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Communication Skills in Between Doctor and Patient and Breaking the bad news
- 1. COMMUNICATION SKILLS ( Patient Counselling & Breaking the bad news)
- 2. COMMUNICATION SKILLS ( Patient Counselling & Breaking the bad news)
- 3. Orindom Shing Pulock COMMUNICATION SKILLS ( Patient Counselling & Breaking the bad news) Introduction Communication Gap
- 4. Who are We? Professional who Practices Medicine promoting, maintaining, or restoring health study, diagnosis, prognosis and treatment Doctor
- 5. Doctors Represented By Regulated By International Code of Medical Ethics
- 6. Doctors Declaration of Geneva The Modern Hippocratic Oath Geneva, Switzerland 2nd Assembly of WMA 1948 1968 1983 1994 2005 2006
- 7. Doctors The Health and Well Being of My Patient will be my first concern
- 8. Components of Health Doctor Health ProfessionalsHealth Physical Social Emotional Spiritual Intellectual Environmental
- 9. Medical Care in health outcome 20%Medical Care Only 20% of our Health outcomes in depends on Medical Care
- 10. Are we facing a sensitization process? Emotionless Disease Professional
- 11. Quote “The greatest mistake in the treatment of diseases is that, there is the physician for the body and physicians for the soul. Although the two cannot be separated.” - Plato, 500 BC
- 12. What do patients want to be Satisfied? • The doctor has to be seen as humane • Technically competent • Interested in psychosocial aspects • And the provision of Medicine
- 13. What do you need to be Happy? Navigating the specific resources can improve the blood pressure and cholesterol level Same as introducing a newer drug without any side effects
- 14. Treatment adherence in proper counselling 33% 40% Increase adherence to treatment in proper counselling
- 15. From the view point of a Patient? We think, we are doing our best, But, there is a lot that we could be doing better
- 17. Anika Nahrin COMMUNICATION SKILLS ( Patient Counselling & Breaking the bad news) Definition of Communication Components of Communication Importance of Communication
- 18. “communicare” or “communis” The sense of sharing is inherent in the very origin and meaning of “communication” Origin “to impart”, “to participate”, “to share” or “to make common”
- 19. The process of passing information and understanding from one person to another It is essentially a bridge of meaning between the people By using this bridge, a person can safely cross the river of misunderstanding @Keith Davis What is Communication?
- 20. Communication is an exchange of ideas, facts, opinions or emotions of two or more persons. What is Communication? @WilliamNewmanandCharlesSummer:
- 21. Candid Clear Complete Concise Concrete Correct Courteous A Communication Process Should be
- 22. Components of Communications VERBAL Use of sounds and words to express yourself NON VERBAL Facial expressions, the tone and pitch of the voice, gestures displayed through body language and the physical distance between the communicators WRITTEN Email, Internet websites, Letters, Proposals, Telegrams, Faxes, Postcards, Contracts
- 23. Non verbal is the first thing our mind reads before a word is even spoke Components of Communications The most important thing in communication is Hearing What Isn’t Said
- 24. Importance of Communication Skills 1 Stronger decision-making and problem-solving 2 Increased productivity 1 Stronger decision-making and problem-solving 3 Convincing, compelling and clearer results 2 Increased productivity 4 Enhanced professional image Convincing, compelling and clearer results3 5 Sound relationship 4 Enhanced professional image 6 Ensured successful response 5 Sound relationship
- 25. Essentials of Effective Communication A common communication environmentA common communication environment Cooperation between the sender and the receiverCooperation between the sender and the receiver Selection of an appropriate channelSelection of an appropriate channel Correct interpretation of the messageCorrect interpretation of the message Receiving the desired response and feedback
- 26. Positive feedback occurs when the receiver receives the desired response based on a clear understanding Negative feedback occurs when there is an undesired response because of miscommunication In some cases, not getting feedback is also a sort of feedback. For instance, complete silence on the part of the receiver is also an indicator of either effective communication (agreement) or a failure on the part of the communicator (inability to understand, dissent). Types of Feedback
- 27. Musfika Iffat COMMUNICATION SKILLS ( Patient Counselling & Breaking the bad news) Communication in Doctor Patient Relationship How to Communicate
- 28. Integrated Teaching Programme Department of Surgery C1 Batch, 57th MBBS, Chattogram Medical College
