p “ The heart of the day to day activity of a etna] practicing physician is an effective docto patient relationship. The doctor-patient relationship can make or break the outcome of interaction. The key to an effective doctor-patient relationship is communication. Seanned with CamSeanneePowered by er a Objectives CaN) At the end of the session (August), the students must be able to: Define key terms Identify the forms of communication Describe the attitudes in communication Identify the opening and closing skills Demonstrate the attitudes and the active listening skills Seanned with CamSeanneeba Cra) a process through which information or ideas are being conveyed, transmitted or imparted by the use of signs, symbols or words to achieve certain understanding or even changes in the behavior. Seanned with CamSeanneeba Sra) The use of effective communication can assist physicians to provide better care of their patients. Seanned with CamSeanneebe Powered by LN Establish relationship between the persons ! I Stream Yard involved Impart new information Reinforce knowledge Direct the receiver in some ways as to: Chan; Stimulate thoughts ge attitude and behavior Provoke questions Reinforce attitude Functions of communication Seanned with CamSeanneeba Sra) 2. MESSAGE- subject matter which needs to be presented and how it is being communicated NDER- source / initiates communication verbal and non-verbal Intended messag Unintended message- given off beyond awareness 3. CHANNEL OF TRANSMISSION- way of sending the message to one or more senses Written/ oral/ non-verbal 4, RECEIVER- perceives the sender’s message 5, FEEDBACK- allows evaluation of the interpretation of the message 5 Elements of communication Seanned with CamSeanneere ba Sr) Linguistic Paralinguistic Non-linguistic *all 3 can occur simultaneously Seanned with CamSeanneeere ba messages that are conveyed through words which may Renan relate to ideas or to describe feelings or behaviors. Interviewers exhibit 4 types of verbal responses Exploratory Clarifying Affective Honest labeling Seanned with CamSeanneea” Exploratory- open- ended responses that encourage a Canaan person to continue talkis Direct and indirect leads and probes Clarifying- ensures that the message was indeed received and allows a person to correct/check interpretation Paraphrase, perception check and summary Affective- attends to feelings, attitudes and values and fosters self-awareness Reflecting feeling and probes Seanned with CamSeanneeere p / Exploratory- open- ended responses that encourage a " Pl 'Y- OP P e SDC person to continue talki Direct and indirect leads and probes Clarifying- ensures that the message was indeed received and allows a person to correct/check interpretation Paraphrase, perception check and summary Affective- attends to feelings, attitudes and values and fosters self-awareness Reflect Honest labellin, the issues feeling and probes speaks directly and honestly about Seanned with CamSeanneeoN Guide to honest lab StreamYard Rapport is already established Person is ready Choose words that shed light and not to contribute to nestly does not mean speaking brutally ainful or unwelcome interpretation should be shared with compassion and sensitivity to the effect such news may have to the receiver Seanned with CamSeanneeba SCC) Non-word messages conveyed through speech Vocal messages affected by intonation, pacing, sighs, grunts and pauses. A person who has stopped speaking because of clings must be allowed a few moments Paralinguistic communication Seanned with CamSeanneeba SCC) FACIAL EXPRESSION BODY PLACEMENT USE OF TOUCH PHYSICAL ARRANGEMENT Non-linguistic communication Seanned with CamSeannee=a os Seth) ells much about their feelings and the nature of their relationship to those around them Personal space- 3ft front, Ift behind Body position- inclined Sitting position- sa Parallel movement-mirror image Complementary movement-conveys under and challenge Seanned with CamSeanneePowered by w® SNC] Seanned with CamSeanneean DN SDI Every communication has 2 components, the itive and the affective or emotional tone. »orge Engel MD ~ introduced the psychosocial approach model Seanned with CamSeanneeperry mH SNC] A physician who is bio-psychosocially oriented is concerned with diseased organ patient's feelings and perceptions of his illness manner in which these feelings and perceptions and the disease itself interact with the larger family, community and cultural systems to which the patient belongs. (George Engel MD Seanned with CamSeanneepor w® SNC) When a client feels empathy of his/her doctor, he/she feels understood, rapport is quickly built, the