C O M M U N I C AT I O

N SKILLS
DR. LANA HALASEH, MD, MCFP (COE)
C O N S U LT A N T F A M I LY P H Y S I C I A N
G E R I AT R I C S P E C I A L I S T & H O S P I TA L I S T
DISCLAIMER

These slides do NOT replace the seminar and they only amend what we

discuss during our talk.. Please do not rely entirely on them!

OBJECTIVES

1. To understand the importance of communication skills

2. The know the different communication skills needed during the interview
with patients
3. Specific communication skills for different people including children and
adolescents
 DEFINITION

• Communication can be defined as ‘the

successful passing of a message from one
person to another’.
 COMMUNICATION

• There are five basic elements in the

communication process:
• The communicator
• The message
• The method of communication
• The recipient
• The response
 COMMUNICATION

• Important principles facilitating the

communication process are:
• The time factor, facilitated by devoting
more time
• The message, which needs to be clear and
correct
• The attitudes of both the communicator
and the recipient
BENEFITS OF GOOD
COMMUNICATION
• Good communication:
• Builds trust between patient and doctor
• May help the patient disclose information
• Involves the patient more fully in health
decision making
• Leads to more realistic patient
expectations
• Produces more effective practice
• Reduces the risk of errors
COMMUNICATION CYCLE
COMMUNICATION CYCLE
1. Prepare
2. Open
3. Gather
4. Elicit patient’s perspective
5. Communicate during examination
6. Patient education
7. Planning
8. Closure
COMMUNICATION CYCLE

E PA R E
1 . P R
 1. PREPARE

• Physical environment:
• Comfort and privacy
• The patient should be physically
positioned to feel empowered (e.g.
avoid talking down to a patient on a
bed)
• Doctors should review themselves as
well (e.g. dress code, sitting position,
postures)
 PREPARE

• Review of the patient’s health record.

• When a record is examined well, the
reasons for the consultation can often be
anticipated to improve communication;
• What happened at the last consultation
• What are the important medical issues for this
patient
• Any recent test results
• Brief notes on personal characteristics, likes/
dislikes (e.g. has needle phobia)
 PREPARE
• Reading the body language;
• Cultural and social backgrounds (e.g. dress and
appearance)
• Medical issues at hand

• Picking up on these clues early;

• Helps in anticipation
• Avoids communication breakdown
• Makes the patient feel that the doctor is
interested in him or her
COMMUNICATION CYCLE
E N
2. OP
 2. OPEN

• address the patient by his or her preferred name

(and anyone else entering the room)
• Try to make the patient feel comfortable
• Try to appear ‘unhurried’ and relaxed
• Focus firmly on the patient (eye-to-eye contact
is crucial)
• Use open-ended questions where possible (e.g.
what brings you here today?)
COMMUNICATION CYCLE
3 . G AT
HER
 3. GATHER
• Verbal vs. non-verbal communication
• Silence (start) vs. talking (later)
• Silence = Active listening
• Active listening;
• Understand
• Make no interruptions (e.g. note-taking, computer
entry, mobile phone… etc)
COMMUNICATION CYCLE

4. ELICIT
PATIENT
CONCERNS
 4. Elicit Patient Concerns

• Facilitation
• The open-to-closed cone
• Summarization
 FACILITATION

• Facilitation refers to comments or

behaviors by the doctor that encourage
the patient to keep talking.
• This could include:
• a head-nod
• a ‘Tell me more about that’
 The Open-To-Closed Cone

• The process of ‘diving in’ and exploring the

patient’s initial concern.
• Helps to collectively determine the patient’s
concerns and needs.
• All lead to more appropriate prescribing and
more efficient practice.
 SUMMARIZATION
• It is when the doctor provides the patient
with a verbal summary of the information.

• This helps to:

• Ensure that we have obtained a complete
understanding of the patient’s concerns
• Reduce the chance of patient concerns being
missed
• Reflect back to the patient the doctor’s
understanding of them
• e.g. “Is there anything else today?”
NON-VERBAL
COMMUNICATION
• Body language
• Human communication takes place through the use of
gestures, postures, position and distances
• The interpretation of body language is a special study
in its own
• Non-verbal component comprises the majority of the
impact of any communicated message
• Examples include:
• The depressed patient
COMMUNICATION CYCLE

5 . C OM M U N I C AT I N G D U R I N G
E XA M I N AT I ON
5. COMMUNICATING DURING
EXAMINATION
• Consent
• Explain the procedure and acknowledge any
unpleasant previous experiences
• Explaining what we are observing and
finding will help the patient feel valued and
respected
• Continue to keep an ear out for any further
concerns
COMMUNICATION CYCLE

6. PATIENT
EDUCATION
6. PATIENT
EDUCATION
• In most consultations, information flow often
moves repeatedly back and forth between
patient and doctor.
• Four techniques that will help maximize
patient understanding are:
• Signposting
• ‘Chunk and Check’
• Avoiding jargon
• Using visual and physical techniques to
communicate
 6.A. SIGNPOSTING

• Explicitly stating what the doctor has done

and/or is about to do
• e.g. I have finished examining you, now I
would like to explain what I think the issues
are

• Signposting helps orientate and relax the

patient, and makes him focus better on
what the doctor is saying
6.B. “CHUNK AND
CHECK”
• It is where the doctor provides a chunk of
information to the patient and then immediately
checks the patient’s understanding of it.

