INTRODUCTION TO

BLOCK MEDICAL
COMMUNICATION
Putu Sutisna
Communication:
imparting, conveying or exchanging of
ideas, news, knowledge etc.

Several forms of communication.
Purposes of Communication
to form & maintain relationship
to give information
to convey feelings
to persuade
to solve problems
to alleviate distress
to make decisions
to give reassurance
Communication in Medicine
Doctor patient/family
Doctor doctor
Doctor community

In what parts of doctor-patient consultation
does communication take place?
Main areas covered in Block MC
1. Communication with patient
A.Taking medical history & review of body
systems
B. Giving information to patient
C. Special approach to specific
patient/situation
2. Paper presentation and discussion
3. Writing medical letters & notes, and Cur Vitae
4. Scientific writing
5. Health education & health promotion for
community


Good communication skills can be
learnt.
What are needed?
Written instructions (references)
Opportunities to practice
Feedbacks (SGD)
Discussion on performance (SGD)
BASIC CONCEPTS OF
COMMUNICATION
WITH PATIENT
AND FAMILY
Putu Sutisna
Doctor-Patient
Communication

Influencing Factors
1. Patient-related factors
- Physical symptoms
- Pathological factors related to illness
- Previous experience of medical care
- Current experience of med care
2. Doctor-related factors
-Training in communication skills
- Self-confidence in ability to communicate
- Personality
- Physical factors (e.g. tiredness)
- Psychological factors (e.g. anxiety)
3. Interview setting requirements
- Privacy
- Comfortable surroundings
- Appropriate seating arrangement

Guidelines for conducting interview
(anamnesis) with patient
A. Beginning
1. Greet patient by name, shake hand (?)
2. Ask patient to sit down
3. Introduce yourself
4. Explain purpose of interview
5. Say how much time available
6. Explain need to take notes
B. Main part of interview
1. Maintain +ve atmosphere, warm manner,
eye contact
2. Use open questions, esp at beginning
3. Listen carefully
4. Be alert and responsive to verbal & non
verbal cues
5. Facilitate patient verbally & non-verbally
6. Use closed questions when appropriate
7. Clarify what patient has told you
8. Encourage patient to be relevant
C. Ending
1. Summarize what patient has told you
2. Ask if patient wants to add anything
3. Thank the patient
Three key skills for communicating
effectively with patient
1. Questioning
2. Listening
3. Facilitating
Questioning
Main purpose of interviewing patient:
to obtain information about patients
condition that is accurate, complete and
relevant
Good communication with patient alone
contributes to correct diagnosis in about
80% of cases


Open questions
should be used as much as possible
to obtain great deal of information from patient

Would you please tell me how you have been
feeling in the past few days?
I understand that you have had pain. Would
you please tell me more about it?
Can you tell me what brings it on?etc
Closed questions
Give patient little choice in the way to answer
Usually elicits little information, only yes or
no.
Have you been feeling unwell today?
I see from your GPs notes that you have had
chest pain. Do you still have the pain?
Was it tight or dull pain?
Did it go down your arm?
Did it get worse when you exercised?
Advantages of open questions
More relevant information in given time
Patient feels more involved
Patient can express all concerns and
anxieties about problems
When to use close questions?
To obtain specific information not yet given
by patient
In emergency cases


Listening
Advantages of active and effective listening:
Gathering and retaining information accurately
Understanding implications for patient of what is
being said
Responding verbal & non-verbal signals or cues
Demonstrating you are paying attention and
trying to understand
Facilitating
Part of effective listening, aims to help patient to
talk fully about his/her problem.
By verbal way
Please go on and tell me more about your
pain.
Yes, I understandplease continue.
By non verbal way
Leaning slightly forward toward patient
Making eye contact
Nodding head at appropriate time

Communication
with Patients Family
How the family can help?
Provide emotional & social support
Provide practical support
Provide understanding of belief about illness &
treatment

Provide information about family history
Help avoid/overcome bad patients
compliance
Overcome difficulties arising from secrets
Anticipate/address problems that may
affect other family members

Patients appreciate/respect doctors who
are warm and sympathetic
are easy to talk to
introduced themselves
appear self-confident
listen to the patients and respond to their
verbal cues
ask easy-to-understand questions
Patients complain most frequently
about doctors who
would not listen
would not give information
showed lack of concern or lack of respect
for the patients

Students who were given communication
training vs those who were not:
Get 3 times more accurate information about
patients problem
Are more emphatic
More self-confident
More able to use open questions and respond
to verbal cues
Given higher ratings by the patients


Summary
The ability to communicate effectively and
sensitively is essential in medicine
Communicating effectively with patients
involves the core skills of questioning, listening
and facilitating
Good communication leads to: accurate history
taking and diagnosis, patients compliance with
treatment plan, patients satisfaction with the
care given
The skills of good communication can be learnt
and retained
Having all the advances in medical science
and technologies, we may not ever
forget..
the essential aim of a physician since the
ancient time:
To cure sometimes,
relieve often,
comfort always


THANK YOU
Lectures main objectives:
To describe the importance of good
communication with patients
To describe the factors that may influence
the outcome of communication between
the doctor and patient
To explain the technique of conducting
effective communication with patients that
involves questioning, listening and
facilitating
Non-verbal cues:
Eye contact
Posture
Gestures
Facial expressions
Way voice is used
Pitfalls in communication
Asking too many or complicated questions
Not allowing patient to tell story in his/her
own words
Unnecessary interruption
Failing to pick up important verbal & non-
verbal cues