIN THE PROBLEM(S) TO THE PATIENT
9- Explanation incorporate Pt.’ ICE
10- Confirm Pt.’ understanding

61. D- ADDRESS THE PATIENT’S PROBLEM(S)
11- Management Plan
12- INVOLVE Pt. in management plan

62. E- MAKE EFFECTIVE USE OF THE CONSULTATION
13- Enhance Concordance
14- Follow-Up

64. IMPROVING CONSULTATION SKILLS

65. IMPROVING CONSULTATION SKILLS
* Constant Learning and Practice * Feed-Back: - Self monitoring/Peer review - Audio-visual technique - Role play

66. Dysfunctional consultation

67. Signs of Dysfunctional consultation
Poor reputation among patients
Upset patients or doctors
Increasing complaints
Increasing critical events
Reduced job satisfaction

68. Hearing or linguistic difficulties Upset patients Psychiatric illness
Patient factors
Hearing or linguistic difficulties
Upset patients
Psychiatric illness
Loss of faith in the doctor (poor reputation, adverse incident etc)
Patients that ‘violate’ the doctors values e.g. drug misusers or alcoholics
Problem Patients

69. Doctor factors:
Attitudes – a doctor centred consulter, burnt out depersonalisation, angry, defensive, ‘over caring’- always wanting to be liked or hard-line doctors.
Poor emotional housekeeping.
Skills – poor consultation or clinical skills resulting in an inappropriate management plan.
Knowledge – lack of knowledge leading to an inappropriate or suboptimal management plan.
Bored –lack of personal or professional development

70. Patient–doctor factors
Cultural issues
Failure to identify hidden agendas.
Failure to identify the patients fears, beliefs or expectations.
Failure to generate a management plan appropriate to the patient’s circumstances.

71. Practice factors: Pressure of time – running late.
Poor systems (e.g. telephone access, appointments, admin).
Poor staffing, inappropriate skill mix etc which unnecessarily increase workload.
Unnecessary interruptions – telephone, staff, patients.
Physical factors - lay out of the room, lighting, extraneous noise.

72. Doctor should be able to
* Cure some time.
* Relieve often.
* Prevent hopefully.
* Comfort always.

73. شكــــــراً
THANKS