Information giving skills and patient education

I-             Information giving skills and patient education

   The medical interview is not merely gathering information, reaching a specific diagnosis and handing a prescription but it extends to providing the patient with detailed information about his problem, treatment plan or options.

Then, the doctor will be the sender and the patient is the receiver. Doctor’s role here is to give information and correct the patient’s knowledge. When providing such information, in addition to advice and instructions, the doctor should consider the following:

1-    Providing simple and clear information by monitoring jargon (medical terms), difficulty and certainty: the doctor has to check the patient’s understanding before and during the explanation, he has to use concrete and applied examples. For instance, instead of saying “don’t eat high cholesterol diet” it is better to say “avoid eating fried food”. Use few sentences and give one message at a time. Use easy words according to the level of patient’s education. Use body language as it reinforces messages and regulates conversation.

2-    Putting important things first, i.e. the doctor should begin with what is most important, followed by what is less important to ensure that the patient recalls the most important instructions.

3-    Using repetition: repetition should be used carefully considering the patient’s background. To ensure full understanding, it is preferable to give the patient instructions several times using different words.

4-    Categorizing information to reduce complexity & aid recall: if the information is complex, it should be broken into units which are clearly signaled to the patient e.g. “there are tree things you need to know”.

5-    Using tools: where the information is complex, presenting models or doing a diagrams and sometimes use of technical aids, can be very helpful.

II-            Feedback

Feedback is necessary to tell the sender and receiver that the message was understood. Feedback means changing of roles, so the sender will be the receiver and vice versa.

·         If the feedback is from the doctor (e.g. when the doctor explains diagnosis to patient after gathering information) he should give clear, specific and direct feedback in order to reduce uncertainty, solve problems, build trust, strengthen relationships & improve work quality. Feedback should be immediate in the same session. The doctor should be descriptive rather than evaluative, dealt with facts instead of opinions.

·         If the feedback is from the patient (e.g. the patient is invited to repeat the instructions to ensure his understanding), it is obtained through asking him open questions and also through observing non-verbal signs that indicate patient’s understanding.

·         The importance of feedback from the patient is:

                         - to ensure his understanding.

                         - to clarify difficult points.

                         - to gain the satisfaction of the patient.

III-           Closing the interview is better achieved by doctors, ask if patient has questions, prioritize and summarize points of importance raised during the consultation. This is important to ensure that there is a shared understanding of patient’s needs and that both are prepared to work together. Clarify follow-up oe contact arrangements, acknowledge patient and close the interview.

Information gathering skills

I-             Information gathering skills

   A critical part of all doctor-patient interaction involves acquiring information from the patient that enables the doctor to reach an accurate diagnosis of the patient’s condition. In this situation the doctor is the receiver and the patient is the sender. During the interview we do not give information. The following are skills needed for information gathering:

1-    Using an appropriate balance of open to closed-ended questions:

Open ended questions invite extended answers not a “yes/no” response. Example of an open ended question is “please, tell me about your pain”. This provides a better description of the pain than closed questions as “is it a colicky pain?”. They are better used when a description of the patient’s condition is needed. Avoid embarrassing questions (Have you ever have sexually transmitted disease?, Avoid leading questions (Don’t you think that..?) Avoid multiple questions in the same time.

2-    Active listening and silence: Doctor has to invite patient participation, to use silence appropriately as a way of encouraging the patient to express himself and should not judge what a patient says. The followings are the important techniques for active listening:

·         Concentrate on speaker’s message.

·         Keep eye contact.

·         Pay attention to the message rather than the speaker.

·         Mentally summarize what the speaker is saying.

·         The notes of important key notes.

·         Prepare questions or counter arguments.

·         Give the speaker the chance to express himself.

3-    Clarifying patient expectations about the consultation: Doctors need to clarify with the patient what their expectations are about the consultation, this may help to reveal cases where the symptom presented by the patient is not in fact the patient’s main concern. The latter may be called a “hidden agenda”, which if not identified could result in inaccurate diagnosis of the patient’s problem.

4-    Clarifying the information given by the patient: doctors should clarify the meaning of what the patient is saying in order to ensure that the doctor understand his patient fully echoing or restating is a repetition of the speaker’s words followed by a pause. It encourages the speaker to elaborate on a point.

5-    Sequencing events: After obtaining description of the patient’s condition, the doctor should ask the patient to arrange the experienced events in sequence, in order to develop a logical picture of the patient’s condition.

6-    Directing the flow of information: Although it is important to give the patient the opportunity to communicate freely yet, the doctor has to maintain control over the interview content and direct them towards the problem in question.

Doctor-patient interpersonal skills

I-             Doctor-patient interpersonal skills

   This refers to the basic skills that help to create an effective relationships, and including the following:

Appropriate physical environment: A prerequisite for communication is to prepare the environment for communication process, to enhance privacy, comfort and attentiveness. For example, arranging settings in a manner which is neither threatening nor distant, or having a curtain to create a sense of privacy, will improve the outcome of an interview.

