Mastering clinical communication v2 ss1

AL TABABA
TRAINING
SERIES
E XC E LL ENC E I N PAT I ENT
CO M M U N IC AT I ON - H OW TO M A S T E R?

T H E M I N D O F A
M A S T E R
C L I N I C I A N

Communication
Skills:
The Route to your
Patient Heart &
Mind

Importance of a good Doctor-Patient Relationship
Patient-Doctor communication is important:
• Improved satisfaction
• Improved compliance with doctor’s advice, medications etc.
• Improved decision making
• Better health outcomes
• Decreased malpractice claims

Principle: 1
Tell Good
News
Give Hope

Principle: 2
Show
Empathy &
Care

Principles: 3
Master the Art
of
Non-verbal
Communication

Principle: 3
Master the Art
of
Non-verbal
Communication:
Appearance
• Appearance-Goal is to INSPIRE
Confidence-Be Breath & Body-odour
Vigilant

Principle: 4
Master the Art
of
Therapeutic
Communication
Therapeutic Communication
Focuses on advancing and enhancing
the patient's comfort, safety, trust,
or health and well-being-A Happy
Patient!

Principle: 4
Master the Art
of
Therapeutic
Communication
Therapeutic communication defining
attributes were as follows:
“an important means in building interpersonal relationships”,
“a process of information transmission”,
“an important clinical competency”,
“a structure with two different sections” and
“a significant tool in patient centered care”.

What a Patient
LOVES or Hates
about his/her
Doctor?
What should the Doctor DO
or NOT DO to be truly LOVED
by his/her Patient?

Loves!
The One who knows the
right opening-words with
a smiling face and
welcoming posture!
Knows how to BUILD
BRIDGES!
Rapport: ‫جام‬ِ‫س‬ْ‫ن‬‫إ‬
Welcome Um Ahmed, Allah bless you with
health. I am Dr. Mohammed. Please tell me what
is bothering you. Insha-Allah you will surely get
better.

Loves!
The One who is
ALWAYS there for
help!
Always available and approachable–
Does not mind been approached or
contacted particularly in emergencies
or for clarifications and advice.

Loves!
The One who is a
GOOD LISTENER!
Active Listening/Unhurried Attentive Behavior–
Being attentive to what patient is saying, verbally
and non-verbally.
Sits facing the patient, open posture, leans toward
him/her, eye contact, relaxed, nods to encourage.

Loves!
The One who
NOTICES (without
been told!)
Sharing Observations– Making observations by
commenting on how the other person looks, sounds,
or acts. Example: “you look tired” or “I haven’t seen
you eating anything today”. Don’t miss “uplifting
comments”: “you seem to have succeeded in losing
weight!”

Loves!
The One who is willing
to sit beside his/her
patient (without been
told!)
Socializing especially for inpatients when appropriate
and time permits– just for more dialogue over a cup
of tea or coffee may mean a lot for the patient and
his/her family. It sends a strong message of care and
support and strengthens rapport.

Much Loved!
 Ready to “SIT” by his/her patient!
 Share a cup of coffee!

Loves!
The One who always
Motivates despite
his/her patient failures!
Motivates Always– Saying to his/her patient that they are
a “failure”, demotivates and demoralizes and is non-
therapeutic. A patient who fails to achieve agreed goals
e.g. losing 1 instead of 5 kilograms of weight over 2
months, should not be called a failure! Promoting self-
efficacy and Motivation e.g. by saying: “Good you
managed to lose some weight. It is a good start to build
on!” is the right therapeutic statement”.

Loves!
The One who knows
how to respond to
suffering:
EMPATHETICALLY”
Sharing Empathy– The ability to understand and
accept another person’s reality, to accurately
perceive feelings, and to communicate
understanding. Example “It must be very frustrating
not to be able to sleep because of your hurting
joint”.

Loves!
The One who
always GIVES HOPE!
Sharing Hope– Communicating a “sense of
possibility” to others. Encouragement when
appropriate and positive feedback. Example “I
believe you will find a way to face your situation,
because I have seen your courage in the past”.

