Doctor Patient communication

1. Dr ANJANA MOHITE
MS(ENT)Gold Medalist; D.L.O
Associate Professor
Dept of ENT.
DY PATIL MEDICAL COLLEGE KOLHAPUR ,MAHARASHTRA
INDIA
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2. “Medicine is an art whose
magic and creative ability
have long been recognized
as residing in the
interpersonal aspects of
patient-doctor
relationship”.
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4.  Communication is a fundamental pre-
requisite of medical profession.
 It is the key for a meaningful
relationship between a doctor and
patient.
 From obtaining medical history to
conveying treatment plan the doctors
relationship with his patient is built on
good communication.
 Each of you must develop your own
good way of communication as this is
crucial in ensuring professional success
for you.
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5. 1. Better understanding of pt problem, thus
better diagnostic capacity.
2. Helps manage difficult cases thus
decreasing the frustration of both doctor n
pt in situations of emotional outburst.
3. Decreases work stress and increases job
satisfaction.
4. Pts level of satisfaction improves.
5.Furthur leading to increase in compliance
to docs advice.
6. It has positive impact on pts psychology,
mental health, tolerance power and quality
of life.
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6. 1. Creating a good interpersonal
relationship.
2. Facilitating exchange of
information.
3. Including patients in decision
making.
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7.  Verbal
 Non-verbal
 Paraverbal
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9.  Deals with content of message including
selection of words.
 Includes information about nature, course
and prognosis of disease.
 Various Rx options available.
 Nature, cost and yield of investigations.
 Risks and benefits of invasive procedures.
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12.  Includes body language like posture, gesture,
facial expression and spatial distance.
 This influences important outcomes like
patient satisfaction, adherence to advices and
clinical outcome.
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15.  Includes tone, pitch, pacing and
volume of voice.
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17.  While communicating most of us focus
on the verbal component, but this
constitutes only 10% of the message
delivered.
 Whereas non verbal and para verbal
components contribute 90% of the
total message delivered.
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18.  Never forget the importance of
those few minutes that you get
in this communication.
 This is not only for patient
experience but also for your
own satisfaction as a Clinician.
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19.  Assess- belief, behaviour and knowledge.
 Advice-provide specific information on health
risks and benefits of change.
 Agree-Collaboratively set goals based on pts
interest and confidence in their ability to
change behaviour.
 Assist-identify barriers, problem solving
techniques and social support.
 Arrange- specific plan for follow up like mail,
visits, phone calls.
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20.  Patient
 Families
 Colleagues
 Community
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21. Demonstrate the ability
to communicate to
patients in a respectful,
patient, non-threatening,
non-judgmental and
empathetic manner.
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22. Build a relationship:
 Greet and show interest in patient as a person.
 Use words that show care and concern throughout
the interview.
 Use tone, pace ,eye contact and good posture.
Open the discussion:
 Allow pt to complete his or her opening statement.
 Ask is there anything else? To elecit full set of
concerns.
 Explain and/or negotiate an agenda for visit..
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23. Gather information:
 Use open ended questions (“tell me about…”)
 Structure clarify and summarise information.
 Actively listen and give pt opportunity to correct or
add.
Understand the patients perspective:
 Ask about life events, circumstances..
 Explore beliefs, concerns and expectations about
illness and treatment.
Check for mutual understanding of diagnostic and
treatment plans.
 Encourage questions.
 Share information.
 .
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24. Reach Agreement on Problems and Plans:
 Encourage the patient to participate in
decisions/choices to the extent he or she desires.
 Check the pts willingness and ability to follow the
diagnostic and treatment plans.
 Identify and enlist additional resources and
supports as appropriate.
Provide Closure:
 Ask if pt has other issues, questions or concerns.
 Summarise and affirm with plan of action.
 Clarify follow-up or contact arrangements.
 Acknowledge patient and close interview.
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25. Objectives : 4Es:
 Engage
 Empathy
 Educate
 Enlist expectations
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26. Performance task can be done by the 5 step
CLASS system: (difficult med interview)
 Context
 Listening skills
 Acknowledgement
 Strategy
 Summary
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27. 1. Knock the door before
entry.
2. Walk in calmly and
confidently.
3. Shake hands with the
patient.
4. Smile every so often.
5. Introduce yourself .
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28. 6. Address the patient using first or last
name or general terms like Dada,
Bhaiya, Kaka, Kaki, Ajji, Ajobha.
7. Always sit down, lean forward and
let the patient also sit comfortably.
Have eye contact and a listening
ear.
8. Give the patient your complete
attention & chance to speak.
9. Use hand gestures to emphasise
points.
10. Use open ended questions.(tell me
what is happening, how can I help you)
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29. 11. Keep family in loop, especially
in disoriented, elderly, deaf
mute and unconscious patients.
12. Address on important issues.
13. Give patient a chance to ask.
Use more of “how” questions.
14. Be true, engaged and
connected till the end of
conversation.
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30. 15.Absolutely entertain the
patient for those few minutes
b’cos he has waited for hours
to see and hear you!
16.Let the conversation end
with a hope on both sides.(we
will work on this together, we will face it
together)
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31. 1. Enter unguarded in patients
room.
2. Walk in hurriedly.
3. Forget to greet/ shake hand
or say namaskar.
