ADAPTED MACY MODEL: COMMUNICATION SKILLS FRAMEWORK

!"#$%&'# )*+, &-' .$/0 .+#'1 )+* 23&'*45'678 65&- $##5&5+3 +) %+53&7 )*+, +&-'* '45#'3/'953)+*,'# /+,,:35/$&5+3 )*$,'6+*;7 <0 =*> ",0 ?$3
THREE FUNCTIONS OF THE INTERVIEW:

1. GATHER THE INFORMATION
Cpen the |nterv|ew and |dent|f|cat|on (ID)
Cpen Lhe lnLervlew and lnLroduce yourself.
Ask how Lhe paLlenL would llke Lo be addressed.
llnd ouL some baslc ldenLlfylng facLors abouL Lhe paLlenL
(conflrm age, where he/she llves, do you work lnslde or
ouLslde Lhe home?)
L||c|t Ch|ef Comp|a|nt (|e keason for V|s|t)
llnd ouL why Lhe paLlenL ls seeklng medlcal aLLenLlon.
Ask open-ended quesLlons: @2345&'8 A57&'38 B:,,$*5C'>D
!

Ask paLlenL Lo Lell Lhe sLory chronologlcally: "E1'$7' 7&$*& )*+,
&-' <'F53353F 6-'3 &-57 7&$*&'#GD
#

LlsLen ALLenLlvely/AcLlvely wlLh mlnlmal lnLerrupLlon, uslng
verbal and non-verbal cues
3
(See 1able 1)
Summarlze whaL you have heard/check for accuracy.
Ask Lhe quesLlon: @H-$& '17'D$
%
&' @27 &-'*' $30&-53F '17'GD
Lo flnd ouL lf Lhere's anyLhlng else Lhe paLlenL had concerns
abouL Loday LhaL he/she wanLed addressed.
lan Lhe vlslL wlLh Lhe paLlenL (le: seL Lhe agenda). Check for
agreemenL of Lhe vlslL's agenda.
I||| |n deta||s of n|story of resent I||ness (nI):
Ask open-ended quesLlons: @2345&'8 A57&'38 B:,,$*5C'>D
!

Ask Lhe paLlenL Lo Lell Lhe sLory chronologlcally: "H-0 #+3I&
0+: 7&$*& )*+, &-' <'F53353F 6-'3 &-57 7&$*&'#D
J

LlsLen ALLenLlvely/AcLlvely wlLh mlnlmal lnLerrupLlon, uslng
verbal and non-verbal cues
3

Summarlze whaL you have heard and check for accuracy and
undersLandlng.
Ask closed-ended quesLlons Lo clarlfy and flll ln deLalls ln a non-[udgmenLal,
non-leadlng and non-lnLerrogaLlve manner.
Comp|ete the at|ent's Med|ca| Database:
2

ast Med nx: Ask for deLalls abouL pasL medlcal hlsLory (any
ongolng lllnesses, any currenL medlcaLlons, any allergles,
smoklng, alcohol and drug use hlsLory).
Soc|a| nx: Ask for deLalls abouL a paLlenL's soclal conLexL
(where do Lhey llve, flnanclal concerns, who ls ln Lhelr famlly,
who do Lhey have for supporL ln Lhelr llves: parLner, klds,
parenLs, frlends eLc, do Lhey work ln/ouL of Lhe home, are Lhey
on soclal asslsLance or dlsablllLy leave?).
Iam||y nx: Ask for deLalls abouL Lhe paLlenL's famlly hlsLory
(any chronlc lllness such as dlabeLes, hyperLenslon, hearL
dlsease, sLroke, lung dlsease (asLhma, CCu), lnflammaLory
bowel dlsease eLc, cancer hlsLory, heredlLary condlLlons
Ask abouL Lhe K LI7M
o 1) C|ar|fy]Conf|rm what you th|nk you know,
o 2) Ask about Causes for the symptoms,
o 3) 1h|nk and ask about what ser|ous]||fe-
threaten|ng Comp||cat|ons cou|d ar|se.
N'45'6 +) B07&',7M .$0 #+ $ -'$# &+ &+' 7:*4'0 &+ '37:*' 3+&-53F ,577'#


2. BUILD THE RELATIONSHIP WITH THE
PATIENT (THROUGHOUT THE ENCOUNTER)

undersLand Lhe paLlenL's perspecLlve abouL
Lhe lllness, sympLoms, concerns
Lxplore Lhe lmpacL on Lhe paLlenL's llfe and
Lhe paLlenL's LhoughLs/concerns/
emoLlons abouL Lhe lssue aL hand.
Lxplore famlly, communlLy (le rellglous or
culLural) bellefs and values wlLh regards Lo
Lhe lssue aL hand.
Convey empaLhy wlLh empaLhlc
sLaLemenLs, acknowledge paLlenL's
concerns and emoLlons expressed
Convey empaLhy non-verbally (eye conLacL,
leanlng ln, noddlng, mlrrorlng faclal
expresslons) See 1ab|e 1
___________________________________________
1A8LL 1: Verba| & non-verba| behav|ours
assoc|ated w|th |mproved hea|th outcomes:
('&) *+,- +. /0 12345,5/671. 8&))965,/.5&6:434.+)/.5, '+;5+< =>*(1 #??# !@ A!B
Verba| behav|ours:
LmpaLhy, 8eassurance and SupporL
aLlenL-CenLred CuesLlonlng 1echnlques (ex. above)
oslLlve 8elnforcemenL
Pumour
sychosoclal 1alk
1lme ln PealLh educaLlon & lnformaLlon sharlng
lrlendllness, CourLesy
CrlenLlng aLlenL uurlng Lxam
Summarlzlng and Clarlfylng

