С ommunication in Medicine

What is communication?
Communication is social interaction through messages

Transmission Model
being paged in hospital
giving instructions
questionnaire

Interactional Model
Medical interview (planning
treatment, discussing
options)

Five communication skills
Verbal Communication
Non-verbal communication
Voice management
Listening ( Active)
Cultural awareness

An extract from a patient interview:
Doctor Do you have any history of
cardiac arrest in your family?
Patient No, we’ve never had no trouble
with the police
West and Frankel (1991)

Communication
Skills and Strategies

The Biopsychosocial Model
The biopsychosocial approach was
developed at Rochester, USA decades ago
by Drs. George Engel and John
Romano

Date of download:
4/15/2012
Copyright © American Psychiatric Association. All rights reserved.
From: George Engel, M.D. (1913–1999)
Am J Psychiatry 2005;162(11):2039-2039 doi:10.1176/appi.ajp.162.11.2039
George Engel

Biomedical VS Biophychosocial
Traditional
biomedical models of
clinical medicine focus
on pathophysiology
and other biological
approaches to
disease
The biopsychosocial
approach emphasizes
the importance of
understanding human
health and
illness in their fullest
contexts

The Biopsychosocial Model
The biopsychosocial approach
systematically considers biological,
psychological, and social factors and
their complex interactions in
understanding health, illness, and health
care delivery.

Biopsychosocial-oriented clinical practice should include
(1) self-awareness;
(2) active cultivation of trust;
(3) an emotional style characterized by empathic curiosity;
(4) self-calibration as a way to reduce bias;
(5) educating the emotions to assist with diagnosis and forming therapeutic relationships; (
6) using informed intuition; and
(7) communicating clinical evidence to foster dialogue, not just the mechanical application of protocol.

To apply the biopsychosocial approach to clinical practice, the clinician should:
Recognize that relationships are central to providing health care
Use self-awareness as a diagnostic and therapeutic tool
Elicit the patient’s history in the context of life circumstances
Decide which aspects of biological, psychological, and social domains are most important to understanding and promoting the patient’s health
Provide multidimensional treatment

Doctor-centred approach
diseases and patient are completely separate
tightly controlled
doctors take the dominant role
patients have limited participation
patients not expected to participate actively
patients’ health is in entirely in the hands of the doctor
doctors ask leading questions
impact of disease on patients’ life is barely considered

Patient-centred approach
patient is expert of their own disease
patient is the main source of information
holistic approach
social, physical and economical factors are important
doctors show empathy
patients are more likely to comply with treatment
doctors are more responsive to patients cues

Calgary Cambridge guide to the medical interview
Kurtz SM, Silverman JD, Draper J (1998) Teaching and Learning Communication Skills in Medicine. Radcliffe Medical Press (Oxford)
Silverman JD, Kurtz SM, Draper J (1998) Skills for Communicating with Patients. Radcliffe Medical Press (Oxford)

communication process
of a medical interview
Initiating the session
Gathering information
Providing structure
Building relationship
Explanation and planning
Closing the session

Clinical Skill Online: www.elu.sgul.ac.uk
The e-Learning Unit
The e-Learning Unit (ELU) was established in 2005 to deliver a high quality elearning experience to its students, and to create first class research and development groups, focussed chiefly on innovation and international collaboration in the field of virtual patients. eLU has three distinct research and development groupings: more..
What is Clinical Skills Online?
The Clinical Skills Online (CSO) is a project aimed at providing online videos demonstrating core clinical skills common to a wide range of medical and health-based courses. This project has been funded by the Higher Education Academy Subject Centre for Medicine, Dentistry and Veterinary Medicine.

Initiating the session
Establishing initial rapport
Greets patient and obtains patient’s name
Introduces self and clarifies role
Demonstrates interest and respect, attends to patient’s physical comfort
Identifying the reason(s) for the consultation
Identifies the patient’s problems or the issues that the patient wishes to address with appropriate opening question (e.g. “What problems brought you to the hospital?” or “What would you like to discuss today?” or “What questions did you hope to get answered today?”)
Listens attentively to the patient’s opening statement, without interrupting or directing patient’s response
Confirms list and screens for further problems (e.g. “so that’s headaches and tiredness; anything else……?”)
Negotiates agenda taking both patient’s and physician’s needs into account

Question technique
The ‘cone technique’ moves from open to close
questions. It ensures that the doctor obtains a
picture of the problem from the patient perspective,
by opening up the discussion. With the need to
confirm specifics and narrow down the cause of
symptoms, the doctor then follows with more closed questions.

Types of Questions
closed questions – the response Yes\ No or one-word answer leading questions – phrased to elicit a particular answer (Does the itching always start first thing in the morning)
open questions - the response is more than one word (why, where, when etc.)
When did you first feel the pain?
How long have you had it?

Is Patient-Centred Approach Universal?
the University of Iowa research suggests that
patients are most satisfied with care and most
likely to follow treatment plans -- like taking
medication or making diet changes -- if they see a
doctor whose attitudes toward patient-physician
roles are in line with their own.

some patients, especially older patients, prefer a doctor with a more traditional "doctor-centered" or "paternalistic" style, someone who spends less time explaining a condition and seeks little patient input when it comes to treatment decisions.

Alan Christensen, professor of psychology:
"There are patients who strongly believe it's the physician's job to make decisions…”

References
The Biopsychosocial Model 25 Years Later:Principles, Practice, and Scientific Inquiry /ANNALS OF FAMILY MEDICINE ✦ WWW.ANNFAMMED.ORG ✦ VOL. 2, NO. 6 ✦ NOVEMBER/DECEMBER 2004
Clinical Skills online://www.elu.sgul.ac.uk/ cso
Silverman JD, Kurtz SM, Draper J (1998) Skills for Communicating with Patients. Radcliffe Medical Press (Oxford)
Patient-Centered Approach Can Backfire / ScienceDaily (Aug. 13, 2007)