Environmental Characteristics: Equipment, lighting, background noise, arrangement of seating
What aspects of non verbal communication would you take into consideration during a consultation?
Facial Expressions: If not controlled we can reveal what we are thinking
Eye Behaviour: Express emotions, maintains feedback, flow of conversation
Body Positioning: Posture is a key indicator of s dis/interested attitude, Good rapport may be indicated by posture and gesture mimicking, Gender differences in body posture, body movements can be distracting, deception can be indicated by either excessive movement or unusually restricted
Spatial Distance: Different cultures expect different distances, status and gender influence amount of body space, In consultations a desk between dr and patient can act as a physical barrier which in turn can be interpreted as a psychological one and affect rapport
Paralanguage/ Vocal behaviour: tone of voice and rate of speaking can reveal emotional state, interruption behaviour is influenced by status and gender, ummms and eerrrrs may reflect difficulty speaking or a habitual way of talking
Touch: Can be therapeutic, use and degree of touch is influenced by culture and gender, can enable dr to diagnose and directly communicate care and concern for patient, can trigger positive feelings
Why are interpreters underused on the NHS?
Lack of awareness of the service
Lack of available service
Lack of training or confidence in working with interpreters
Time it takes to organise and conduct a consultation
Involves sharing a degree of control with a third party
(Unconscious) institutional racism
What are the advantages of working with trained interpreters?
Better management plan
What are the difficulties of using a family member as an interpreter?
From patients perspective a reluctance to discuss sensitive subjects
Concerns about confidentiality
Mistranslation may occur
Can introduce difficulties due to family relationships, emotional involvement, maturity of relative
Relatives may have their own agenda
What should you do if a patient insists on using a relative or friend as an interpreter?
Explain the importance of using a professional interpreter and possible serious consequences of misinterpretation
Respect their wish and record in notes
Record and impression that interpretation was not full or adequate
IF you feel there is a conflict of interest you may assert your right to have a trained interpreter on your behalf
What should one check if the interview does not seem to be going to plan?
Check that the
- Interpreter speaks English and the patient's language fluently.
- Interpreter is acceptable to the patient.
- Patient prevented from telling you things because of the interpreter
- There is a good relationship with the patient
What are interpreters trained to do with regards to preparation of the interview?
Name and role of health prof
Date, time and duration of consultation
Name, age, sex of pat
Context of consult (e.g. breaking bad news)
Exact lang and dialect spoken by pat
Is any reading or written translation required
Whether a relative or advocate will be present
What are interpreters trained to do with regards to during the interview?
Must observe confidentiality at all times
Conduct themselves professionally
Respect the values and practices of health prof organisation
Attentive to wishes of patient
Respect right of patient to object to interpreter
Interpret accurately and competently
Be competent in both lang
Respect rights of parents being involved with child as patient decisions
Aware of sensitive factors that vary among individuals and groups - Health beliefs and attitude to illness
What practical things should you do prior to a consultation to make it more effective?
Check patient and interpreter speak the same language and dialect
Allow for pre-interview discussion
Ask interpreter how to pronounce patient's name correctly
What practical things should you do during to a consultation to make it more effective?
At the start:
� All interpreter to greet patient
� Explain his/her role
� Introduce you and your role
� Explain interview is confidential
� Is patient happy with interpreter
� Encourage interpreter to interrupt and intervene
� Active listening
� Allow enough time for consultation
What practical things should you do after to a consultation to make it more effective?
Check patient has understood everything
Check whether patient has any questions
Have a post consultation discussion with interpreter
Identify the skills required for giving out information to patients.
To gauge the correct amount and type of information
To provide explanations that the patient can remember and understand
To use an interactive approach to ensure a shared understanding
To involve the patient and plan collaboratively to the level that the patient wishes
Why do people not adhere to behaviour changes?
Dr unclear about advice
Patient not understood/accepted
Patient may disagree with advice
May have secondary gains from illness
Discrepancy between the doctor's and patient's perception of risk
May understand/agree but too difficult -Impractical/expensive
Unnaturalness of manufactured drugs
Danger of addiction and dependency
Danger of becoming 'immune over time'
What domains should be considered when promoting behavioural changes?
Identify and mobilise support - 'who or what might help you?'
What skills can a Dr use to enhance behavioural change from action to maintenance?
Offer support - 'I'm glad to see that you have succeeded in...'
Arrange a follow up - 'I'd like to see you again in...'