Loves!
The One who
JOKES POSITIVELY!
Sharing Humor– Contributes to feelings of
togetherness, closeness and friendliness. Promotes
positive communication in the following ways;
prevention, perception, perspective. Example “well
you haven’t lost much weight but you might still beat
me at the gym”

Loves!
The One who
ACCEPTS NEGATIVE
FEELINGS!
Sharing Feelings–can help patients express emotions
by making observations, acknowledging feelings, and
encouraging communication, giving permission to
express “negative” feelings and modeling healthy
anger. “I can feel your anger on not seeing a good
change in your weight despite trying hard”.

Loves!
The One who is never
afraid of using the
MAGIC OF TOUCH!
Using Touch– Most potent form of
communication. Comfort touch such as holding a
hand or a kind shoulder tap, is especially
important for vulnerable patients who are
experiencing severe illness or are emotionally
upset.

Loves!
The One who knows
WHEN TO PAUSE!
Silence– Time for the healthcare provider and
patient to observe one another, sort out feelings,
think of how to say things, and consider what has
been verbally communicated. The healthcare
provider should allow the patient to break the
silence.

Loves!
The One who DIGS
DEEPER into his/her
patient concerns!
Clarifying– To check whether understanding is
accurate, or to better understand, the healthcare
provider restates an unclear or ambiguous message
to clarify the sender’s meaning. “I’m not sure I
understand what you mean by ‘sicker than usual’,
what is different now?”

Loves!
The One who FOCUSES
on his/her patient most
important concern!
Focusing– Taking notice of a single idea
expressed or even a single word. An example
is “out of the many issues you have with your
health, difficulty sleeping seems to be
bothering you.” Can you tell me more?

Loves!
The One who is able to
Restate or Paraphrase-
“INTERPRET and RE-
ARTICULATE” his/her
patient complaints!
Restating & Paraphrasing– Both prompt and encourage
patient expansion on his/her concerns. Restating using
patient’s words-e.g. you said your mind keeps wondering
or in one’s own words. The latter, consists of repeating in
fewer and fresher words the essential ideas of the
patient. For example the patient says “I can’t focus. My
mind keeps wandering.” The healthcare provider says,”
You’re having difficulty concentrating?”

Loves!
The One who is able to
use both Open and
closed-ended questions to
better understand his/her
patient complaints!
Asking Relevant Questions– Open or closed-ended (only 1
or 2 options for answer )-To seek information needed for
decision making. Open-ended questions allows the
patient to take the conversational lead and expand on
pertinent information about a topic. For example “Tell me
about your chest pain” or Closed-ended-“Was your chest
pain sharp or dull?”

Loves!
The One who is able
to deal with his/her
patient as a human
being not as a
disease!
Asking Relevant Questions-the human element–
enquiring about the psychosocial impact moves the focus
from a disease-oriented domain to a more humane,
illness-oriented domain.
For example: have your illness stopped you from looking
after yourself, your family or hindered you from enjoying
the things you love?

Loves!
The One who is able
to SUMMARIZE well
as a sign of
attentiveness to
his/her patient story!
Summarizing– Pulls together information for documentation.
Gives a patient a sense that you understand. It is a concise
review of key aspects of an interaction. Summarizing brings a
sense of closure. Example “It is my understanding that your
back pain is dull and is continuous but gets worse with
walking. Panadol helps but only a little. Seems your pain
stopped you walking as much as you like. Is this correct?”
patient responds “Yes these are true.”

Principle: 5
Never
Do the
Following!
Non-Therapeutic Communication
The Killers!

Hates!
The One who
FOCUSES ONLY on
the Bad News!
Focusing on Bad News– only passing on the bad results of
tests, poor prognosis to his/her patients. “Your blood test
shows your kidneys have failed and that you have anemia”
may be true but may be devastating to the patient.
The healthcare provider need to use the right technique for
breaking bad news e.g. SPIKES and also mention the good
results and importantly give hope!.

Hates!
The One who
FOCUSES ONLY on
the Bad News!
A simple Tool to ease the bad news : The Sandwich
Technique
Bad news in between two good news:
e.g. Dear you have excellent heart and kidney tests but
your cholesterol is not good but we can definitely make it
better for you.

