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Communication Skills

Hamid Khalifa: 2015/

Objectives of communication skills

It helps us to analyse and make an assessment for our

communication skills aiming to get more improvement.

Communication skills in clinical setup helps us to

conduct patient-centred approach.

To understand the correlation between communication

skills, knowledge and clinical reasoning. And this helps
us to become good clinicians, and to get more
improvement for achieving other important outcomes.
Root of communication word:

Communication word comes from Latin word is

called: commūnicāre
Com: means with
Muni: means to share

Community: people sharing some things together
such as;
as; ethnicity, religion, flag, services, etc..
Definition of Communication Skills:
Communication skills are the corner stone of any
effective relationship between doctors and patients.

Communication is classified into 2 types:

1. Verbal type;
type; and it’s all information we gather by
using speech (35%
2. Non-
Non-verbal type;
type; and it’s all information we gather by
using body language, gesture, facial expression…
85% of your success in your professional field;

is depending on
Your ability to communicate with others
Uses of Communication Skills
1- Health Education.
2- Arriving to diagnosis.
3- Management plan.
4- Ensuring better patient satisfaction .
5- Enhancing self-
self-esteem of the doctor.
6- Cost-
Cost-effective utilization of resources.
Principles of Communication Skills

1- Body language.
2- Listening skills.
3- Empathy.
4- Key questions.
5- Reassurance & Encouragement.
1- Body language:
The physician who;
sits down, creates a comfortable atmosphere and
appears to be less dominating, looks like more
interested for patient’s story.
In contrast, the physician who repeatedly clicks
his pen, looks at his watch, or shuffles papers is
clearly not interested.
Aspects of Body Language
When you lean forward around 45 degrees while you
sitting on your chair, that means; the patient’s story is
Meanwhile, your backward posture on the chair means
you are busy or not interested.
In some culture; closed leg and hand position means
you are not a respected person.
Clothes of the doctor are belonging to the body
language as well.
Frequent movement; doctors who find themselves
changing position frequently give feeling of rejection.
2- Listening Skills:
Eye contact
Many physicians have a difficulty to maintain eye contact
when they ask sensitive questions such as; (family
violence or psychological problems,…….) ,
So, when you looking away while you ask sensitive
questions that gives the patient a clue that you don’t
want to know the answer.
As a doctors, we listen not only by our ears but with
our eyes, mind, heart, and imagination as well;

Attentive listening means giving the patient

undivided attention, and tells the other that we are
interested and concerned.
Meanwhile, listeners who don’t look to the patient
and don’t nod their heads while they are listening;
are almost judged un friendly or not interested.
Why do we have two ears and just
one mouth?!!!
Nodding Head;
It is a movement of your head up, down, left and right
during the listening to the patient.

Types of Nodding Head :

1. When you nod your head slowly that means; I am
listening to you.
2. When you nod your head a little bit fast that means;
you are right.
3. When you nod your head quickly that means; I am
interested to your story.
Factors for effective listening :
1. Wait a bit before answering or response and don’t
interrupt the patient.
2. Clarifications questions; the first who asks, the one
who guide.
3. Re-talk with different way (restatement) by using
your own language.
Scientifically approved; when you are listening with
attention; this leads to release the endorphins
enzyme inside the patient’s body and cause feelings
of happiness.
Obstacles of Listening
1. Busy or concern with other matters.
2. Cultural differences.
3. Cognitive differences.
4. Tiredness & Monotony.
5. Psychotropic substances.
3. Empathy:
It is one of important principles in communication
skills, to change in our perception of the clinical task
from the doctor-centered approach to the patient-
centered approach.

Signals to make good connection. Touching the
patient may be appropriate when the patient
expresses joy or sadness.
Offer some things to the patient such as a good place
for sitting or tissue and water when he starts crying.
It should be remembered that for patients of other
cultures touch should be used with caution, as it may
have meanings and stigmas not shared by the doctor’s
4. Key questions:
When the doctor feels that some things have been
left unsaid, closed-ended questions will help the
patient to express himself properly.

