def process of communication types barriers ......etc

1. Communication
Skills
by
Dr. Mona M Aboserea
Professor of Public Health &
Community Medicine

2. Contents
 Communication skills
 Consultation
 Counselling
 Breaking bad news
 Quizzes

3. Concepts
 What is communication?
The process in which feelings or ideas are
expressed as messages sent , received and
comprehended .
It should be dynamic , continuous
and reciprocal .
 Once you send it, it is
irreversible (non erasable).

4. Why is Communication Important?

5. The Communication Process Model

7. Principles of communication
1. Listening
2. Probing
3. Observing
4. Informing

8. Listening
 Focus your attention: Avoid barriers
 Show that you are listening
 Understand ideas and pick words
 Retain information (memory, notes)
 Give your feedback

9. Probing
 What clients think
 Encourage clients to talk: tell them that
you are really listening and want to hear
more
 Ask open questions
 Keep privacy

10. Observing
Non verbal communication:
 Facial expression
 Voice tone
 Body language

11. Informing
 In a clear, correct, concise and complete
way
 Consider the needs, language and
obstacles
 summing
 Check back with the speaker to ensure
that the statement is accurate

12. Means of communication
1. Verbal: written or spoken
2. Non verbal: any thing except words:
 Body movement
 Posture: way of setting, standing
 Gesture: movement of hands, legs, arms
 Facial expression, eye contact
 Space
 Touch
 Paralanguage: mmm

13. Means of communication

14. Barriers to communication
ReceiverSender
Distortion
Feedback

15. Sender (Speaker)
 Personal appearance
 Gender Differences
 Language differences
 Psychological barriers: stress, frustration,
anger, tiredness
 Cannot communicate the message

16. Receiver (Listener)
 Personal
 Physiological
 Psychological
 language

17.  Unclear, confusing
 Difficult words
 Not interesting to the receiver
Message

18. Channel
 Noise
 Not accessible to the receptor

19. Effective communication
 Avoid Barriers to Communication.
 Send Understandable Messages:
Effective communication.
 Actively Listen.
 Utilize Non-verbal Signals.
 Try multiple channels

20.  How do you know that your
communication was effective?
 Feedback
 Your message affect other people:
start to change behavior
 Had effect on the whole community

21. Consultation and
counseling
 Consultation: a process of a dialogue
that leads to a decision
 Counseling: helping a person or a group
of people to develop self help

22. Consultation Models
Bad consultations result from
 having insufficient clinical knowledge,
 failing to relate to patients or
 failing to understand the patient's
behaviour, his perception of his illness
or its context

23. Consultation
 A process in which the counselor works
with (parent, teacher, administrator) with
the goal of positive change in the child
 Voluntary problem-solving process with
goals of enhanced services and improved
functioning

24. Individual Consultation

25. Individual Consultation

26. Group Consultation

27. Triad of Consultation
Consultee
Client System
Consultant
The triadic relationship in consultation

28. Consultation
After each consultation session five things
must be established:
1. Discover the reasons of patient attendance
2. Define clinical problem (HPT, DM)
3. Address the patient’s problem (details)
4. Explain the problem to the patient
5. Make effective use of the consultation

29. The Consulting Process
1. Pre-entry
Look at oneself to see if you are right for the
task and services to be provided
2. Entry, problem exploration and contracting
learn about needs, presenting problem, people
involved, previous interventions, and
expectations of seeker

30. The Consulting Process (Cont.)
3. Diagnosis stage
Information gathering, problem confirmation,
goal setting, and potential interventions
4. Solution searching and intervention selection
avoid favorite paradigm
consider human and structural factors

31. The Consulting Process (Cont.)
5. Evaluation
 Ensures professional effectiveness
 Were goals achieved?
 Did interventions work?
6. Termination
 Describe what was and was not successful
 Look for areas of improvement

32. Initiating the Session
Gathering Information
Explanation and Planning
Closing the Session
BuildingtheRelationship
AttendingtoTask
Expanded Framework

33. Providing
Structure
Initiating the Session
preparation
establishing initial rapport
identifying the reason(s) for the consultation
providing the correct amount and type of information
aiding accurate recall and understanding
achieving a shared understanding: incorporating the patient’s
illness framework
planning: shared decision making
Closing the Session
Building the
relationship
•
•
•
•
•
•
•
•
•
•
Gathering information
Physical examination
Explanation and planning
making
organisation
overt
attending to
flow
• exploration of the patient’s problems to discover the:
biomedical perspective the patient’s perspective
background information - context
• ensuring appropriate point of closure
• forward planning
using
appropriate
non-verbal
behaviour
developing
rapport
involving
the patient
•
•

