Physician Communication: Building Effective Relationships with Patients, Slides of Communication and Presentation Skills

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EMPATHIC LISTENING 1 docsity.com The Initial Encounter  Patients may feel embarrassed, afraid, apprehensive, strongly dependent on the doctor, or overwhelmed by the „psychological size‟ of the doctor as a professional with high expertise and social class.  Patients feel comfortable with doctors who make them feel at ease in spite of their imperfect self image and engage in brief small talk such talking about the weather, cricket or any current news stories etc. 2 docsity.com Act like the consultant you are  Consultants use certain critical communication skills to get patients to start the interview, then they respond to what they hear by demonstrating their understanding and acceptance of their patient's messages.  Physicians are mainly trained that the purpose of the initial interview is "history taking," with insufficient emphasis on building rapport and fostering a relationship (Bird and Cohen-Cole, 1990). 5 docsity.com Defining the Problem and additional goals 6  The main goal of the initial interview is to define the problem faced by the patient.  But additional goals also need to be kept in mind by the physicians to facilitate the first step:  (1) demonstrating their empathy  (2) confirming their understanding and acceptance of patients‟ communications  (3) reducing their "psychological size,“  (4) enlisting full participation of the patient in this collaborative relationship. docsity.com Listening is the key in initial encounters 7  By demonstrating understanding, empathy and acceptance, the doctor will make it easy for the patient to collaborate in the relationship and give full information about their problems and needs.  Active listening is the kind of listening that would encourage the patient feel part of the collaborative process and elicit intelligent responses from the patient. docsity.com Attending behaviors 10  Attending involves the caregiver in a physical position of inclining his or her body toward the speaker  facing the person squarely at eye level  taking a position at an appropriate distance from the patient  Being too distant may block communication; sitting or standing too close may cause discomfort. docsity.com Attending behaviors 11  Skilled listeners typically nod or shake their head when touched deeply by the patient‟s account  The most critical component of attending is consistent eye contact  avoiding glances around the room or at your watch  avoiding keeping your eyes glued on your paper when taking notes  Physicians who at first feel uncomfortable with intense eye contact may begin by focusing on the speaker's mouth—later on the eyes docsity.com Do not take notes all the time 12  When the physician feels a need to make a note on something important the patient has said, they might say,  "Would you mind stopping for a moment to let me make a note of what you just reported?" docsity.com Active Listening 15  It involves listening attentively, then "feeding back" to the sender your understanding of the meaning of the sender's message.   What ? docsity.com Active Listening Patient Sender agan7-aoqooam CODE >_>» “| can't stop thinking it’s going to be cancer." er r~Aoo wo Physician She is really worried. Receiver docsity.com Active Listening Patient r>— Physician E | P Ray! [: m4 % # c CODE | § She worry is really d 25 4, i "I can't stop thinking it's ‘ worried. n going to be cancer.” n = : Receiver Sender . . . Active Listening “You are really worried the lump will be cancer.” (® docsity.com Active Listening 20  When using Active Listening, the receiver doesn't remain silent after hearing what is communicated  But puts what he or she has understood into his or her own words (code) and then feeds its back to the sender to get verification, modification, or correction. docsity.com Concerns about Active Listening 21  It is time consuming  It sounds like parroting the patients‟ answers  It is difficult to learn docsity.com Feeding back without empathy 22  Patients particularly send lots of messages that contain such feelings as fear, disappointment, frustration, worry, helplessness, sadness, and so on.  If physicians fail to feedback such feelings, patients naturally will feel that the essential part of them at that moment is not being understood. docsity.com Nonverbal clues by patients 25  Here is a small sample of patients' nonverbal clues:  Becoming suddenly quiet, non communicative  Changing facial expression  Looking away or down  Getting fidgety, shaky  Making some hand gesture  Looking sad, downcast  Not eating anything on their tray. docsity.com Using Active listening for empathy 26  You seem upset (or sad or worried, etc.). Am I right?  Do I detect that you have a concern about my fee?  Something on your mind?  Do you want to tell me something?  You don't seem yourself today.  Anything wrong? docsity.com Patients’ use of coded messages 27  Patients use coded messages to show their feelings such as:  Not another X ray?  (To nurse) Wish I could be as cheerful as you are.  (To nurse) When do I get out of this jail?  It's all Greek to me.  (To nurse) Do I have to get on this damn scale again?  What have I done to deserve this?  Are you telling me all I should know? docsity.com Proven Benefits of Active Listening 30  WSE (doctor): What bothers you most about your problem?  Bill: I can't do home repairs, can't take RV trips, and it especially  irritates me that I can't play the electric organ.  WSE: You really enjoyed playing that organ?  Bill: Yes. I was pretty good at it, too!  Nancy: He was very good. He played well and enjoyed it. [Nancy was Bill's wife.]  WSE: You had to give up something you were good at…  WSE: I wish I knew how to play card games. I never took time to learn is in my earlier years.  Bill: I think I would enjoy teaching you. Why don't we try? docsity.com Proven Benefits of Active Listening 31  Reducing fear of feelings: people fear that expressing their feelings is not a good thing. But catharsis of emotions makes the patients heal faster and feel confident of their role in the healing process:  Here is an example of the use of empathy by a physician  when a mother initially refused to grant consent for her son to have a diagnostic lumbar puncture when meningitis was suspected clinically: docsity.com Proven Benefits of Active Listening 32  Physician: What concerns you about the spinal tap?  Mother: I refuse to give consent.  Physician: [remaining calm and showing genuine interest] Tell me  more about why you are worried.  Mother: I think my son will get better without that long needle.  Physician: You are concerned about the length of the needle. [The  physician reflects to the mother her concern about the needle;  this conveys to her his understanding of the problem. He purposefully  avoids lecturing about the known safety of the needle.]  Mother: Yes, I am concerned. It could make him bleed into his back.  Physician: What do you mean? [Again, the physician tries to understand  the fear rather than repeat his explanation of the procedure.] docsity.com Proven Benefits of Active Listening 35  Acceptance fosters change: by criticizing how someone behaves or feels provokes defensiveness, closes them to further advice, and deters from looking at themselves.  Accepting their point of view helps them think of what changes they can bring to improve themselves.  Strong feelings get defused: People free themselves of troublemaking feelings when they are encouraged to express them openly to an accepting listener.  Active Listening, then, is a powerful defusing skill. docsity.com Proven Benefits of Active Listening 36  Patients are more willing to listen to you: Patients will be more willing to listen to and accept their physicians' or nurses' inputs if they previously have felt understood and accepted by them.  This builds a collaborative relationship between the two parties. docsity.com