Introduction to communication patterns

1
Introduction to communication patterns

• Amanda Howe
• MA MEd MD FRCGP
• Professor of Primary Care
• University of East Anglia, Norwich, U.K.

2
Objectives

• By end of keynote
• Be able to identify your taken for granted
  assumptions about doctor patient communication
  in family medicine
• Have reconsidered some established models for
  analysis
• Become aware of contribution of different
  disciplines to this field of learning and
  research
• Be able to apply some simple tools to your
  consultations
• Have begun to think of some areas for study in
  practice
• Be able to identify issues in consultation where
  communication patterns may mislead us

3
Definitions1

• To communicate
• impart, reveal, bestow
• succeed in conveying ones meaning
• have something in common with another
• A pattern
• something to be copied, a model
• a design or guide when something is to be made
• recognisable repetitive structure
• thus, Communication patterns
• - A set of behaviours by which people habitually
  seek to convey meaning to another
• NB may not be successful or model
• 1Chambers English Dictionary, 1998

4
Assumptions

• What do you take for granted in your
  communication with patients?
• Discuss
• Consider further after the workshop
• Your own learned styles(s)?
• Need to modify this to patients?
• Time limits?
• Tasks to be achieved?
• Language and cultural barriers?

5
Models of communication in family medicine

• Doctor centred versus patient centred
• Calgary Cambridge OLOBA
• Objective Led Outcome Based Analysis
• Broader consultation analysis models
• Leicester Assessment Package
• LIV-MAAS
• MRCGP video rating scale
• Consultation Quality Index
• gtgtgtgt
• (NB. these look at communication and clinical
  care)

6
Evidence based assumptions in these models

• How we communicate is essential to successful
  outcomes both diagnostic and relational
• There are recognisable components to the
  consultation (not necessarily sequential in time)
• gt initiating, building rapport, gathering
  information, providing structure, effective
  explanation, shared decision making
• The opening component of the consultation must
  give scope to the patient to communicate reveal
• Some parts of the consultation must be doctor
  led
• Behaviours can be observed and evaluated
• but meaning cannot be interpreted by an
  outsider

7
Disciplines which contribute to studies of
communication

• Family medicine (core clinical skill)
• Psychology
• Sociology (influence of power culture)
• Linguistics (meaning, communication styles)
• Ethics and law (constraints, confidentiality)
• Education (learning, research into impacts)
• Humanities (indirectly but effectively)
• Philosophy (epistemology)

8
Practical Approaches

• Use an accredited evidence based checklist
• CPD opportunity to look at ones consultations
  (video, observer, simulated patients)
• Audit patient feedback CQI, LIV-MAAS
• Audit diagnoses especially any mishaps - for
  contribution of communication problems
• Reflect on difficult consultations especially
  cultural barriers, anger, somatisation consider
  further training if needed
• Read and think!

9
Communication patterns - recommendations

• Consultations should include recognisable
  components
• gt initiating, building rapport, gathering
  information, providing structure, effective
  explanation, shared decision making
• The opening component of the consultation must
  give scope to the patient to communicate reveal
• Microbehaviours e.g. clarification, checking,
  and safety netting are crucial to effective
  communication
• Nonverbal behaviours may be as important as
  verbal
• Continuous reflection on this aspect of
  professional behaviours is essential for all FMPs

10
Communication - can be misleading

• PSYCHOLOGICAL IMPAIRMENT drugs, depression,
  damage, disability
• DISTRUST vulnerability, power, abuse
• LANGUAGE BARRIERS
• CHARACTER introversion / extroversion,
  emotional literacy / expressiveness
• IMITATING vs genuine EMPATHY/RESPECT
• gtgt looking behind the message
• SYSTEMS CONSTRAINTS time, design
• gtgt need for underlying attitudinal development,
  organisational facilitation and self management
  

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Introduction to communication patterns
Amanda Howe MA MEd MD FRCGP Professor of Primary
Care University of East Anglia, Norwich, U.K.