COMMUNICATION SKILLS

• Dr.Abdulmoneam Saleh
 Importance
Poor communication is the most important factor
causing complaints from patients and relatives
against doctors. “The Victorian Medical Board”
Definition of Communication

The successful passing of a message from

one person to another
What is communication?
Latin
Communicare = (to have something in) common

Oxford English Dictionary

“The exchange of information between individuals,

by means of speaking, writing or using a common
system of signs or behaviour”

Microsoft Encarta Dictionary 2001

Doctors Patients
Knowledge Beliefs
Vulnerable
Perceived power
Frightened
Health Unwell
Responsibilities Rights
Middle class Any class
 Basic Elements of Communication

The communicator
The message
The method of communicating
The recipient
The response
 Facilitating factors of communication

The rapport between the people involved

The devoted time
The passing message
The attitudes of both the communicator and the recipient
Consultation skills of young doctors
Patients preferred those who
● Introduced themselves
● Were sympathetic
● Appeared self-confident
● Listened to them
● Responded to verbal cues
● Asked precise and simple questions
● Did not repeat themselves
Maguire P et al 1989
Consultation skills of young doctors
Listen to the patient
They
are
telling
you
the
diagnosis !!
Evidence for benefits
● The longer the doctor waits before interrupting the patient,
the more likely they are to discover the full spread of
issues ( Marvel 1999)
● Picking up and responding to patient cues shortens rather
than lengthens the visits (Levinson 2000)
● Asking patients to repeat in their own words increased
retention by 30% (Bertakis 1977)
● Patients who are viewed as partners and informed of
treatment rationales are more adherent to treatment
( Schulman 1979)
● Communication was the most important factor in
compliance (McLane 1995)
 Active Listening
 The single most important communication skill.
Described by Egan as follows:

One does not listen with just his ears.

He listens with his eyes and with his sense of touch.
He listens by becoming aware of the feelings and emotions that arise
within himself because of his contact with others.
He listens with his mind, his heart and his imagination.
He listens to the words of others, but, he also listens to the
messages that are buried in the words or encoded in all the cues that
surround the words (his own emotional resonance is another ear).
He listens to the voice, the demeanor, the vocabulary, and the
gestures of the other.
He listens to the context, verbal messages and linguistic pattern, and
the bodily movements of others.
He listens to the sounds and the silence.
 Golden Rules for Effective Listening

Listen with understanding, in a relaxed, attentive silence.

Use effective questions such as:

You seem very sad today.
You seem upset about your wife/husband …..
You seem to be telling me that your main concern seems to …
It seems you’re having trouble coping.
 Positive attitudes for Communication

Caring
Empathy
Respect
Interest
Concern
Confidence
Competence
Responsibility
Trust
Sensitivity
Perceptiveness
Diligent.
 Communicating Strategies

Avoid jargon
Modify language
Provide clear explanations
Give clear treatment instructions
Evaluate the patient understanding
Summarize and repeat
Avoid uncertainty
Avoid inappropriate reassurance
Arrange appropriate referral (if necessary)
Ensure patient is satisfied
Obtain informed consent.
 At First Contact

Address the patient by his or her preferred name

Make the patient feel comfortable
Be unhurried and relaxed
Focus firmly on the patient
Use open-ended questions where possible
Make appropriate reassuring gestures
 Non verbal Communication or Body Language

The most important feature of the communication process

Albert Mehrabian showed the impact of the message as follows:

Words alone 7%
Tone of voice 38%
Non verbal communication 55%

Recognizing Body Language

Improves rapport and understanding of the patient’s fears and concerns.

Allows doctors to modify their behaviour promoting optimum communication.

Interpretation of Body Language

Readiness to go gesture = a desire to terminate the consultation

Barrier signals (folded arms, crossed legs, ankle lock pose) = defensive mechanism to
 Rapport Building Techniques

Mirroring: whereby the limb positions and body angles of the person you are talking to
can be copied. So that they look at you and they see themselves as in a mirror.

It is not necessary to copy uncomfortable gestures or unusual limb positions such as

hands behind the head.

A partial mirror is often sufficient.

Pacing: whereby a certain rhythm like breathing, talking and movements of the head,
hands and feet of the person you are talking to can be copied.

It will establish a sense of oneness or rapport with them.

So, you can change their pace by changing yours (leading)

Vocal copying:

Copying intonation, volume, pace, rhythm, breathing and length of sentence before
pausing.
Barriers
● Lack of skills
● Inadequate knowledge & training
● Undervaluing the importance of communicating
● Lack of time
● Uncomfortable topics (e.g. child protection)
● Lack of confidence
Barriers
● Tiredness/ Stress
● Language barriers (e.g. overseas doctors/patients)
● Personality and class differences between doctors and
patients
● Concerns regarding confidentiality
● Lack of knowledge of illness/condition
How to communicate better
 Essential components of a consultation
•Building the doctor–patient relationship
•Opening the discussion and gathering information
•Understanding the patient’s perspective
•Sharing information
•Reaching agreement on treatment
•Closure
Building the relationship
● Reduces anxiety and distress
● Improves willingness to engage

● Break the ice

● Offer choice to see them alone first
● When the child does not speak…..
● Rapport building
Opening the discussion
● Opening statement eg
What can I do for you?
What are your concerns about Sam?
● How to involve children…
Eye contact
Patience
Use name
Open posture
Gathering information
● Listening skills
show you are listening
nonverbal behaviour
clarifying
summarising
● ICE
Ideas
Concerns
Expectations
Rapport building
● Company + privacy
● Distraction
● Praise
● Explanation
● Reassurance
Sharing information
● “Frame” your explanation
Tell them what you are about to tell them
Find out what they know already
Build on ICE
Use appropriate language
Use visual aids
Sharing information
● Check understanding
● Eye contact
● Asking questions
● Forward posture

● Offer other sources of information

● Letters
● Leaflets
● Internet
Closing the consultation
● Summarizing an action plan
● Safety environment
● Tell them what happens next
 Follow up

Be available for phone calls

Ensure patient obtain results of investigation ordered
Ensure any promised follow up is carried out
Phone the patient if you have any lingering concerns
Arrange as an advocate if necessary, e.g., pressing for hospital
admission.
THANK YOU