4. Have a grumpy face.
5. Address the patient as Ye, Tu,
Aree, O Bhai, Boss…
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32. 6. Stand and converse with the
patient or relatives.
7.Never sit with crossed hands.
8.Stare at the patient.
9.Ask closed ended questions or
“why” questions.
10.Continuously talk without a
listening ear.
11.Consider patient histories as
robotic set of tick boxes.
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33. 11. Using excessive technical
jargon.
12. Subtle body language.
13. Get engrossed in your
mobile/ computer work/
laptop while patient is talking
to you.
14. Interrupt the patient
15. Just disappear..
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34.  Anger is most often an outward expression of
fear, and recognising this can restore your
sense of compassion.
 Patients don’t care how much you know until
they know how much you care!
 Address them Early ,Effectively ,Effeciently
and Empathetically.
 Lot of emotions are built up in the room so
address their Feelings first.
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35.  Upset patients come in 2 flavors,
Obvious and Verbal Quiet and Seething
Iceberg - some frustration underneath
To de-escalate the tense situation,
REMAIN PROFESSIONAL AND ENGAGE IN ACTIVE LISTENING
1. You look really upset.{ Makes them feel clear}
2. Tell me about it. { Listening and feel heard and draw
cues}
3. Im so sorry that this is happening to you. {empathy}
4. What would you like me to do to help you? {Listen}
5. Heres what I like to do next. {suggest with confidence}
6. Thank you so much for sharing your feelings with me.
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36. 1. Honesty in
thought and
speech.
2. Consistency in
expression.
3. Clarity in
delivering the
message.
1. Facial expressions.
2. Body language.
3. Ability to listen to
others.
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37.  Never be formal with them. Discuss once or twice
a day.
 Talk about and appreciate the efforts made by
them.
 Most of attendants surf internet and gather lots
of information. Try to satisfy their queries by
giving better references.
 Always express the dynamic nature of disease.
 Second opinion should be sought proactively.
 Never express shock, try to convince that all
efforts are being made to get situation under
control.
 Consent taking is an important part of
counselling.
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38.  Junior doctors including postgraduate
students,fellows interns also the nursing and
supportive staffs are part of the team.
 Always keep them united and motivated.
 Follow these principles: Great courtesy should
be displayed to nurses, paramedical staffs
and other supporting staff.
 An effective team work improves the quality
of patient care and reduces workload among
healthcare professionals.
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39.  Lead by setting examples.
 Team will not work with full sincerity unless
and until they appreciate the hard work and
ability of doctor.
 Try to teach them basics and principles of
management of commonly encountered
diseases in your ward. This will keep them
motivated.
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40.  Never talk low about your colleagues or scold
residents, fellows or students in front of
patients or their attendants.
 Be cautious while asking questions to Jr
residents while on rounds. Patients may feel
insecure in absence of senior consultants who
may not be present at all times. This creates
a doubt in mind when these JR prescribe
drugs for common complaints.
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41. Surgeons and
Anaesthesiologists:
Need to communicate?
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42.  Surgeons and anaesthesiologists are
the key players in the operating room
aiming for a common goal, i.e safety
and good outcome for patient.
 Both of them behind the mask often
cannot read each others minds.
 Lack in quality communication causes
stress and in some situations may
affect patient outcome.
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43.  Natural reluctance to interrupt.
 Fear of embarrassment.
 Out right retribution.
 Concern about being misjudged.
 Simply not knowing what to say or
how to say it.
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44.  Infectious Diseases
 Environmental health
 Natural Disasters
 War
 Preventive treatment: working to control potential
epidemics they prevent disasters.
 Doctors have the standing and knowledge to push
back against fake medical news.
 Doctors are the only one voice among many that
shape public policy.
 They have an unique position of trust and
respect,which they can use to push governments
towards health care policies that will genuinely
benefit the public.
 Through interviews, chats and documentaries they
educate the public.
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45.  Love for medicine is love for Humanity!
 Effective Communication is the Heart and Art of
Medicine!
 Good doctor is a good communicator.
 It is crucial in building a trustworthy doctor patient
relationship that helps in providing holistic care,
therapeutic success and job satisfaction among
doctors.
 I hope this formal training in “Communication Skills”
today will definetely help you in your forthcoming
clinical endeavours.
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46. 1. D.Y.Patil Medical College AET-COM Sensitization Workshop
Module, October 2018.
2. D.Y.Patil Medical College,Revised Basic Course Workshop in
MET, Course Notes, October 2018.
3. How can Doctors improve their Communication Skills?
Piyush Ranjan, Archana Kumari and Avinash Chakrawarty
Journal of Clinical and Diagnostic Research 2015
March;9(3): JEO1-JEO4.
4. S Chatterjee, N Choudhary. Medical communication skills
training in the Indian setting: Need of the hour. Asian J
Transfus. Sci.2011;5:8-10.
5. A.K.Shukla, V S Yadav, N Kastury. Doctor-Patient
Communication: An Important but often ignored aspect in
Clinical medicine.JIACM.2010;11:208-11.
6. Doctors Strike:Latest News, Videos, Photos. Times of
India[Internet]2014 Oct 6. http://times of
india.indiatimes.com/topic/Doctors-strike.
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47. Thank you
for your patient listening !
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