Non-verba| cues & act|ons:
Pead noddlng,
lorward lean,
ulrecL 8ody orlenLaLlon
uncrossed Legs and Arms
Arm SymmeLry
Less MuLual Caze

3. EDUCATE THE PATIENT AND AGREE
ON A PLAN:
Share |nformat|on ln chunks/blLs and
blLes"
2,3
, easlly undersLandable ln language,
no medlcal Lalk" or [argon, conclse and clear.
rov|de educat|on c|ear|y. use dlagrams or
plcLures lf helpful. Lncourage quesLlons.
Invo|ve pat|ent |n mak|ng a dec|s|on LhaL
works for Lhls lndlvldual paLlenL wlLh hls/her
unlque conLexL and clrcumsLances.
|. ulscuss posslble opLlons, raLlonale, beneflLs
and rlsks.
||: llnd ouL whaL paLlenL Lhlnks/feels abouL
Lhese opLlons and whlch opLlons are
amenable Lo paLlenL. Check paLlenL's
undersLandlng, concerns abouL Lhe opLlons.
Lncourage quesLlons.
keach agreement
|: Shared declslon-maklng: negoLlaLe and
muLually agree on a plan LhaL ls accepLable
from dlfferenL perspecLlves.
||. Check for paLlenL's wllllngness and ablllLy Lo
follow-Lhrough wlLh plan, glven paLlenL's
conLexL and clrcumsLances.
|||. ulscuss follow-up, resources or supporLs
requlred Lo carry Lhrough Lhe plan.
Check back for agreement by summarlzlng
Lhe vlslL, plan and nexL sLeps, lnvlLlng any lasL
quesLlons or clarlflcaLlons and follow-up.
Lncourage paLlenL's parL ln Lhe plan.
rov|de c|osure: Lnsure lL's noL an abrupL
end, Lhank paLlenL.




**Remember to listen attentively, summarize and check back for understanding throughout the interview**

1. 8oyle eLc al. lnvlLe, LlsLen and Summarlze: A aLlenL-CenLred CommunlcaLlon 1echnlque. Academlc Medlclne vo. 80. no. 17. !anuary 2003. 29-32
2. n?u Macy lnlLlaLlve on PealLh CommunlcaLlon. Cvervlew of Lhe SLrucLure and Sequence of LffecLlve uocLor aLlenL CommunlcaLlon new ?ork, n?. Accessed 13 !une, 2013. Avallable from hLLp://nyumacy.med.nyu.edu/currlculum/model/m00a.hLml.
3. 8eck eL al hyslclan and aLlenL CommunlcaLlon-sysLemaLlc revlew !A8l 2002 13 (1)
4. 8arrler eL al. 1wo Words Lo lmprove hyslclan-aLlenL CommunlcaLlon: WhaL Llse? Mayo Cllnlc roceedlngs. 2003: 78:211-214
3. 1an A, Manca u. llndlng common ground Lo achleve a "good deaLh": famlly physlclans worklng wlLh subsLlLuLe declslon-makers of dylng paLlenLs. A quallLaLlve grounded Lheory sLudy. 8MC lam racL. 2013 !an 22,14:14. dol: 10.1186/1471-2296-14-14.
Version 3- Sept 2014 Dr. Amy Tan, Physicianship Program, FOMD, University of Alberta



SUMMARY OF EFFECTIVE COMMUNICATION DURING THE MEDICAL INTERVIEW:

















*REFERENCES:
Rider EA Communicating with children and families. In Rudolph, C, Lister G, Gershon A, First L, Rudolph, A; eds. Rudolphs Pediatrics, 22
nd
edition. New York. McGraw-Hill 2011
Also adapted from:
1) A Practical Guide to Teaching and Assessing the ACGME Core Competencies, 2010, Second Edition
2) Teaching Communication in Clinical Clerkships: Models from the Macy Initiative in Health Communications Kalet, Adina; Pugnaire, Michele P.; Cole-Kelly, Kathy; Janicik,
Regina; Ferrara, Emily; Schwartz, Mark D.; Lipkin, Mack Jr.; Lazare, Aaron. Academic Medicine. 79(6):511-520, June 2004.
3) Frankel RM, Stein. T. Getting the most out of the Clinical Encounter: The Four Habits Model. The Permanente Journal Fall 1999 Vol 3. No. 3


Version 3- Sept 2014 : Dr. Amy Tan, Physicianship Program, FOMD, University of Alberta

SUMMARY OF INTERVIEW COMPONENTS of the ADAPTED MACY MODEL
FRAMEWORK:

ACRONYM:
CLASS

Context
Listening Skills,
Acknowledgment and exploration of emotions,
Strategy for management (ie: Shared-Decision-making, Patient
Education),
Summary closure.
DID YOU GATHER ALL THE NECESSARY INFORMATION?

ACRONYM:
I CAN HELP MY PATIENTS FIND SOME RELIEF!

ID
Chief Complaint
History of Present Illness
Meds/Allergies
Past Medical History
Family History
Social History
Review (of Interview, Systems)


The Adapted Macy Model Framework guides you through how to elicit this information in a patient-centred manner [PROCESS];

the acronym helps to remind you of what information you need to elicit [CONTENT].

MUST BE ABLE TO DO BOTH CONCURRENTLY