- 29. “A safe doctor is a good doctor” Communication in Doctor-Patient Relationship Comprehensive treatment of the patient Patient satisfaction Comprehensive treatment of the patient Patient satisfaction Improved complianceImproved compliance Improved health outcomeImproved health outcome Patient’s safetyPatient’s safety Doctor’s safety
- 30. How to Communicate Listen Make him feel you listen Understand Make sure you understand Respond Make sure he is listening Make sure he understands His response
- 31. Listening The biggest communication problem is, we do not listen to Understand We listen to reply “ ”
- 32. Listening – making Eye Contact Eye contact is more intimatethan words will ever be
- 33. Listening – total Attention
- 34. Interpretation and Understanding My doctor told me today I need to watch my drinking now I drink in front of a mirror
- 35. Video communication Integrated Teaching Programme Department of Surgery C1 Batch, 57th MBBS, Chattogram Medical College
- 36. Avilash Dhar Suva COMMUNICATION SKILLS ( Patient Counselling & Breaking the bad news) Basic Elements of Counselling Counselling regarding disease Counselling regarding Treatment
- 37. Basic Elements of counseling in b/w Doctor and Patient Regarding Disease Regarding Treatment ©Amita,A.etal.,2015,IJIPLS
- 38. Counseling regarding disease Explaining the Nature of the disease Explaining the Chronicity of the disease Supply Information sheets (e.g. Leaflets) Providing Diet chart Providing Awareness about the disease Complication Explaining management of emergency condition Making the family members aware about the condition
- 39. Counseling regarding treatment Explaining about the dose, dosage and timing Explaining the Side Effects of the Medication Steps after missed dose Risks of Treatment Failure Warning about drug interaction Adjustment according to comorbid condition Lifestyle and dietary modification
- 40. Integrated Teaching Programme Department of Surgery C1 Batch, 57th MBBS, Chattogram Medical College
- 41. Postoperative Counselling A 40 years old patient X diagnosed with Cholecystitis yesterday had Cholecystectomy, Her attending Dr. is now visiting her in the Post- operative ward
- 42. Postoperative Counselling A 40 years old patient X diagnosed with Cholecystitis yesterday had Cholecystectomy, Her attending Dr. is now visiting her in the Post- operative ward Doctor Y: How do you feel now? I feel pain doctor and I'm so weak: Patient X : Don’t worry, you’ll feel better soon, hopefully, so here is a diet chart I'm going to provide for you, Please avoid fried or fatty food for at least a week, even after that , you should eat low fat and high dietary fiber containing foods like oats, scrambled eggs, vegetables and fruits Okay doctor, can you suggest me some : medication for pain? Doctor Y: : Patient X
- 43. Postoperative Counselling A 40 years old patient X diagnosed with Cholecystitis yesterday had Cholecystectomy, Her attending Dr. is now visiting her in the Post- operative ward Doctor Y: How do you feel now? I feel pain doctor and I'm so weak: Patient X : Don’t worry, you’ll feel better soon, hopefully, so here is a diet chart I'm going to provide for you, Please avoid fried or fatty food for at least a week, even after that , you should eat low fat and high dietary fiber containing foods like oats, scrambled eggs, vegetables and fruits Okay doctor, can you suggest me some : medication for pain? Doctor Y: : Patient X Doctor Y: Sure! I have prescribed you some painkillers, take them when you feel excessive pain and if you ever suddenly suffer from fever or bleeding please immediately come to the hospital I understand. When can I take off the bandage? : Patient X Doctor Y: Come after two weeks for a follow up. I have written the date in your discharge paper. Hopefully, everything will be fine soon. Take Care. Thank you so much doctor!: Patient X
- 44. Preoperative Counselling A 35 years old female patient diagnosed with cervical cancer came to the OPD and discussing about the further treatment plan
- 45. Preoperative Counselling Doctor : Hello, Please have a seat. Hello Doctor : Patient Thank You : Patient Doctor : Have you brought the reports of yours? Yes, Doctor. I have just collected them this morning. Please have a look : Patient Doctor : [After seeing the reports] I have some bad news for you. Do you have any company right now? No, but you can tell me. It’s alright : Patient
- 46. Preoperative Counselling Doctor : Your reports suggest that you have cervical cancer in an very advanced stage I’m afraid. And I believe a surgery is needed as early as possible Doctor : In this surgery, we have to remove your ovaries, uterus and cervix. It is called radic- al hysterectomy Is there any complications? : Patient Doctor : Yes, I’m afraid there are. But first I want to know, is your family complete? [Begins to cry] What kind of surgery, doctor? : Patient
