Clinician-PatientCommunication

Institute for Health Care Communication

Model of Clinical Care

Biomedical tasks

Find it

Fix it

Model of Clinical Care

Communication tasks

Engage

Empathize

Educate

Enlist

Model of Complete Clinical Care

Integrates Biomedical tasks

and

Communication tasks

ChallengeAccomplish Two Different Tasks

Clinicians have a voice, the voice of medicine

Patients have a voice, the voice of experience Meshier, 1984

Challenge: Patient’s voice

Patients want to tell the story of the illness

Patient are concerned with the personalmeaning of the illness

Patients seek a relationship based on trust

Challenge: Clinician’s voice

Clinicians want to obtain a history quickly

Clinicians ask close-ended questions to getthe facts

Clinicians construct a differential diagnosis

Opening

Introduce yourself

Greet the patient

Welcome the patient

Maintain eye contact

Engagement defined

A connection which continues throughout theencounter

Person-to-person

Professionally, as partners

Replace paternalism for respect of the patient’sautonomy

Barriers To Engagement

Inquiry or an inquisition?

Control?

Interruptions?

Complaints? Beckman & Frankel, 1984

Engagement Involves

Process: Engaging the person

Orient to the process of visit or care

Tasks: Engaging the agenda

Getting the story

Technique: Engage the person

Use the first few minutes to build rapport

Be curious about the person: work, family,developmental state, hobbies

Use a pleasant, consistent tone of voice

Technique: Orient to the Process ofVisitor Care

Ask why the patient is in the office

Attempt to see the situation from the eyes of thepatient

Explain every aspect of care

Technique: Engage the Patient’sAgenda

Elicit expectations or goals for the encounter

Get all complaints documented

Be thorough and systematically evaluate thepatients complaints

Technique: Summarize Agenda

List the patient’s issues

List your issues with the patient’s condition

Conflict will occur with

Inadequate assessment of relevant facts

Faulty perceptions of beliefs and attitudes of thepatient

Poor communication

Technique: Negotiate Agenda

Prioritize

Negotiate

Technique: Elicit patient’s story and becurious about

Feelings

Ideas

Impact on Functioning

Expectations Stewart et al, 1995

Technique Elicit Patient’s Story

Use open-ended questions

Allow the patient time to tell the story

Acknowledge the story

Use short summaries

Techniques: Bridge Between TwoVoices and Tasks

Translate between what you have heard andwhat the patient has said

Bridge between your voice and the patient’svoice

Funnel the story to the issues to be addressed Mishler, 984

Outcomes of Successful Engagement

Develop more accurate diagnosis

Have all the concerns

Increase likelihood of adherence to theregimen

Establish a partnership

Empathy defined

Patient experiences

Being seen

Being heard

Being accepted

Barriers to Making an EmpatheticConnection

Is this sympathy (my feeling) or empathy(patient’s feelings)

Will this take more time? The demand forservice limits empathetic connections andleads to conflict

Empathy can save time

Patients provide clues about their social andemotional concerns

When we have an inadequate understanding of relevantfacts, we cannot realistically assess relevant questionsabout values

When the clues are missed, patients repeat them

Visits with missed clues are longer by up to 3minutes

Levinson et al 2000

Techniques: Patient Experiences BeingSeen

See fully clothed new patients

Acknowledge

Facial and bodily expressions

Mode of dress and physical presentation

Notable physical characteristics

Eliminate physical barriers

Techniques: Patient Experiences BeingHeard

LISTEN to the story

Patient’s feelings

Patient’s values

Patient’s thoughts

Reflect on your understanding

Verbal

Nonverbal

Techniques: Patient Experiences BeingHeard

Use the patient’s language

Allow the patient to correct yourunderstanding

The best intentions go awry if clinicians lack theability to communicate understanding effectivelywith the patient.

Technique: Patient Experiences BeingAccepted

Judge the behavior, not the person

Normalize when possible

Use appropriate self-disclosure

Outcomes of Successful Empathy

Improved adherence

Increased level of connection and mutualsatisfaction

Reduced clinician frustration

Reduced patient anxiety

To see things genuinely through the eyes of thepatient is one of the most difficult insights toattain.

The End

You have completed a communication skillscourse that has identified a set ofcommunication skills requisite for developingexemplary professional behavior.