client is more willing to reveal him/herself and the doctor is where the client is coming from and Seanned with CamSeanneesi i Sri) 1. GENUINENESS 2. UNCONDITIONAL POSITIVE REGARD 3. EMPATHY Attitudes in Communication Seanned with CamSeanneepor w& SNC] 1. GENUINENESS- bei needs and ideas ¢ Pers ‘can be himself with another so they know him as he tnuly is is aware of his innermost thoughts and feelings, accepts them and whenever appropriate, shares them responsibly 3 ingredients: self-awareness, self-acceptance and self expression Attitudes in Communication Seanned with CamSeanneeperry oN SNC) choose to believe that there is good in a person regardless of the extemal qualities - involves accepting, respecting and supporting another person Attitudes in Communication Seanned with CamSeannee| a | — i | 6 a a =o SNC) 3. EMPATHY- ability to put oneself in the shoes of the other - to be with, feel with, and think with the other - ability to really see and hear another person and understand him from his perspective Attitudes in Communication onan ceca s Seanned with CamSeanneepor ba CT OPENING SKILLS 1. Attend 2, Bracketing 3, Leading - Direct and Indirect 4, reflecting content- paraphrasing and perception check b reflecting feeling « reflecting experience Active listening skills ee eee ee Seanned with CamSeanneepor mH NCC) 1, ATTENDING SKILLS- involves the listene hissher physical attention to the speaker, - it includes: a. attentive, open posture ». appropriate body movement . appropriate eye contact with speaker 4, open and receptive facial expression ¢. establishing a non-distracting environment Seanned with CamSeanneepor w& SNC) LOVERS Lean forward ‘Open posture Verbal/voice of compassion contact Relaxed Seating arrangement Seanned with CamSeanneepor eH SNC) 2. BRACKETING- form of psychological attending. - it is a mental skill involving suspending ‘own judgement and feelings and then setting them aside for a while in order to listen more fully to the patient oer eee ed Seanned with CamSeanneepor mH StreamYard 3. LEADING SKILLS a. Indirect Lead- open invitation by the MD to the patient to talk about whatever concerns him. = encourages the speaker to continue talking Seanned with CamSeanneeper mH SNC) a. Indirect lead examples: What can I do for you?” ‘What would you like to talk about?” verbal: “yes”, “go on”, “and then”, “I see ‘Uhmmm’ non-verbal: nodding, smiling, eye contact Seanned with CamSeanneepom EN SDI 3. LEADING SKILLS b. Direct lead- the MD chooses the direction where the conversation should go. oftentimes itis based on the disease entity that the MD is considering itis also worthwhile to choose basing it on ‘what is most emotionally disturbing for the patient - €q.:“Tell me more about your headache...” “Let’s talk about...” Seanned with CamSeanneepor mH SNC) 4, FOCUSING- patients in emotional pain sometimes brings up a lot of things one after the other. - in such cases, ask the patient to do the choosing of what is most important to him err eee ed Seanned with CamSeanneeperry mH SNC) 5. PROBES- are questions that the MD asks in order to find more about how the patient is reacting to the illness - ask open-ended questions not answerable by yes or no - avoid “WHY” questions - use HOW, WHAT, “could you please explain” - elicit more information like content and feelings for eee ed Seanned with CamSeanneepor mH SNC) How does that make you feel? Can you tell me more about that feeling? What is it that makes you feel that way the most? Seanned with CamSeanneemmr SN] 6. ATTENTIVE SILENCE- one of the hardest skills to master, as people often feel uncomfortable with silence and feel the compulsion to jump in and fill in the silence. > silence is the most appropriate response, as when the speaker is searching for a response the speaker is e ally distressed, silence allows the person to experien. composure and continue the communication Opening skills Seanned with CamSeanneepom DN STI - allows listener to communicate that s/he understands the perspective of the speal Seanned with CamSeanneepor nw SNC) A. Reflecting Content Paraphrasing = listen for the basic message of the patient; restate to the patient a concise and simple summary of the basic messag don’t add a mention Seanned with CamSeanneePowered by SNC) EXAMPLE REFLECTING SKILLS: Post MI husband Lreally love my wife. She does many things for me constantly She reminds me of my medicines, she sees to it that I get to sleep carly, she fusses about my food, she keeps tract of where I am all the time because she said that she is worried about me. Sometimes though, / can breathe because of all these things PARAPHRASE: “You