Communication skills

Communication Skills in Clinical
Practice

Aim
• Give the patient adequate opportunity
to express his feelings
• Help to elicit as accurately as possible,
the information needed to make a
diagnosis and plan treatment in the
limited available time

 The exchange of thoughts, messages, or
information, as by speech, signals, writing, or
behavior.
 Interpersonal rapport.
 The art and technique of using words effectively to
impart information or ideas.
 The field of study concerned with the transmission
of information by various means, such as print or
broadcasting.
 Any of various professions involved with the
transmission of information, such as advertising,
broadcasting, or journalism
Definitions

Standard Definition
Communication is a process whereby
meaning is defined and shared
between living organisms.
Communication requires a sender, a
message, and an intended recipient,
although the receiver need not be
present or aware of the sender's intent
to communicate at the time of
communication

• 77% of patients don’t express their reason
of attendance during consultation
• 50% of patients leaving doctor’s office with
insufficient information on their illness
• 50% of patients leaving doctor’s office don’t
know how to use their medication
Patient Communication

 70% of the patients can be diagnosed by
only communication
 Patient satisfaction increases when he/she
can have a good communication with doctor
 Doctors who are good communicators are
less suited by their patients
CONTD

Components of Communication
Source
Message
Vehicle
Receiver
Feedback

Vocabulary
• The doctor should ask questions in clear,
unambiguous language suitable to the patient's
age, education, and cultural background.
• The pattern of questions should follow some
logical grouping and sequence. If the doctor
does have an after-thought, he should explain
himself.
• Topics that the patient may feel sensitive about
should usually be introduced in the latter part
of an interview when confidence and rapport
have been established.

Causes of Reticence
• The presence of a third party
• Sometimes the fact that the doctor is also the family
doctor may inhibit an adolescent from speaking freely.
• The patient may fear that revealing his complaints will lead
to the realization of his worst fears.
• A reluctance to take up the doctor's time with concerns
that the patient may feel are undeserving of his time and
attention.
• Embarrassment or shame about the nature of the
complaint
• Cultural barriers

Ways Of Facilitating Communication
• By Non-verbal (body) language
• By speech
• By appropriate use of silences

Non - Verbal
• Unhurried manner
• Head nodding
• Eye contact
• Smiling
• Discarding pen and notes
• Leaning forward towards the patient
• Active (attentive) listening
• Appropriate use of touch
• Empathy: the capacity to sense what it is like
to be the patient

By Speech
• A variety of simple short responses from the doctor will encourage
the patient to continue speaking.
e.g. “Yes, I see”, “Go on”, “I understand”.
• Reflecting: encouraging the patient to continue speaking by
reflecting back to him a phrase, idea, or significant word from what
the patient has said.
Patient: "The period pain are not too bad, but the headaches I get
before the periods starts to make me desperately miserable for three
or four days every month"
Doctor: "You feel desperate at that time?
Patient: "Yes, to be honest I do. Recently there have been several
times when I have thought of doing away with myself, because at
that time it felt as if there was nothing to live for"

• Clarifying: make clear to the patient what he is trying
to put into words
e.g “Are you trying to tell me that you are really afraid
this is something very serious? Is that what you feel?
• Summarizing: summarizing all or part of the patient's
accounts of things
e.g "So if we could just go over the main points of
what you have told me so far. Your periods were
perfectly normal and regular until five months ago.
Then you missed two periods completely and then
bled heavily for three weeks. Since that time there has
been some scanty loss most days, but no pain at any
time. Is that correct?
CONTD

Appropriate Use Of Silences
Silence can occur when the patient runs out of
words or is unsure about expressing his feelings:
- Resist the temptation to disarm the silence with a
new question on a new topic.
- Let the silence remain unbroken for a little time
while continuing to look at the patient with a facial
expression of unhurried, interested and concerned.
- Signal “Go on” either verbally or non-verbally.

Facilitating The Open Expression
Of Deep Feelings
 Resist the temptation to jump in with distracting
questions or a less motive topic.
 Do not exhort the patient to cheer up or to "take a
grip on themselves"
 Remains silent for a moment and continue to look
towards the patient with an expression of concern
 Mirroring: letting the patient see what his non-
verbal expression show (like holding a mirror)
“You were almost biting your teeth when you
mentioned your son"
If the patient shows evidence of suppressed
emotions the doctor should:

Confrontation: a more blunt and direct way of
saying what the patient appears to be going
through.
“You were very angry when you mentioned
your son”
CONTD

 Breaking the Bad News
 Difficult Patient
 Patient Centered Approach
 Decision Making
 Art of Presentation
Special Considerations

Communication skills

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