Communication Skills I:

Essentials of Clinical
Communication

Prepared by: Assoc Prof Dr Rukhsana Hussain Malik

Head, Medical Education Unit
&
Assoc Prof Dr Eddie Soon,
Department of Psychiatry
Head of Counseling
 Learning Outcomes
 Describe significance of doctor-patient
communication
 Describe characteristics of good

communication
 Describe message cycle
 Discuss causes of miscommunication
 Describe communication styles
 Introduction
 Effectivedoctor-patient communication is a
central clinical function, and is the heart and art
of medicine and central component in the
delivery of health care

 The 3 main goals of doctor-patient communication

are creating a good interpersonal relationship,
facilitating exchange of information, and
including patients in decision making
 Introduction
 Effective doctor-patient communication is
determined by the doctors' “bedside manner,”
which patients judge as a major indicator of
their doctors' general competence
 Studies on doctor-patient communication

have demonstrated patient discontent even

when many doctors considered the
communication adequate or even excellent
 Doctors tend to overestimate their abilities in

communication
Doctor Patient Contacts
500,000 GP consultations every working day

The nature of the relationship determines the

success or otherwise of the contact

Central to this is the exchange of information

Communication and Diagnosis

Patients who feel at ease and who are

encouraged to talk freely are more likely to
disclose the real reason for consulting
Communication and Treatment
Advice, reassurance and support from the
doctor can have a significant effect on
recovery - the placebo effect
The Paternalistic Approach
 The traditional D-P relationship
 Doctor takes on role of “parent”
 Patient submissive

“If I’ve told you once I told you

1,000 times, stop smoking!!”

 Shift towards mutuality

The Doctor’s consultation style
Patient centered consultation style

Less authoritarian - encourages patient to tell

about their feelings and concerns

Open questioning, showing interest in the

psycho-social aspect of illness
An integrated approach to information
gathering.

Seeking to include physical, psychological

and social factors ….

Is likely to produce a better outcome.

Human Communication
The patient will never care how much you know,
until they know how much you care
Doctor-patient communication can be complex

as most people do not open up spontaneously

Communication can be

Verbal
Direct
Indirect: Advertisements
Non-verbal
Facial Expressions
Body language
 People use all their senses in communicating and
understanding each other

Face Eyes

Communication

Body Is the way we

interact
Voice
with fellow humans

Communication is the art of

Words transmitting information,
ideas and attitudes from
one person to another
Communication Styles

The Director The Accountant

The Stabiliser
The Party Person
Characteristics of Good
Communication
 Two people cannot talk at once
 If you keep very quiet, you listen better
 To understand your patient and get more

information listening skills is a must

 Talking is a social skill that can be learned
 Importance of Effective
Communication
 Allows physician to get to know the patient,
so that the patient becomes a person, not
just a medical problem
 Better compliance with effective

communication
 Communication can be therapeutic
 Avoid doctor shopping, unnecessary tests, etc
 Communication helps in conveying correct

messages
ENCODE DECODE
 COMPONENTS OF COMMUNICATION PROCESS

—Sender / Encoder is a person who sends the message. A sender

makes use of symbols (words or graphic or visual aids) to convey the
message/idea and produce the required response.
— Encoding – Encoding is the process where the information you
would like to communicate gets transferred into a form to be sent
and decoded by the receiver.

— Channel – Channels are the medium/way you convey your message.

These channels include verbal such as telephone, and face-to-face
conversations as well as non-verbal such as e-mail and text
messaging. Each individual channel has its strengths and weaknesses
in terms of communicating.
 Decoding – Decoding is on the receiving end of
communication – what the recipient understands. Is the
information accurately decoded and understood?

 Receiver – Recipient (decoder ) is a person for whom the

message is intended or aimed. The degree to which the
decoder understands the message is dependent upon
various factors such as knowledge of recipient and their
responsiveness to the message.

 Feedback - Feedback is the main component of

communication process as it permits the sender to
analyze the efficacy of the message. It helps the sender in
confirming the correct interpretation of message by the
decoder. Feedback may be verbal (through words) or non-
verbal (in form of smiles, sighs, etc.). It may take written
form also in form of memos, report,etc
Avoid Cycle Breakdown
 Listen carefully

 Think clearly

 Speak clearly

 Understand clearly

 Act responsively
Advantages of Good
Communication
 Doctors with better communication and
interpersonal skills are able to detect
problems earlier, can prevent medical crises
and expensive intervention, and provide
better support to their patients

 Thismay lead to higher-quality outcomes and

better satisfaction, lower costs of care, greater
patient understanding of health issues, and
better adherence to the treatment process
Therapeutic Relationship
 The D-P relationship is central to
therapeutic progress.
 The personhood of the doctor is a key – a
significant factor
◦ to the quality of the relationship and
◦ a successful outcome.
 The goal of a healthy relationship is rapport
that leads to desired change.