Check and reaffirm agreed plan - ' until we next meet what will you do?'
Goal setting - SMART
What does SMART stand for and when is it applied?
S - Specific
M - Measurable
A - Attainable
R - Relevant
T - Time related
What skills can a Dr use to enhance behavioural change whilst the patient is in relapse?
Role: Offer support & Normalise
- Name feelings and reassess commitment to change
- What are you thinking?
- How are you feeling?
- What do you want to do now?
- How committed are you to try again?
- Where should we go from here?
What reflective statements can one use as a Dr?
Listen to what patient says
Consider what patient means
Describe what you think patient means as a statement not as a question
Describe ways in which written communications are used in health care.
Individual Patient: Correspondence, medical records, prescriptions, consent forms etc.
Generic Patient: Drug leaflets, information leaflets, print media etc.
Generic Provider: Drug leaflets, clinical guidelines, professional staff appraisal, print medias.
What are key aspects of effective written communication?
Tailored to the purpose & audience
Logical, clear & unambiguous
Correct grammar & spelling
Appropriate length and format
Appropriate use of language
Contains relevant accurate information
How can a patient's individuality be maintained in written communication?
Correct spelling of patient's name
Accurate reflection of what took place
Language and terms patient can understand
Use quotes from the patient where suitable
Use 'you' to be specific
Be sensitive to issues of confidentiality
What are the 12 standards from the RCP for generic medical record keeping standards?
1. The patient's complete medical record should be available at all times during their stay in hospital
2. Every page in the medical record should be available at all times during their stay in hospital
3. The contents of the medical record should reflect the continuum of patient care and should be viewable in chronological order
4. Documentation within the medical record should reflect the continuum of patient care and should be viewable in chronological order
5. Data recorded or communicated on admission, handover and discharge should be recorded using a standardised proforma
6. Every entry in the medical record should be dated, timed (24hr clock), legible and signed by the person making the entry. The name and designation of the person making the entry should be legibly printed against their signature. Deletions and alterations should be countersigned.
7. Entries to the medical record should be made as soon as possible after the event to be documented and before relevant staff member goes off duty. If there is a delay the time of the event and the delay should be recorded
8. Every entry in medical record should identify the most senior healthcare professional present (who is responsible for decision making) at the time the entry is made
9. On each occasion the consultant responsible for the patient's care changes, the name of the new responsible consultant and the date and time of the agreed transfer of care, should be reorded
10. An entry should be made in the medical record whenever a patient is seen by a Dr. When there is no entry in the hospital for more than 4 days for acute medical care or 7 days for long-stay continuing care, the next entry should explain why
11. The discharge, record/discharge summary should be commenced at the time a patient is admitted to hospital
12. Advanced decisions to refuse treatment, consent, cardio-pulmonary resuscitation decisions must be clearly recorded in the medical record. In circumstances where the patient is not the decision maker, that person should be identified e.g. lasting power of attorney
When is it appropriate to use telephone communication in healthcare?
Patient telephone consultation
Telephone follow-up for long term conditions
Consultation with a senior colleague
Obtaining test results
Preventing missed appointment
OOH triage centres
What are the advantages of telephone conversations?
Some patients may feel they can open up more
What are the disadvantages of telephone conversations?
Lack of non verbal clues
No direct observations
No diagnostic tests
Need for active listening
Third party consultations
Cultural & Language obstacles
Lack of telephone
When could telephone communications are used in health care
Long term conditions: Stable asthma, Diabetes, Monitoring of depression
Routine post-op follow up: TURP, children tonsillectomy
Umcomplicated acute conditions: UTI
Health promotions: Counselling for smoking cessation
What key aspects are there for structuring a telephone conversation?
- Check pt notes/results
- identify known conditions, drug allergies and recent consultations
- Introduce yourself
- Build a rapport using tone of voice
- Thorough history as a lack of physical examination
- Use open and closed questions to include/exclude conditions
- Ensure pt's agenda has been established
- Allow time for pt to ask questions
- Agree on plan of action
- Provide treatment/disposition advice
- Let caller disconnect first
- Accurate records
- Record date & time of call
- Record pt's name, age, gender
- Summarise points
What key skills are there for presenting information via a telephone conversation?
Active listening & detailed history taking
Frequent clarifying & paraphrasing
Picking up cues
Offering opportunities to ask questions
Offering patient education
What key skills can be used for presenting information to colleagues via telephone?