Hates!
The One who ASKS
ABOUT PERSONAL
MATTERS that are
irrelevant to his/her
patient concerns!
Asking personal questions – Asking personal questions
that are not relevant to the situation, is not professional
or appropriate. Don’t ask questions just to satisfy your
curiosity.
“Why aren’t you married yet?” is not appropriate. What
might be asked is “How would you describe your views
about getting married?”.

Hates!
The One who
“PATERNALISTICALLY”
decides for his/her
patient!
Giving personal opinions– Giving personal opinions, takes
away decision-making from the patient. Remember the
problem and the solution belong to the patient and not
the healthcare provider.
“If I were you I would go for surgery” can be reframed to
say,” Let’s talk about what options that are available for
your treatment.”

Hates!
One who LESSENS or
BELITTLES his/her
patient significant
concerns!
Changing the subject– “Let’s not talk about your difficulty
sleeping, it’s time for you to get back to work”.
Changing the subject when someone is trying to communicate
with you is rude and shows a lack of empathy. It blocks further
communication, and will look like you don’t really care about
what they are sharing.
The right way: “Time to get back to work now but shall meet
again soon to talk about your sleeping difficulties.”

Hates!
The One who
GENERALIZES or use
STEREOTYPIC
comments!
Automatic responses– “Older women are always incontinent.”
“All our house physicians are poorly trained.”
These are generalizations and stereotypes that reflect poor
healthcare worker judgment and threaten healthcare provider-
patient or team relationships.
A religious stereotypic comment e.g. salamat without an offer
for help or an invitation for more explanation is non-
therapeutic.

Hates!
The One who LIES OR
MISLEADS his/her
patient!
False Reassurance– “Don’t worry, everything will be all
right.” When a patient is seriously ill or distressed, the
healthcare provider may be tempted to offer hope to the
patient with statements such as “you’ll be fine.” Or “there’s
nothing to worry about.”
When a patient is reaching for understanding, these phrases
that are not based on fact or reality can do more harm than
good.

Hates!
The One who SHOWS
PITY to his/her
patient!
Sympathy– Sympathy focuses on the healthcare
provider’s feelings rather than the patient’s. Saying “I’m
so sorry about your amputation, it must be terrible to
lose a leg.” This shows concern but more sorrow and pity.
It doesn’t encourage the patient to expand on his
concerns and therefore allow for a better understanding
on how he/she is feeling.

Hates!
The One who asks
WHY instead of WHAT
is of concern to
his/her patient!
Asking for Explanations– “Why are you so upset?” A
healthcare provider may be tempted to ask the patient
why he/she believes, feels or is acting in a certain way.
Patients frequently interpret why questions as
accusations. “Why” questions can cause resentment,
insecurity and mistrust. It’s best to phrase a question to
avoid using the word “why”. “You seem upset. What’s on
your mind?”

Hates!
The One who ARGUES
with his/her patient!
Arguing– “How can you say you are not getting better when
your mood is now improved!!” Challenging or arguing against
perceptions, denies that they are real and valid to the other
person. They imply that the other person is lying, misinformed,
or uneducated. The skillful healthcare provider can provide
information or present reality in a way that avoids argument:
“You feel like your mood did not improve, even though I
thought you looked happier.”

Hates!
The one who is
JUDGMENTAL to
his/her patient!
Healthcare providers must not impose their own attitudes, values,
beliefs, and moral standards on others, while in the professional
helping role e.g. you drink alcohol, you are not a good Muslim!
Judgmental responses by the healthcare provider often contain terms
such as should, ought, good, bad, right or wrong. Healthcare provider
should be neutral and help patients explore their own beliefs and
decisions. The healthcare provider response “I’m surprised you are
drinking alcohol. Tell me more about it...” gives the patient a chance
to express ideas or feelings without fear of being judged.

Competent Communicators: The Art of being a
Doctor
 You know that you have mastered the
art and science of communication
when your patients comment: “just
speaking to you make us feel
better!”

Please visit and subscribe to
altababa.org

Mastering clinical communication v2 ss1

More Related Content

What's hot

Similar to Mastering clinical communication v2 ss1

More from Imad Hassan

Recently uploaded

Mastering clinical communication v2 ss1