1. Communication HINF 371 - Medical Methodologies Session 11

2. Objective Understand the importance of communication in achieving better outcomes Understand the importance of communication in achieving better outcomes

3. Reading Mar CD, Doust J, Glasziou (2006) Chapter 2: Communication in clinical care, health promotion and disease prevention, Blackwell Publishing and BMJ Books, USA Mar CD, Doust J, Glasziou (2006) Chapter 2: Communication in clinical care, health promotion and disease prevention, Blackwell Publishing and BMJ Books, USA Redelmeier, DA; Schull, MJ; Hux, JE; Tu, JV; Ferris, LE (2001) Problems for clinical judgment: 1. Eliciting an insightful history of present illness, Canadian Medical Association Journal, Vol: 164, Issue: 5, p:647-652 Redelmeier, DA; Schull, MJ; Hux, JE; Tu, JV; Ferris, LE (2001) Problems for clinical judgment: 1. Eliciting an insightful history of present illness, Canadian Medical Association Journal, Vol: 164, Issue: 5, p:647-652 Redelmeier, DA; Tu, JV; Schull, MJ; Ferris, LE; Hux, JE (2001) Problems for clinical judgment: 1. Obtaining a reliable past medical history, Canadian Medical Association Journal, Vol: 164, Issue: 6, p:809-813 Redelmeier, DA; Tu, JV; Schull, MJ; Ferris, LE; Hux, JE (2001) Problems for clinical judgment: 1. Obtaining a reliable past medical history, Canadian Medical Association Journal, Vol: 164, Issue: 6, p:809-813 Rob Buckman (1999) Communication Skills in Clinical Practice (video recording): a video guide Rob Buckman (1999) Communication Skills in Clinical Practice (video recording): a video guide

4. Tasks of Communication Define the reasons for the patients’ attendance Define the reasons for the patients’ attendance Nature and history of the problem Nature and history of the problem Their etiology Their etiology The patient’s ideas, concerns and expectations The patient’s ideas, concerns and expectations The effects of the problems The effects of the problems Consider other problems Consider other problems Continuing problems Continuing problems At-risk factors At-risk factors Achieve a shared understanding of problems Achieve a shared understanding of problems Involve patients in choosing and implementing management Involve patients in choosing and implementing management Encourage the taking responsibility for health Encourage the taking responsibility for health Use time and resources appropriately Use time and resources appropriately Establish or maintain a relationship with the patients that helps to achieve these tasks Establish or maintain a relationship with the patients that helps to achieve these tasks Why did the patient come? What other medical problems can be dealt with? Can health promotion or disease preventions be offered? Can patient be made more self-sufficient?

5. Good Communication = better two way understanding = better two way understanding Patient centred vs disease centred Patient centred vs disease centred Enablement= accepting patient preferences as face value Enablement= accepting patient preferences as face value Listing their problems Listing their problems Arranging them by priority Arranging them by priority Deciding which problems need adressing in this consultation Deciding which problems need adressing in this consultation Deciding if they had been met afterwards Deciding if they had been met afterwards Motivational interviewing: understanding patients agenda, ensuring it is clearly foremost, ye providing enough information to alter that agenda Motivational interviewing: understanding patients agenda, ensuring it is clearly foremost, ye providing enough information to alter that agenda Continuity Continuity Safety Net: formal follow-up, explicit invitation, informal blanket invitation, implicit invitation Safety Net: formal follow-up, explicit invitation, informal blanket invitation, implicit invitation

6. Communication Errors Comprehension Ambigous language Ambigous language Libido, neoplasm, Libido, neoplasm, Leading questions Leading questions Better= improved or normalized? Better= improved or normalized? Tacid Misunderstanding Tacid Misunderstanding How questions are asked – sequencing How questions are asked – sequencing How cultural norms impact How cultural norms impact Context of the question based on the responders perception Context of the question based on the responders perception Telescopic effects Estimating the past Estimating event frequency in the past PHYSICIAN DRIVEN PATIENT DRIVEN

7. Communication Errors Recall Failure of Memory Failure of Memory Technical details fade faster than emotional Technical details fade faster than emotional Provide ways to improve memory Provide ways to improve memory Diary Diary Recording devices Recording devices Agree on questions for next visit Agree on questions for next visit Write down key points Write down key points Automative Shortcuts Automative Shortcuts Complex question = estimated answer, gut feel Complex question = estimated answer, gut feel False memories Events with strong memories remembered Embellishments Corroborate Inhibition of memory Weaker memories are suppressed by stronger ones Cues has the potential to cause distortions PHYSICIAN DRIVEN PATIENT DRIVEN

8. Communication Errors Evaluation Inconsistent Expectations Inconsistent Expectations People express emotions when discrepancy between expectations and perceptions People express emotions when discrepancy between expectations and perceptions Expansion of context is necessary Expansion of context is necessary Halo effects Reflecting emotions to the whole person or event Subjective evaluations are influenced by extragenous factors Extremes of success or failure Persistence of beliefs PHYSICIAN DRIVEN PATIENT DRIVEN

9. Communication Errors Expression Extraneous Distractions Extraneous Distractions Room, positions Room, positions Current mood Current mood Ignoble failures Ignoble failures Discrimination Discrimination Heart sink patients Heart sink patients Self-expression Fear of embarrasment Embellish position Distortions to be percieved better Context dependency More stressful environment reduces the likelihood of remembering PHYSICIAN DRIVEN PATIENT DRIVEN