Sperry, Carlson, & Kjos, 2003, pp. 37-38.

Therapeutic Relationship
 Effectiveness is related to mutual respect
and trust.
 Caring, respect, and trust create safety for
clients to share their deepest concerns.
 Client willingness to act and achieve a
positive outcome is based on his / her view
that the environment / relationship is safe.

Sperry, Carlson, & Kjos, 2003, pp. 37-38.

Causes of Miscommunication
 Different levels of:
◦ Understanding
◦ Expectations
◦ Sensitivities
◦ Responsibilities
◦ Language Skills
◦ Social Skills
◦ Social understanding……
 Problems in Communication
 The doctor-patient interaction is a complex
process, and serious miscommunication is a
potential pitfall, especially in terms of
patients' understanding of their prognosis,
purpose of care, expectations, and
involvement in treatment
Barriers to good communication
include:
• patients' anxiety and fear
• doctors' burden of work
• fear of litigation
• fear of physical or verbal abuse,
• unrealistic patient expectations
 Problems in Communication
 These important factors may affect the choices
patients make regarding their treatment and end-
of-life care, which can have a significant influence
on the disease
 Doctors avoiding discussion of the emotional and

social impact of patients' problems because it

distressed them and they could not handle these
issues or they did not have the time to do so
adequately
 This avoidance behavior may result in patients

being unwilling to disclose problems, which could

delay and adversely impact their recovery
 Strategies for Improvement
 Attentive listening skills, empathy, and use of
open-ended questions are examples of skillful
communication
 Listen to patients, take account of their

views, and respond honestly to their

questions
 Breaking bad news to patients is a complex

and challenging communication task in the

practice of medicine and it needs practice
Strategies for Improvement
 Give patients the
information they want or
need to know in a way
they can understand
 Make sure that

arrangements are made,

wherever possible, to
meet patients’ language
and communication needs
Strategies for Improvement
 Be considerate to those
close to the patient and
be sensitive and
responsive in giving
them information and
support
 When on duty, be

readily accessible to
patients and colleagues
seeking information,
advice or support
What is it?
Empathy is the ability to both recognize
and understand the feelings, thoughts,
needs and behaviors of others.
What is empathy?
 Empathy is the ability to understand the
world from another person’s point of view
AND motivation to treat another kindly
based on that understanding.
 allows human beings to understand and

value each others feelings and

understanding
You look upset. Do you need to talk about it?
 Empathetic concern increases
helping

creases helping

n
creases helping
Pity is not empathy: A condescending form of
feeling sorry for the misfortunes of others.
Empathizing with someone is not the same as
pitying or feeling sorry for him or her. This is
an important distinction. When you pity
another person, you look down on him or
her. You think “How awful” or “What a terrible
situation that person is in” or even “Thank
goodness I’m not in that situation.” Pity sets
you apart; empathy brings you together.
Communication Styles
Communication Styles

Aggressive

No Respect
for Others
Passive Style

 Too intimidated to express thoughts and

feelings
 Forfeit their rights or freedoms
 Gives in to demands so that they will be

accepted
 Avoid confrontation at any cost
 Often feels used and taken advantage of
 Driven by anxiety
Aggressive Style

 Intimidates others to gain control of their

thoughts and actions
 Manipulates, accuses, fights
 Little or no regard for other’s feelings
 Driven by anger
Assertive Style

 Recognizes and stands up for own rights

while respecting the dignity of others
 Focuses on specific issues and problems,

without belittling self or others

 Expresses opinion without violating others’

rights
 Minimize opportunities to let other people

take their advantage

Assertive Style

 Open, tolerant, and considerate of other’s

feelings
 Overcome fear to confront issues that require

resolutions
 Communicate feelings of anger diplomatically,

without putting others on the defensive

 Assertiveness Skills
 Know your rights, ask what you want
 Say no and not feel guilty
 Take time to form a response to a comment or

question
 Ask for assistance with instructions or directions
 Experience and express your feelings
 Feel positive about yourself under any conditions
 Make mistakes without feeling embarrassed or guilty
 Own your opinions and convictions
 Protest unfair treatment or criticism
 Recognized for their significant achievements and

contributions
From Davis, Eshelmann, and McKay (1988)
Summary: Characteristics
Passive Assertive Aggressive
Can’t speak up Firm Loud
Don’t know their Direct Bossy
rights
Gets stepped on Honest Pushy
Meek Respect rights of others Dominating
Too accommodating Recognize the importance Intimidating
Talks softly of having needs & rights Use power, position to
respected get things
Don’t stand up for Confident Must get their way
their rights
Avoid conflicts Affective Communicator React instantly
Abused Fighter Abusive
Communicate and be a
blessing!