appreciate all these things that your wife is doing for you, but it kind of suffocates you.” eet eee ee Seanned with CamSeanneepor oN SNC) EXAMPLE REFLECTING SKILLS: Post MI husband I really love my wife. She does many things for me constantly She reminds me of my medicines, she sees to it that I get to sleep ‘early, she fusses about my food, she keeps tract of where Iam all the time because she said that she is worried about me. Sometimes though, / can breathe because of all these things. REFLECT FEELING: “You appreciate your wife’s attentiveness. somehow irritates you, doesn’t it?” err eee ee Seanned with CamSeanneeoN BC! C. Reflecting Experience- oftentimes, the patient has a lot of non-verbal or gestures which reflect some emotional state but the feeling is not articulated. -the MD can mirror the non-verbal behavior back to the patient and ask for clarification as to what the behavior means Seanned with CamSeanneeora A Forms of Interpretation: ci Interpretative statement- declarative statement about your hunches Interpretative question- makes interpreting less risky Fantasy or Metaphor CLOSING SKILLS Seanned with CamSeanneei uidelines for interpretation: Cra) Look at the basic message(s) of the patient Paraphrase. Add your understanding of what the messages mean to him in terms of your theory Keep the language simple and close to the patient’s messa Avoid wild speculations. Offer tentative ideas on what their words and behaviors mean. Solicit patient’s reactions to your interpretation. Teach the patient to do his own interpreting CLOSING SKILLS Seanned with CamSeanneeby 2. CONFRONTATION Pen -enables the MD to challenge the discrepancies, distortions, smoke screens and games that the patient is using, knowingly or unknowingly, to keep himself and others from seeing his problems clearly, thus getting in the way of problem-managing actions -an invitation to examine behaviors that may be self-defeating or harmful to self or others. -an invitation to change behavior. CLOSING SKILLS Seanned with CamSeanneeba SCD ICs You mentioned that smoking relieves your stress, but it worsens your difficulty of breathing also.... (LET THE PATIENT RESPOND) Clarifying: What is more important in your life now? Is smoking and reducing stress more important than being healthy so you can earn for your family? Seanned with CamSeanneeba ran Forms of Confrontation A SC! 2. Challenging distortions - some patients cannot face the situation as it is so that they distort it in various ways. 3. Feedback and opinion -MD’s reaction to the therapeutic interchange, his own perception of the problem CLOSING SKILLS Seanned with CamSeannee7 mH 3. SUMMARIZING Pear -involves tying together into one statement several ideas and feelings at the end of a discussion or interview -broader than paraphrase. -gives focus or direction to counselling process -help clients view their situation in a more focused way, clarify and begin to set goals, Seanned with CamSeanneeran an vi Guide for SUMMARIZING Be Attend to the various themes and emotional overtones as the patient speaks. Put together key ideas and feelings into broad statements of their basic m Do not add new ideas in the summary Decide if it would be more helpfill to let the patient summarize for you. Seanned with CamSeanneeran ow 4. GOAL SETTING Beene) -most important part of the session since it ties all the processes together. -Characteristics: 1. specific and measurable 2. realistic hierarchical desired by the person tailored to him frequently evaluated Seanned with CamSeanneeae SNC) Steps for GOAL SETTING Identify and affirm strengths Discuss resources Identify the needs/wants in terms of behavior one would like for himself or from others. Help patient decide which alternatives he would like to try. Seanned with CamSeanneeran aN SNC) -ATTER HALF OF THE CONSULTATION PROC! MD helped the patient to see the situation from a more realistic point of view MD helped the patient to set reasonable goals toward the resolution of his problem Seanned with CamSeanneeeran w INFORMATION GIVING alia Advising- based on experience Informing- based on expertise **MDs should not pretend to know everything Giving advise and sharing personal experience Seanned with CamSeanneeHELPER SELF-SHARING sas SDC Doctor reveals something about his own personal life Guidelines: Selective and focused Not a burden to the patient Done sparingly Seanned with CamSeanneeran p A Communication flows out of basic attitudes as BST Te) well as through specific methods and skills The person who has mastered the skills but lacks genuineness, love and empathy will find his expertise irrelevant. Seanned with CamSeannee