1. Introduction and techniques of communication

2. Why this Webinar?? Communication between physicians and patients and their families is consistently identified as the most important and least accomplished factor in quality of care ICU Recent incidences of violence against Medical Practitioners are indicators of breaking of bond between Doctor and Patient

3. The Doctor-Patient Relationship and Malpractice Lessons From Plaintiff Depositions Arch Intern Med. 1994;154(12):1365-1370

4. How do you rate your doctor

5. Why was patient shifted to other hospital?

6. Journal of Bone & Joint Surgery2005:87:652-58 Discrepancies between patients assessment and physicians self assessment in Orthopedic care

7. Communication skills and knowledge though very important aspect does not receive deserved attention These skills and knowledge are taught only in context of diagnostic interviewing Even providers with necessary skills do not use them adequately for lack of time without recognizing that they can not afford not to Our most common deficiency in our daily interviews with patients remains a failure to demonstrate an empathic response

9. The Main Skills for Effective Communication Staying Focused Listening Carefully Understanding Others' Point of Views Empathy When Criticizing Taking Ownership Compromise if Necessary Ask for Help Take a Time-Out if Necessary

10. Dr Albert Mehrabians 7%-38%-55% rule Basically three elements in any face-to-face communication – Words – Tone of voice – Nonverbal behaviour (body language) Non -verbal elements are particularly important for communicating feelings and attitude, especially when they are incongruent: if words disagree with the tone of voice and nonverbal behaviour, people tend to believe the tonality and nonverbal behaviour

11. Elements of body language Facial expressions Eyes Posture Gesture Voice Movements Touch Appearance

12. Osgood- Schramm model of communication 1954

13. Berlo's Model of Communication 1960 Source Communication skills Attitude Knowledge Social system Culture Message Content Elements Treatment Structure code Channel Hearing Seeing Touching Smelling tasting Receiver Communication skills Attitude Knowledge Social system Culture EncodesDecodes

14. Models of Communication between surrogate-physician Directive model Informative model Facilitative model Collaborative model

15. SkillExample Crisis communication Acting as a team leader and directing collegues in a clinical emergency Interprofessional discussions Dealing with disagreements between clinical teams about treatment options Communicating with patients Focused history taking in a compromised patient Use of communication aids with an intubated patient Family meetings Initial consultation Clinical updates End-of-life issues Explanation of critical care interventions and honest discussion of prognosis Modifying expectations Negotiating agreement on a withdrawal of treatment plan Various Communications required in critical care CEACCP 2008;8:121-24

16. Principles for Better Communication 1 Ask-Tell-Ask – Ask the family to describe their current understanding of the issue – Tell the family in straightforward language what you need to communicate—the bad news, or treatment options, or other information – Ask the family whether they understand what you just said.

17. Principles for Better Communication 2 When You Are Stuck, Ask for More Information: "Tell Me More.“ – "Could you tell me more about what information you need at this point?” – "Could you say something about how you are feeling about what we’ve discussed?” – "Could you tell me what this means for you and your life?”

18. Principles for Better Communication 3 Use reflections rather than questions to learn more Reflections are restatements of the family’s words or guesses at what the family means – Convey empathy – Empower the family to take control of the conversational platform – Allows silence and time for the family member to respond

19. Principles for Better Communication 4 Skills for Responding to emotions – When people are experiencing strong emotions they are less able to hear cognitive information Emotion – In the midst of a strong emotional reaction, people find it hard to make decisions – What most people want when expressing strong emotions is to feel that their situation and emotions are heard and appreciated

20. Empathy – a major element of communication in ICU Being able to recognize and then show that you are trying to recognize what the other person is going through – Associated with family satisfaction and trust – Enable patients to connect their emotional reactions to their own important values – Helps people talk more about what they are feeling – Acting empathically can enable physicians to create medical plans that serve patients better

21. Principles for Better Communication 5 Assess the Other Person's Informational, Decision- making and Coping Style – Monitors - problem-focused coping – Blunters- emotion-focused coping – Combinations

22. Common Barriers Giving pathophysiology lectures Ignoring the context of the communication encounter Not finding out the family’s information needs and styles Launching into your agenda first without negotiating the focus of the interview Offering reassurance prematurely Pushing the family to make a decision, before they have had a chance to grieve the loss

23. Summary Good communication skills improve medical care and reduce lawsuits. Skilful interviews improve diagnostic accuracy by gathering a superior quantity and quality of data Linked to increased patient satisfaction and patient adherence to medication and treatment regimens as well as to improved clinical outcomes and also reduce medical errors. Would help reduce violent attacks on medical professionals