CANCER EPIDEMIOLOGY

1
(No Transcript)
2
COMMUNICATION SKILLSDr.hashim Rida Fida

• 2011

3

• ???????? ?????? ?? ????? ??? ????????

4
Objectives

• What is communication skills
• Communication theory
• Communication types
• Communication why
• Communication and medicine
• Do doctors need communication
• communication training why? with whom? how?

5
Objectives

• Principles of effective communication
• Communicate as a team
• Communicate with peers
• Doctor mission
• Doctor-pt relationships
• Communication and medical care
• Barriers to effective communication
• Lack of communication why

6
Communication

• Is the act by which information is shared between
  humans. Such encounters may cover
  
• Desires
• Needs
  Perceptions
  Knowledge
  
  Affective states.
  

7
Communication/2

• Communication is the process by which we relate
  and interact with other people.
• It is a mutual process between 2 sides
  (Dialogue) not a one sided monologue.
• It includes listening understanding with
  passion respect as well as expressing views
  ideas and passing information to others in a
  clear manner.

8
Communication/3

• Communication is natural process which may be
  intentional or unintentional.
  
• It may involve conventional or non-conventional
  signals.
• It may take linguistic or non-linguistic forms.
• It may occur through spoken or other modes.

9
COMMUNICATION THEORY

• Communication is a learned skill or a series of
  learned skills which is based on 3 pillars
• Accuracy
• Efficiency
• Supportiveness
• all combine to contribute to effectiveness of
  communication

10
COMMUNICATION THEORY/2

• Experience is a poor teacher it needs
  observation with well intentioned, constructive,
  detailed and descriptive feedback plus rehearsal
  to effect change.
• Communication is an art and like other arts it is
  a learned skill

11
Communication Types

• Verbal communication
• open ended questions
• Non verbal communication
• Body language
• Tone of voice
• written

12
(No Transcript)
13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
(No Transcript)
20
(No Transcript)
21
Communication Why?

• Communication is essential for all aspects of
  life.
• Effective communication is the basis of mutual
  understanding trust.
• Poor communication causes a lot of
  misunderstanding hinders work productivity.

22
Communication Medicine

• Historically the emphasis was on the biomedical
  model in medical training which places more value
  on technical proficiency than on communication
  skills.
• Recently learning communication skills evidence
  based practice become the corner stones of modern
  medicine.

23
Do doctors need communication?

• Doctors need to learn essentials of good
  communication more than other professionals
  because patients are humans with sensitive needs.
• Doctors can not practice medicine without
  effective communication skills.
• Poor communication causes a lot of medico-legal
  and ethical problems.

24
Communication Training why?

• to acquire knowledge of the basic features of
  verbal and non-verbal communication.
• to learn how to take a medical history from
  patients relatives.
• to know about illness behavior, physician and
  patient roles, and relevant cultural beliefs.
• to learn how to draw up a plan for an interview,
  open and close interviews, explain the purpose
  and summary.

25
Communication Training why?/2

• to know how to communicate with patients who have
  a learning disability.
• to gain further experience of doctor-patient
  communication with different types of patient
  (e.g. male, female, different social and ethnic
  groups, school age children elderly people).
• to learn the basic principles of clinical problem
  solving.

26
Communication With whom?

• Patients care-givers
• Nurses auxiliary staff
• Colleagues
• Administrators
• Evidence in court
• Reporting research findings
• Talking to the media
• Public

27
Communication How?

• The medical interview is the usual communication
  encounter between the doctor and the patient.
• It can be classified according to the purpose of
  the interview into 4 types
• History taking
• Breaking bad news
• Consultations
• Obtaining informed consent

28
Effective communication

• Ensures good working relationship
• Increases patients satisfaction
• Increases patients understanding of illness
  management
• Improves patients compliance with treatment

29
Principles of effective communication

• Ensures an interaction rather than a direct
  transmission process (telling someone what to do
  or only listening is not enough).
• Reduces uncertainty.
• Demonstrates flexibility in relating to
  different individuals and contexts).

30
Principles of effective communication

• Requires planning and thinking in terms of
  outcomes.
• Follows the helical model ( i.e. what I say
  influences what you say in a spiral fashion and
  coming back around the spiral of communication at
  a little different level each time is essential).
• Shows empathy learn how to handle emotional
  outbreaks.

31
COMMUNICATE AS A TEAM

• patient
• family
• physician
• other health care providers

• psychologist
• nurse
• social worker
• dietician

32
Communication with peers

• Mutual trust respect
• Exchange information
• Ask your seniors
• Do your share of work
• Communicate with patients in peers
• Seminar workshops help in good communication

33
Doctors Mission

• Doctors primary goals are
• To treat and cure where possible
• To bring relief in suffering.
• To help the patient cope with illness, disability
  and death.

34
Doctor-Patient Relationship

• The doctor-patient relationship is built on
• Honesty
• Confidentiality
• Trust

35
Communication Medical care

• Good communication should be established on
  admission between clients, family and the
  treating multidisciplinary team.
• Client family are encouraged to participate and
  verbalize in the ward round discussion about
• Offered medical care treatment
• Rehabilitation
• Follow- up/re-admission plans
• Doubts worries.