- 47. Preoperative Counselling Doctor : Well! I’m afraid that you won’t be able to conceive after this surgery. There are other complications too. Your menstruation will stop and you’ll experience some symptoms like hot flushes, vaginal dryness, irritability after the surgery Doctor : We hope so. But, there is a slight possibility that there may be further spread. That’s why after surgery you have to come to follow up routinely I have a daughter. And for last one year me and my husband are trying to conceive : Patient Will I be cured after that? : Patient
- 48. Preoperative Counselling Doctor : I’m sorry, there isn’t. I think you should consult with your husband and let me know the result Is there any other way out, doctor?: Patient
- 49. Nowrin Jahan COMMUNICATION SKILLS ( Patient Counselling & Breaking the bad news) Breaking the bad news Emotional Responses Approaches
- 50. Breaking Bad News Any information which adversely and seriously affects an Individual’s view of his or her Future
- 51. Unfavorable Diagnosis Irreversible, Un-treatable, non-stoppable disease Disease Recurrence Spread of Disease Revealing the positive result of a genetic test Stigmatization Late (to treat) stage disease End of life decision Death What are the Bad News
- 52. Emotional response to Bad News Denial Despair Anger Bargaining Depression Acceptance
- 53. Practical Approaches to Bad News Setting and Listening Skills Patient Perception Invitation to Give Information Knowledge Explore Emotions and Empathize Strategy and Summarize Advance preparation Build environment/ Relationship Communicate well Deal with reactions Encourage and validate emotions Background Rapport Explore Announce Kindling Summarize SPIKES ABCDE BREAKS
- 54. Practical Approaches to Bad News Advance preparation Build environment/ Relationship Communicate well Deal with reactions Encourage and validate emotions Background Rapport Explore Announce Kindling Summarize Setting and Listening Skills Patient Perception Invitation to Give Information Knowledge Explore Emotions and Empathize Strategy and Summarize SPIKES ABCDE BREAKS
- 55. Practical Approaches to Bad News Setting and Listening Skills Patient Perception Invitation to Give Information Knowledge Explore Emotions and Empathize Strategy and Summarize Background Rapport Explore Announce Kindling Summarize SPIKES Advance preparation Build environment/ Relationship Communicate well Deal with reactions Encourage and validate emotions ABCDE BREAKS
- 56. Practical Approaches to Bad News Setting and Listening Skills Patient Perception Invitation to Give Information Knowledge Explore Emotions and Empathize Strategy and Summarize Advance preparation Build environment/ Relationship Communicate well Deal with reactions Encourage and validate emotions SPIKES ABCDE Background Rapport Explore Announce Kindling Summarize BREAKS
- 57. Tajkia Mostafa Khadem COMMUNICATION SKILLS ( Patient Counselling & Breaking the bad news) SPIKES Common pitfalls Suggestions
- 58. Knowledge Place Time Company Listening Skills Introduction Physical Context Setting And Listening Skills S - Setting and Listening Skills
- 59. P – Patients’ perception Explore Emotions and Empathize Listen Query Acceptance
- 60. I – Invitation to give Information Ask about details Patients’ right Offer Further query
- 61. K - Knowledge Knowledge Identification Patients’ understanding Physicians’ understanding Provide Facts Positive aspects Response
- 62. E – Explore emotion and Empathize Explore Emotions and Empathize Identification Source Response Degree of Empathy
- 63. S - Strategy and Summarize Closing Clarification Offer agenda
- 64. Video Counselling Integrated Teaching Programme Department of Surgery C1 Batch, 57th MBBS, Chattogram Medical College
- 65. Physicians’ response to Reaction What do you do in an Unfavorable Situation?
- 66. If patient begins to Cry Allow some time to CRY I can see You’re very UPSET Touch the patient APPROPRIATELY After few moments Continue talking, even if patient continue to Cry
- 67. Ask about details Defensiveness Or Irritation With patient is Unhelpful Acknowledge Patients’ position If patient becomes Angry
- 68. If the patient is in Denial Explore Reasons and avoid Combat Check Understanding of patient Give time To Adjust Appreciate Information Gap and Educate Empathize Involve Family Members
- 69. Discussing Prognosis Identify Patients’ Concern Be Realistic Avoid giving specific time of survival Provide examples for what patient can hope Ensure painless symptomatic treatment
- 70. Common Pitfalls Inadequate time/ Information Failure to elicit patients’ understanding of situation Giving news at doctors’ speed Not allowing time for responses False reassurances about the future Allowing denial to remain Removing all hope
- 71. Suggestions “Shots scored 14.5 -21.5%” @ LaLiga, UCL 2017-18, WC 2018
- 72. Suggestions “Mistakes are Inevitable” “Doctors make mistakes, But why don’t we talk about it?”
- 73. “Look, don’t make the same mistakes I did” Suggestions “Redefined Medical Culture”
- 74. Suggestions “Patients’ will never care, how much you know, until, they know how much you care”