• It is frequently surprising to find how far away

the patient’s understanding is from what we
intended to communicate.

• So this technique informs the doctor of any

misunderstandings and hence provides an early
opportunity to correct this.
6.C. Avoiding Jargon

• Because it:
• Impairs the patient’s understanding
• Can also be intimidating

• Jargons will also vary from patient to patient.

• Factors include age and education
6.D. Using Visual and Physical
Techniques to Communicate

• Diagrams
• Models
• Patient hand-outs
• Videos
PROVIDING INFORMATION ABOUT
DIAGNOSIS TO THE PATIENT

• When discussing the diagnosis, the following

should be considered:
• The possible nature of the illness or condition
• The degree of uncertainty of any diagnosis
• The status of the patient’s illness; whether
temporary, chronic or terminal
• Consider breaking bad news guidelines
• Patient’s requests for information
COMMUNICATION CYCLE

7. PLAN
7. NEGOTIATE AND AGREE
ON A PLAN
• Shared or collaborative decision making

• The doctor and patient should treat each

other’s concerns with respect:
• This will lead to a shared responsibility for the
outcome
• Reaching consensus on a treatment plan
• Establishing a mutually acceptable follow-up plan
• e.g. “This is what I would suggest, what do you
think?”
COMMUNICATION CYCLE

8. CLOSE
 8. CLOSE
• Let patients know in advance that closure is being
planned (and why) to allow them to not feel pushed out
of the room (e.g. in case of a full waiting room)

• Avoid “Doorknob presentation” by making sure you

have covered all the patient’s concerns and disclosures
• “Doorknob presentation”: the raising of a patient
concern that happens as the doctor puts his or her
hand on the doorknob to allow the patient to leave
the room
• This has also been called the ‘Oh, by the way
doctor’ syndrome in the USA
 CLOSE

• Summarize the critical points of the

consultation and planned actions and
expectations.

• Thank the patient with an appropriate

parting statement
• According to the patient’s style and cultural
issues.
 COMMUNICATING WITH
CHILDREN
• When treating children, you
must remember that the child is
the patient, but the parent is
also important in such
interactions.
POINTS TO REMEMBER
• Find out where the child is most comfortable on a
parent’s lap or on the floor playing with toys.

• Pay attention to the distance between you and the

child many children like you to physically be at their
level.

• Work with the child using an unstructured, open

approach
Take the child seriously and do not talk down to
him or her

• Offer support

• A child may be more relaxed during a procedure

if you first demonstrate the procedure on a
stuffed animal so the child will know what to
expect
COMMUNICATING WITH
ADOLESCENTS
• Adolescents are in the main healthy and suffer from few serious
illnesses.

• The common reasons for consulting include:

· pregnancy and contraception
· acne and glandular fever
· drug and alcohol problems

• More serious but less common problems include:

· diabetes mellitus, juvenile rheumatoid arthritis,
· sexual abuse, depression and parasuicide
· eating disorders
OBTAINING INFORMATION

• Part or all of the visits, especially during history

taking, should be without the parent present

• it is essential to speak with the parents to

discuss their concerns

• The sex of the physician may be important to

the comfort of some patients.
 (HEADSSS)
ASSESSMENT
• Home
• Education/Employment
• Activities
• Drugs and dieting
• Sexuality
• Suicide (and depression)
• Safety (violence and abuse)
POINTS TO REMEMBER
• Listening, building rapport, acceptance, support

• Taking the young person seriously

• Avoiding writing during the interview, especially

during sensitive questions.
 COMMUNICATING WITH
ELDERLY
• Communication between older adults and health care professionals is
hindered by the normal aging process.
SOME CHANGES ASSOCIATED
WITH NORMAL AGING
• Vision Deficits

• Hearing Deficits

• Decline in memory
• Carefully assess and validate the need for modified
communication techniques especially for dementia
patients.

• Communicate respectfully and in a manner that preserves

dignity.
Ask the patient how he/she prefers to be addressed

Avoid terms such as honey, sweetie, and dear.

• Use communication strategies to meet patients' needs, such as:

Speak slowly and at an adequate volume as needed to ensure effective

communication.
Face the patient, speak slowly and distinctly

Use closed-ended questions requiring only a yes or no response.

Communicate one thought at a time.

• Provide adequate time for decision-making and problem-
solving.

• Assure participation in decision making: advance directives,

health care proxy, DNR, informed consent.

• Assess barriers (drug interactions, dementia, delirium, disease

states, depression) that impact patients' understanding of
information, following directions and making needs known.
(You may want elderly patients to bring a family member or
friend in during the consultation )
 Pocket Talker

• Demonstrate familiarity with adaptive devices

(hearing aid, pocket talker) and assure the use of
needed and applicable communication aids,
including glasses or magnifiers
• Use visual aids such as pictures and diagrams to help clarify and reinforce
comprehension of key points

• Direct instructions/information to family/caregiver as well as patient.

• Communicate respectfully and preserve patient dignity when performing

physical care as well as when communicating.

• Frequently summarize the most important points

POINTS TO REMEMBER
• Allow extra time for older patients.

• Avoid distractions.

• Face-to-Face Communication With Older Adults.

• Listen, reduce or eliminate background noise.

THANK YOU