36
Communication Medical care

• Proper information to clients and family
  regarding services available and how they can
  utilize them.
• Information should be made available on
• Health Education/ Counseling Psychiatry.
• Endocrine, Metabolic, Neurology nephrology.
• Cardiology, Respiratory, GIT hematology.
• Nutrition, Immunization ambulatory care.
• Infections infection control.
• Clinical pharmacy therapeutics.
• Hygiene and Safety.

37

• What are the Barriers to effective communication?

38
Barriers to effective communication

• Personal attitudes
• Language
• Time management
• Working environment
• Ignorance
• Human failings (tiredness, stress)
• Inconsistency in providing information

39
Lack of communication why?

• Clinicians focus often on relieving patients'
  bodily pain, less often on their emotional
  distress, seldom on their suffering.
• Some of them view suffering as beyond their
  professional responsibilities.
• If clinicians feel unable to, or simply do not
  want to, address the powerful issue of patient
  suffering, it is appropriate to refer the patient
  to another professional on the healthcare team
  who is more comfortable in this area.

40
The Art of Consultation

• giving the correct amount and type of information
  to each individual patient.
• Providing explanations that the patient can
  remember and understand which relate to the
  patients illness framework.
• Using an interactive approach to ensure a shared
  understanding of the problem with the patient.
• Involving the patient and collaborative planning
  increase the patients commitment and adherence
  to plans made.
• Continuing to build a relationship and provide a
  supportive attitude.

41
Initiating the Consultation

• Establishing a supportive environment.
• Developing an awareness of the patients
  emotional state.
• Identifying as far as possible all the problems
  or issues that the patient has come to discuss.
• Establishing an agreed agenda or plan for the
  consultation.
• Enabling the patient to become part of a
  collaborative process.

42
Closing the interview

• Confirming the established plan of care.
• Clarifying next steps for both doctor and
  patient.
• Establishing contingency plans.
• Maximizing patient adherence and health outcomes.
• Making efficient use of time in the consultation.
• Continuing to allow the patient to feel part of a
  collaborative process and to build the
  doctor-patient relationship for the future.

43
Questions to ask yourself after each consultation

• Was I curious?
• Do I know significantly more about this person as
  a human being than before they came through the
  door?
• Did I listen?
• Did I make an acceptable working diagnosis?
• Did I explore their beliefs?

44
Questions to ask yourself after each
consultation/2

• Did I use their beliefs when I started
  explaining?
• Did I share options for investigations or
  treatment?
• Did I share in decision-making?
• Did I make some attempt to see that my patient
  understood?
• Did I develop the relationship?  

45
Doctors-Patients Relationship

• Developing rapport to enable the patient to feel
  understood, valued and supported.
• Encouraging an environment that maximizes
  accurate and efficient information gathering,
  planning and explanation.
• Enabling supportive counseling as an end in
  itself.

46
Doctors-Patients Relationship/2

• Involving the patient so that he/she understands
  and is comfortable with the process of the
  consultation.
• Increasing both the physicians and the patients
  satisfaction with the consultation.
• Developing and maintaining a continuing
  relationship of trust respect over time.

47
Dealing with emotional Patients

• Get patients attention lower your voice, move
  so they must turn in your direction.
• encourage them to sit down but let them control
  their emotions.
• Listen not just to the patients needs, but also
  for underlying issues/concerns and unexpressed
  expectations.

48
Dealing with emotional Patients/2

• The use of uh- huh and um has been shown to
  help patients settle down on their own. Feels
  like a lot of time, but really isnt.
• Avoid arguments, use disarming statements.
• Consider rolling with the resistance and agreeing
  with the patient if possible.
• Take a step back from the demand and ask probing
  questions to find underlying concerns. This may
  change a rant into a conversation.

49
Dealing with emotional Patients/3

• Dont assume things, ask to find out
• Dont get emotionally involved, keep your
  professional attitude.
• Dont give false reassuring comments.
• Say no in a tactful manner to the patients
  unrealistic wishes demands.

50
Difficult patient
The term difficult patient refers to a group of
patients with whom a physician may have trouble
forming a normal therapeutic relationship.
51
Breaking Bad News

• clinicians are responsible for delivering bad
  news, this skill is rarely taught in medical
  schools, clinicians are generally poor at
  itbreaking bad news is one of a physicians most
  difficult duties.
• medical education typically offers little formal
  preparation for this task.

52
THE PAST AND THE PRESENT

• Hippocrates advised concealing most things from
  the patient.
• Older physicians, who trained duringthe 1950s
  and 60s, were taught to "protect" patients from
  disheartening news.

53
BREAKING BAD NEWS/2

• any news that drastically and negatively alters
  the patients view of his or her future.
• it results in a cognitive, behavioral, or
  emotional deficit in the person.
• receiving the news that persists for some time
  after the news is received.

54
Message to take home

• Communication between the client, family and
  heath team play a vital role in the compliance
  to outpatient clinic visits and in-patient care
  programs.
• Good communication is essential for proper
  doctor-patient relationship and help avoids
  problems of misunderstanding.
• Effective communication is the key to success in
  professional career.

55

• Thank you