<aside> 💡 Communication Skills in Practice

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1. Discuss the importance and relevance of communication skills in daily practice

   • Importance of communication skills

     • Effect on diagnostic formulation
     • Link with patient satisfaction
     • Relationship to clinical outcomes

     

   • Poor communication and diagnostic formulation

     • Underlie most inadequate diagnoses
     • 54% presenting complaints and 45% of concerns not elicited by doctor
     • 50% psychological problems missed
     • Doctors interrupt patients within 18 secs of consult
     • 40% patients do not agree about presenting complaint
     • 19% higher risk of poor adherence
     • 15% of patients who are considered “difficult” (people who are not easy to understand or communicate with) report dissatisfaction of underlying psychological problems
     • NVC significant role in indigenous patient consultations
     • 37% of physicians did not ask patient’s agenda; only 59% could explain patient’s main concern

   • Communication and patient satisfaction

     • Greater compliance and satisfaction if perceived that physician understands how they feel about their problem
     • Greater adherence with treatment and follow ups with doctor’s communication style
     • Litigations and complaints commonly focus on communication rather than competence

   • Communication and clinical outcomes

     • Increased diagnostic accuracy and patient satisfaction
     • Less psychological distress when patients perceive they have adequate information
     • Doctors trained with good communication skills improve clinical outcomes

   • Doctor patient relations

     • Doctors are in a unique position of privilege (communication of private/personal info)
     • Effective relationships
       • Collaborative approach
       • Mutual respect
       • Being accessible
       • Caring and supportive
       • Privacy and confidentiality

   • Can you teach and learn communication?

     • Communication is a core clinical skill – a series of learned skills
     • Experience can be a poor teacher
     • Communication can be taught
     • Changes from training can be retained
     • Specific learning methods are required to obtain change

   • Communication in patient centred clinical model

     

     • Exploring the Disease and Illness
       • History; physical; lab; feelings; ideas; effects on function and expectations
     • Understanding the whole person
       • The person; proximal context; distal context
     • Finding Common Ground
       • Problems, goals and roles = mutual decisions
     • Incorporating prevention and health promotion
     • Enhancing doctor-patient relationship
     • Being realistic
       • Time; teamwork; use of resources

   • Communication in patient centered clinical model

     • First half: gathering data (history labs, physicals)
     • Second half: closing in on the problem (treatment, medication, follow up, information)

   • Patient centred interview

     • Doctor’s frameworks: (doctor’s agenda) history, physical, lab
     • Illness framework: (patient’s agenda) ideas, feelings, expectations
     • Integration of differential diagnosis and patient’s unique illness experience

     

   • Patient centred care and communication:

     • Doctor addresses biomedical and psychosocial/social context and determinants
     • Consider disease and illness (symptomatic and asymptomatic)
     • Patient’s perception of their illness, values and expectations considered
     • Patient actively involved in decision making
     • Doctor and patient are equal partners in the decision-making process
     • Doctor and patient relationship fundamental
     • Doctor aware of their impact on consultation process

   • Empathy as effective as aspirin, statins

     • Empathy 11% better outcomes
     • Aspirin 6% protective effective over 5 years
     • Smoking 8% increased mortality
2. Define and demonstrate basic verbal (and nonverbal) communication skills
   • Clinical interview
     • Interviewing style (open vs closed questions)
     • Barriers (Physical, psychological)
       • Physical: seating, height
     • Preparation (setting, appearance, consent, confidentiality)
     • Interview techniques
       • Establish rapport (greet, comfort, patient’s agenda):
         • Hi I’m a JCU student
         • Do I have consent
         • What brings you in today, how are you doing?
       • NVC: eye contact, body language, attentive listening
         • Don’t check watch, phone, chew gum etc.
       • Open questions: encourage patient to talk (esp. If you are stuck)
       • Closed questions: answered in a few words, focussing effect
       • Reflect feelings and meaning (echo, and make explicit what a patient has said)
       • Transitional statements: bridges two or more topics
         • "You've told me about your past health, now you could tell me about…"
       • Respect and warmth: body language, facial expressions
   • Elaboration/clarification probe
3. Demonstrate skills in role play, self-reflection, self-awareness and feedback
4. Describe how they could develop these skills to enhance their own communication skills