35. Consultation Styles
 doctor-centred
 dominates the consultation
 asks direct, closed questions
 rejects the patient's ideas
 evades the patient's questions
 patient-centred
 asks open questions
 actively listens
 challenges and reflects the patients' words and
behaviour to allow them to express themselves in
their own way

36. CounselingCounseling
Preparing a counseling sessionPreparing a counseling session
Physical setting
Timing
Interpersonal space

37. 1. Physical setting
 Privacy: in a quiet, calm and no
interruption
 Proper lightening and temperature.
2. Timing
 45-60 minutes

38. 3. Interpersonal space
 4-9 feet (1 feet=30.4cm)
D
 D
P D P P
(×) (√) (√)

39. Counseling,
Consultation, communication process
 Initiating the session
 Gathering Information
 Building Relationship
 Explanation and Planning
 Closing the sessions

40. Initiating the session
a) Establishing Initial Rapport‫ةةةةة‬ :
-Greets the patient and obtains name.
-Introduce self, role and nature of interview.
-Demonstrate respect and interest.
b) Identifying reasons for the consultation:
-Identifies patient’s problems using opening question.
-Listens attentively to patient’s opening statement without
interrupting.
-Confirms lists and screens for further problems.
-Negotiates agenda taking and doctor’s needs into
account.

41. Gathering Information
Exploration of patient’s problem:
-Encourages patient to tell the story.
-Uses open and closed questioning technique.
-Listen attentively.
-Facilitates patient’s responses.
-Clarifies patient’s statements.
-Periodically summarizes.
-Uses concise, easily understood questions.
-Establishes dates and sequence of events.

42. Building Relationship
a) Using appropriate non-verbal behavior:
-Demonstrate appropriate non-verbal behavior (eye contact,
posture, vocal cues).
-Demonstrate confidence.
b) Developing rapport:
-Accepts patient’s views and feelings.
-Provides support.
-Deals sensitively with embarrassing and disturbing topics.
c) Involving the patient:
-Shares thinking.
-Explains rationale.
-Asks permission and Explains process during physical examination.

43. Explanation and Planning
a) Providing the correct amount and type of information:
-Assesses patient’s starting point (prior knowledge).
-Asks patients what other information does he needs and would be helpful.
-Give explanation at appropriate time.
b) Aiding recall and understanding:
-Organizes explanation.
-Uses explicit categorization.
-Uses easily understood language.
-Uses visual methods of conveying information.
-Checks patient’s understanding.
c) Achieving a shared understanding: incorporating the
patient’s perspective:
-Relates explanations to patient’s illness framework.
-Provides opportunities and encourages patients to contribute.
-Picks up verbal and non-verbal cues.
-Elicits patient’s beliefs, reactions and feelings.

44. d) Planning: shared decision making:
-Shares thinking.
-Involves patient.
-Encourage patient to contribute his
thoughts.
-Negotiate acceptable plan.
-Offers choices.
-Checks with patients if he accepts plans
and if his concerns have been addressed.

45. Closing the sessions
a) Forward planning:
-Contracts with patients next steps.
-Explain possible unexpected outcomes.
b) Ensuring appropriate point of closure:
-Summarizes session briefly and clarifies plan of
care.
-Final check that patient is satisfied, comfortable
with plan.

46. Breaking Bad News
 A difficult but fundamentally important
task for all health care professionals
 Physicians feel uncertain & uncomfortable
while breaking bad news, leading to being
distant & disengaged from their patients.

47. Delivering Bad News
Rabow & Mcphee (West J. Med 1999) synthesized a
simple model of ABCDE:
 Advance Preparation
 Build a therapeutic environment/relationship
 Communicate well
 Deal with patient & family reactions
 Encourage and validate emotions

48. Advance Preparation
 Familiarize yourself with the relevant clinical
information (investigations, hospital report)
 Arrange for adequate time in private, comfortable
environment
 Instruct staff not to interrupt
 Be prepared to provide at least basic information
about prognosis and treatment options (so do read it

49. Advance Preparation
 Mentally rehearse how you will deliver the news.
You may wish to practice out loud
 Script specific words & phrases to use or to
avoid
 Be prepared emotionally

50. Build a therapeutic
environment/relationship
 Introduce yourself to everyone present
 Summarise where things have got to date, check with
patient/relative
Discover what has happened since last seen
Judge how the patient is feeling/thinking
Determine the patient’s preferences for what and how
much he/she wants to know

