COMMUNICATION SKILLS WITH

PATIENTS

PRESENTED BY
DR.NITHISH REDDY
GUIDED BY
DR.T.SELVAKUMAR
 BASICS OF COMMUNICATION SKILLS
WITH PATIENTS

The communication skills is

an effective step of making
relationship between doctor
and patient. It plays essential
role through diagnosis and
treatment processes.
 Elements of
communication
There are six core elements in a medical communication
• Initiating the session
• Gathering information
• Explanation and planning
• Closing the session

Two other core elements

• Building the relationship and
• Structuring the consultation.
A patient-centered approach
• Eliciting the patient’s perspective on the illness
• Understanding the patient’s psychosocial context
• Reaching shared treatment goals based on the patient’s values.
 PROTOCOLS

C-L-A-S-S : A protocol for all medical interviews

S-P-I-K-E-S : A protocol for breaking bad news to patients and family members

C-O-N-E-S : A protocol for discussing a medical error with patients and family members

E-V-E : A sub-protocol for any encounter when there are emotions present

B-U-S-T-E-R : A protocol for challenging conversations with patients and family members

B-A-L-A-N-C-E : A protocol for cultural competence

 The C-L-A-S-S Protocol

A protocol for all medical interviews

• Five Key Steps for Clinical Interviews
• C - CONTEXT
• L - LISTENING SKILLS
• A – ACKNOWLEDGE
• S - STRATEGY
• S - SUMMARY
 INITIATING THE SESSION

• The doctor must ensure that the patient is comfortable and reassured,
secure and assured of privacy

• As the patient comes in, a seat could be offered verbally or by gesture, the
patient greeted by name (if possible) and a first easy question asked
showing the doctor’s interest in patient
 Eliciting the Patient’s Agenda

• Avoid opening the interview with “How are you feeling?” or “How are you today?” .

• Instead, the open-ended question “How can I help you today?” brings focus to the
purpose of the visit,

• It is the preferred initial statement for initial and follow-up visits

Suggested phrases
Suggested phrases
 Eliciting patients agenda

As they can elicit specifics about the patient’s chief concern,

Direct questions like “Is including
there something else?” is • The duration
more effective than • Severity
“anything” in eliciting • location of the problem
concerns without • radiation and character of pain
increasing the duration of • relieving and aggravating factors
the visit. • any associated symptoms
• This part is often biomedical in focus and assists in determining a
working diagnosis.
Verbal and non verbal communication
 Understanding patients
perspective

• The patient’s views of his or her illness are a primary focus

• The patient’s perspective includes feelings, ideas, concerns, impact, and expectations.

• Asking the patient about his or her understanding of the cause of the illness may
provide additional diagnostic clues.

• Understanding the patient’s beliefs allows the physician to avoid recommending

interventions that go against the patient’s views.
Eliciting the perspective
 Listening to patients
• Patient’s emotions should not be judged as being appropriate or inappropriate.

• Similarly, normalizing (“Many of my patients experience this” or “This is a fairly

common reaction”) may be perceived as blocking the patient’s feelings.

• Patients often have concerns about future complications and disability from their
medical problems.

• The patient’s fears may help the physician to understand and ensure that the
treatment plan addresses these concerns.
 Expressing empathy

• Empathy is the capacity to understand and relate to the patient’s illness experience
and emotions.

• Physicians can express empathy verbally or through nonverbal gestures, such as

respectful silence, touching a patient’s hand or knee (when culturally appropriate),
or sighing.

• Physicians need to show concern and interest verbally and through facial
expressions.
Examples to express empathy
 The S-P-I-K-E-S Protocol
A protocol for breaking bad news to patients and family members

S-Setting Up the Conversation

P-Perception
I-Invitation
K-Knowledge

E-Emotions

S-Strategy and Summary

 Revealing a diagnosis
• Patients prefer that physicians be seated when breaking bad news.

• Detailed information is requested more often by patients who are younger, female,
and more educated.

• Recommendations for breaking bad news include first assessing the patient’s prior
knowledge and understanding of the illness.

• Patients should be given time to absorb the news and limit further information in
this initial stage.
Revealing new diagnosis
 Shared decision making

• Discussing treatment options can help patients make more informed choices.

• The pros and cons of each option should be outlined, including benefits, risks and
costs .

• watchful waiting.

• Ask-tell-Ask .

• Shared decision making can be supported .

 The C-O-N-E-S Protocol
•This protocolis used when there is a sudden deterioration in the
patient’s medical condition

Context Opening Narrative Emotions Strategy &

Shot Summary
 The E-V-E Protocol

A sub-protocol for any

encounter when there
are emotions present

E – Empathic
E – Explore V – Validate
Response
 A protocol for challenging
conversations with patients and
family members
Be prepared

Use non-judgmental listening

Six second rule

Tell me more” statements

Empathize and validate

Respond with a wish statement

 A protocol for cultural
competence
7 Areas to Cover in Taking a Cultural History -“BALANCE”

Beliefs & Values

Ambience

Language & Health Literacy

Affiliations

Network

Challenges

Economics
 Patients feedback on lack
of communication
Non-verbal communication skills
1. Lack of eye contact
2. Negative facial expressions
3. Para language
 Patients feedback on lack of
communication

Verbal communication skills

• Active listening
• Inappropriate choice of words
• Inadequate information
• Poor quality of information provided
• Poor attitudes
• Lack of respect
 Conclusion
• Effective communication skills are a need in medical
and dental practice and are beneficial to patients,
doctors and caregivers.
 References
• Hashim MJ. Patient-centered communication: basic skills. American family
physician. 2017 Jan 1;95(1):29-34.

• Perera HJ. Effective communication skills for medical practice. Journal of the
Postgraduate Institute of Medicine. 2015 Nov 27;2.

• Biglu MH, Nateq F, Ghojazadeh M, Asgharzadeh A. Communication skills of

physicians and patients’ satisfaction. Materia socio-medica. 2017 Sep;29(3):192.A

• Baile WF. The Complete Guide to Communication Skills in Clinical Practice/Walter

F. Baile. Houston: MD Anderson Cancer Center, Medical Graphics & Photography.
2014.