Establsih doctor-patient relationship: through greeting the patient in an acceptable manner according to culture norms, considering his age, sex, etc. Using the patient name to establish a relationship, also treating the patient with respect to preserve his dignity and encourage his participation.

Active listening: using both verbal and non-verbal communication. The doctor is offering acceptance by using communication signals (cues) as nods and phrases such as “right”, “I see”, etc. The willingness to listen actively should be signaled by the use of open questions to elicit full answers; e.g. “Tell me about your problems”.

Empathy, respect warmth, support, reassurance and reflection: These issues are the heart of interpersonal skills and they also involve being non-judgmental in attitude. The doctor should clearly show his concern about patient’s problems, hopes and expectations. Reassurance is letting the speaker know that you understand his or her problem. Reflection is acknowledgement of feelings, they are statement rather than questions, that attempt to interpret the emotion behind what patients are saying. To tell the patient for example :you seem very concerned about your condition”.

Language:

-Doctor should monitor the level of medical jargon and use simple terms according to patient’s education and background to offer explanations and discuss alternatives.

- It is also important for the doctor to monitor the use of potentially frightening words as “cancer or lump”.

- The doctor should monitor the certainty with which he offers opinion so that the patient is neither misled by unreal certainty nor left confused by apparent doubt in doctor’s mind.

Nom-verbal communication: skills of non-verbal communication should convey to the patient that the doctor is attentive and interested. In the same time, a good communicator observes carefully as well as listens carefully. Doctor has to learn how to interpret the body language of the patient. This will help him to identify signs may contradict verbal messages, replace them, or reinforce them.

Factors affecting communication process

<<Factors affecting communication process>>

 

Factors related to the individual:

                 “Permanent Factors”

          1-    Mental disabilities as low IQ.               

          2-    Physical disabilities as deaf, mute, blind.                                                   

          3-    Previous learning.                                    

          4-    Special talent.                                          

 

               “Temporary Factors”

     1-    State of physical health.

     2-    Pre-occupation with some problem.

     3-    Motive or interest in special subject.

Factors related to the environment

      1- Noises and distractibility.

      2- Comfortable environment as light, Seats, weather…etc.

      3- Territory (personal private space).

      4- Uses of audiovisual aids.

Core communication skills: to put a proper plan for management, a physician should use the following core communication skills:

I-             Doctor-patient interpersonal skills.

II-            Information gathering skills.

III-           Information giving skills and patient education.

IV-          Feedback.

V-           Closing the interview.

Body language

Examples of encouraging and discouraging body language

“encouraging body language”	“discouraging body language”
-          Eye contact (showing interest).                      -          Wide open eyes at something.      -          Relaxed mouth.      -          Relaxed movements.      -          Attentive expression.      -          Leaning towards the person.	-   Looking away all the time (not interested).                                -   Half closed eyes (lack of interest).             -   Compressed lips or teeth clenched.           -    Stiff movements.             -   Boredom, as yawning and tapping fingers.             -  Leaning back away from the person           -  Crossing arms in front of the chest.

Importance & types

Importance of communication

       1.    60 to 80% of diagnosis and treatment decisions are made from medical history alone. It is not only important to recognize the disease, but also be aware of the patient’s emotional response to his disease.

       2.    Better communication enhances patient compliance to treatment plans, and because most of health problems are behavior related, medical interview should be more patient-centered to encourage motivation and compliance.

       3.    Good communication has an impact on health outcome.

       4.    Effective communication contributes to doctor’s clinical competence and self-assurance.

       5.    Effective communication contributes to patient’s satisfaction.

Types of communication

I-             Verbal communication

This is done by using language, weather spoken or written. Clear messages require using effective verbal communication techniques.

Spoken communication involves:

      a)    The tone of the voice.

      b)    The art of asking and answering questions.

      c)    The quality of language used according to the recipients.

Verbal communication with highly educated people should be proportional to their educational background.

      d)    The words used should not be ambiguous (i.e should not have more than one meaning).

II-            Non verbal communication

People communicate with their bodies as well as their words. The way we sit, stand and move, facial expressions and eye contact all say something to the person we are talking with. This is called body language (non-verbal communication). It is the exchange of a message without using words, this type of communication is more powerful than the verbal one, because it affects the emotions of the receiver.

E.g. Talking of a physician with a patient without eye contact affects negligence while talking to him with eye contact reflects attention.

Introduction

   Good doctor-patient communication has been described as the corner stone of good medical practice. The medical interview is the basis of medical practice, and communication is the basis of the medical interview.

Objectives:

      1-  Define communication and enlist its elements.

     2- Recognize the importance of learning communication skills.

      3-  List types of communication and give example for each type.

     4-  Identify factors affecting communication process.

     5- Identify different methods or tools used in communication.

Definition

Communication is the transmission of a message between two persons, or between

 one person and a group.

Elements of communication

-          Sender: Sends the message.

-          Receiver: Receives the message; can be individual or group.

-          Message: The idea, information, attitude, or behavior that is being exchanged.

-          Channel: The method through which the message is sent.

-          Feed back: The reply to the message that tells the sender if the message was well or poorly received.