51. Build a therapeutic environment/relationship
(contd)
 Warning shot “I’m afraid it looks more serious
than we had hoped”
 Use touch where appropriate
 Pay attention to verbal & non verbal cues
Avoid inappropriate humour
 Assure patient that you will be available

52. Communicate well
 Speak frankly but compassionately
 Avoid medical jargon
 Allow silence & tears; proceed at patient’s pace
 Have the patient describe his/her understanding of the
information given
 Encourage questions
 Write things down & provide written information
 Conclude each visit with a summary & follow up plan

53. Deal with patient and family reactions
 Assess & respond to emotional reactions
 Be aware of cognitive coping (denial, blame, guilt,
disbelief, acceptance, intellectualization)
 Allow for “shut down”, when patient turns off & stops
listening
 Be empathetic; it is appropriate to say “I’m sorry or I
don’t know. Crying may be appropriate
 Don’t argue or criticize colleagues

54. Encourage and validate emotions
 Offer realistic hope
 Give adequate information to facilitate decision
making
 Explore what the news means to the patient &
inquire about spiritual needs
 Inquire about the support systems in place

55. Encourage and validate emotions
 Attend to your own needs during and following the
delivery of bad news (counter-transference can be
harmful)
 Use multidisciplinary services to enhance patient care
( hospice)
 Formal or informal debriefing session with concerned
team members may be appropriate

56. What to do?
 Introduce yourself
 Look to comfort and privacy
 Determine what the patient already knows
 Warn the patient that bad news is coming
 Break the Bad News
 Identify the patient’s main concern
 Summarize and check understanding
 Offer realistic hope
 Arrange follow up and make sure that some one

57. How to do it?
 Be sensitive
 Be empathic and consider appropriate touching
 Maintain eye contact
 Give information in small chunks
 Repeat and clarify
 Regularly check understanding
 Do not be afraid of silence or tears
 Explore patient’s emotions and give him time
to respond
 Be honest if you are unsure about something

58. What not to do?
 Hurry
 Give all the information in one go
 Give too much information
 Use medical jargon or unclear language/words
 Lie or be economical with the truth
 Be blunt. Words can be like loaded pistols/guns
 Guess the prognosis (She has got 6 months, may
be 7)

59. Quotation
 The greatest revolution of our generation is the discovery
that human beings, by changing the inner attitudes of
their minds , can change the outer aspects of their lives.
William James
American Psychologist & Philosopher

60. Angry Patient
WHAT TO DO?
 Introduce yourself
 Acknowledge the person’s anger
 Try to find out the reason for his anger, e.g.
frustration, fear or guilt
 Validate his feelings
 Let him ventilate his anger or any feelings that
led to his anger
 Offer to do something or for him to do something

61. Angry Patient
HOW TO DO IT?
 Sit at the same level as the patient, not too close
and not too far, with eye contact
 Speak calmly without raising your voice
 Avoid dismissive or threatening body language
 Encourage the person to speak with open ended
questions
 Empathize as much as you can with verbal and
non verbal cues
 Be aware of your own safety

62. Angry patient
WHAT NOT TO DO?
 Glare at the person
 Confront him or interrupt him
 Patronize him or touch him
 Put the blame on others/seek to exonerate
yourself
 Make unreasonable promises
 Block his exit
 If the person is a patient’s relative, be mindful
about confidentiality

63. Quizzes
 Explain two other models of breaking bad
news? With illustration by examples?
 How to use communication skills in taking
history from anxious patient?
 Differentiate between counselling &
consultation?

64. SCENARIO 1
Sameh, a 55-year-old chain smoker taxi driver with
persistent cough for 3 months, attends your clinic to find out
the biopsy report of a lesion shown on a chest x-ray and CT
scan. He is rather anxious, that he has a serious condition.
His biopsy report confirms that he has a Bronchogenic
Carcinoma of right lung.
You are required to proceed with this consultation.

65. Scenario2
 A 44-year-old woman attends your clinic to find
out the result of an MRI of her spine. She has
had constant pain all over her spine for the last 2
months. She also has a history of Breast cancer,
which was treated 5 years ago.
 Her report shows that she has secondaries all
over her spine
Proceed with this consultation.
(Examination not required)

66. Summary

67. A FORMULA FOR SUCCESS
FLUENCY SKILLS
+
COUNSELING
+
TEACHING RESPONSIBILITY
=
EFFECTIVE THERAPY

68. Thank You