5. Encouragement and Reassurance:

It is useful and effective for the interview to
encourage the patient from time to time by such
complimentary expression as :

- What you have said is really helpful

- I never had such an educational discussion like this
- I never thought of it from that angle.
How reassurance should be like?

Reassurance must be specific for what the patient’s anxieties are.

Premature reassurance is ineffective and may be interpreted by
the patient as a rejection
When reassurance, can be given with confidence, it should not be
delayed and should not be a false hope.
When the nature of the disease is explained, every day language
should be use.
Process of Comm. Skills by Using
(Cambridge-Calgary model )

1. Initiating the interview

2. Gathering information
3. Providing structure
4. Building relationship
5. Explanation and planning
6. Closing the interview
Cambridge-Calgary consultation model
Establishing initial rapport
1. Greets patient with warm smile, and obtains
patient’s name
2. Introduce your self
3. Demonstrates respect and interest, attends
to patient’s physical comfort
Uses open and closed questioning technique,
appropriately moving from open to closed

Listens attentively, allowing patient to complete

statements without interruption.

Facilitates patient's responses verbally and

non–verbally e.g. use of encouragement, silence
(recall time), repetition, paraphrasing,
Summarises at the end of a specific line of
inquiry to confirm understanding before moving
on to the next section

Some times the patient deviates in his story to

less important topics, it is our duty to guide him
back in the right path without offending him.
Using appropriate non-verbal behaviour

• Eye contact, facial expression.

• Posture, position & movement.
• Vocal signals e.g. rate, volume,
tone of voice.
• Uses empathy to communicate
and appreciate the patient’s
1. Providing the appropriate amount and type of
2. Delivering information in a form that facilitates
recall and understanding especially when there
is serious health problem (Breaking Bad News).
3. Encouraging the patient to become involved
collaboratively in making decisions about their
Recall time
The patient may be so full of emotions that he may go
into silence, At such times, the doctor should give
enough time to the patient to recollect and start again.
• Ask the patient for desirable time for next
appointment .
explaining possible unexpected outcomes, what to
do if plan is not working, when and how to seek help.
This makes patient feels happy not only because he
will be intended to the plan of management - but also
with what to do if it things go wrong.
Barriers of Communication
1. Physiological barrier: difficulties in hearing or
inability to see clearly.
2. Psychological barrier: emotional disturbance,
low intelligence & comprehension difficulties.
3. Environmental barrier: noise, overcrowding in a
room & invisibility.
4. Culture barrier: language variation, customs,
Breaking Bad News

The patient should be told all relevant information

regarding the illness, expected outcomes,
treatment options, risks and benefits of treatment,
and other needed information based on the
patient’s specific values and needs.
Psychological Reactions of the patients who were
told of the diagnosis of cancer:

1) First phase:
phase: period of early reaction within few
days (deny the facts).

2) Second phase:
phase: period of distress/ after 1-2
weeks (phase of anxiety, depression, insomnia,
appetite loss and loss of concentration).
3) Third phase:
phase: period of adaptation after 2
weeks – 1 month (sometimes 2 months), when the
patient adapts the new situation.
Steps protocol for delivering bad news:

1) You should plan what you will say and it’s

important to confirm diagnosis and prepare
yourself for all the expected answers that the
patient or his relative could ask about further
2) Choose good location because it is not nice to tell
the diagnosis on the corridor or on the phone, which
55% of patient who has told by phone expressed
negative feeling.
3) Determine what the patient knows about his
problem to determine what information the
patient he needs and the ability to know new

4) Keep the patient up to date about his condition

even though before the diagnosis, which you start
from suspicion or possibility of the disease and
tell the facts after a definite diagnosis is made.
Some points you have to care about
Don’t say to the patient; that there is nothing I can do, or
there is no effective treatment.
Don’t hurry to explain all details on one occasion. It’s
recommended to have many interviews.
Put yourself in the patient’s place and not judge
patient’s reactions prematurely.
Give Recall Time, show empathy & immediate