Skills For Communicating With Patients 2nd

Skills for Communicating
with Patients
Second Edition
Jonathan Silverman
Associate Oinicol Deon and Dirtor of Communkotion Stud.in
School of CJinicof Medidne
Uni..rs;l'f of Ccmbrklge, UK
Suzanne Kurtz
Profesror of Cornmunrcocion
Focuhies of Education and Medicine
University of CoJgory. Alberto, Conodo
and
Juliet Draper
0NeOf'
Eosrern Deonety CoKOde Comnwnlc:oo'on SkJlls Te0<hlng Project. UK
Forewords by
Jan van Dalen

and
Frederic W Platt
Radcliffe Publishing
Oxford San f ran<isoo
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structure relationship
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Preparation
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Identifying the reasons for the consultation

structure Exploration of the patients problems to discover the:
relationship
Making biomedical perspective patients perspective Using
organisation appropriate
overt background information context non-verbal
behaviour
Attending Physical examination
to flow Developing
Explanation and planning rapport
Providing the correct type and amount of information Involving

Aiding accurate recall and understanding the patient
Achieving a shared understanding: incorporating the
patients illness framework
Planning: shared decision making
Closing the session

Ensuring appropriate point of closure
Forward planning
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Gathering information
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Patients narrative
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Attentive listening
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Clarification
Time-framing
Internal summary
Appropriate use of language
Additional skills for understanding
the patients perspective
Content to be discovered
THE BIOMEDICAL PERSPECTIVE DISEASE THE PATIENTS PERSPECTIVE ILLNESS
Sequence of events Ideas and beliefs
Symptom analysis Concerns
Relevant systems review Expectations
Effects on life
Feelings
BACKGROUND INFORMATION CONTEXT

Past medical history
Drug and allergy history
Family history
Personal and social history
Review of systems
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REVISED CONTENT GUIDE TO THE MEDICAL INTERVIEW
Patients problem list
Exploration of patients problems

Biomedical perspective disease Patients perspective illness
Effects on life
Feelings
Background information context

Family history
Review of systems
Differential diagnosis hypotheses

Including both disease and illness issues
Physicians plan of management

Investigations
Treatment alternatives
Explanation and planning with patient

What the patient has been told
Plan of action negotiated
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Content to be discovered
Biomedical perspective disease Patients perspective illness

Effects on life
Feelings
Background information context

Family history
Review of systems
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Premature
way out
Contemplation
Reflect positive
statements to
Active change
enable patient to
reach a decision Give information
about change Provide choices for
action
Agree target
START Precontemplation Provide skills and
support
Explore health Feed back patients views
belief and establish to instil awareness of
readiness problem
for change (cognitive dissonance)
Maintenance
Provide appropriate
Relapse follow-up, individual or
If patient does not group support
return, send further Consider community
invitation support network
If patient returns, explore
difficulty with change and
attitude
OPTIMAL RECOVERY
Change consolidated
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High 10
Stuck: frustrated Moving: committed

This is important but I dont I think this is important and
know where to start; I havent Im going to do it no matter
been very successful in the past what the obstacles are
Conviction
Stuck: unaware/critical Stuck: sceptical

This is impossible and I dont I could do this, but its not
want to bother with it anyway worth the energy
Low 1 High 10
Confidence
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b+#B' Y)?>K,/ I",$' TNB
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43&3(3,)3% !"%
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TNB
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=),@:,A"+#)B @1-#&.( #C [[MFGB
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J"*K9,) I' Q::8< W' ^779:88 T "+. H:+); Q 1233M"5 !)7=9+* <)"78< =,:@);;9:+"7; 9+S:7S). 9+
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71.$&-. I'<# 5"<-8( '&C DLFL4B
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Skills For Communicating With Patients 2nd

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Skills For Communicating With Patients 2nd

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Skills for Communicating

Jan van Dalen

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