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Therapeutic relationships and the illusion of communication
Lisa Roberts PhD MCSPArthritis Research UK Senior Lecturer in Physiotherapy / Consultant Physiotherapist
University Hospital Southampton
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Plan
• The challenge of communication
• Issues of truth telling
• Current research
• Opening clinical encounters
• Implications for practice
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Communication is …..
‘The most important aspect that health professionals have to master’
Weatherall (1998)
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Communication
Importance of:
• Verbal communication
• Non-verbal (55-97%)
• Patient-therapist relationship
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Poor communication
80% of patients’ complaints arise from a breakdown in communication
Towles BMJ;1998:301-4
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Non-specific treatment effect
• Touch
• Showing interest (Hawthorne effect)
• Professionalism
• Actively listening
• Environment
• Technical equipment
• Placebo effect ….
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The most important thing in communication is to hear what isn't being said.
Peter Drucker
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Why do we tell lies?
• To reduce fear • To tolerate stress • To gain control over uncertainty• Superstition • To enhance well-being • To protect privacy / confidentiality • To help others• To be malicious
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Physiotherapists’ perceptions…
…of the most important factors in successful treatment
• patient-therapist relationship
• patients’ resources
More important to success than treatment techniques
Stenmar & Nordholm. Physical Therapy 1994;74:1034-9.
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Aim of the pilot study
To measure the content and prevalence of the verbal and non-verbal communication that occur between physiotherapists and patients with low back pain in an outpatient setting.
Roberts L & Bucksey SJ. Communicating with patients: what happens in practice? Phys Ther 2007; 87: 586–94
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Roberts & Bucksey Physical Therapy 2007;87(5):586-94
Patients (n = 21) Physiotherapists (n = 7)
Video recording: Initial treatment session (n=21)
Key findings
1. Verbal & non-verbal communication can be measured with valid and reliable tools
2. Affective behaviours were more prevalent among experienced physiotherapists
3. Video camera was perceived to influence communication, planning and treatment
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Communication and clinical decision making in low back pain consultations
• Funded by Arthritis Research UK
• 'What communication and clinical decision making takes place in consultations between physiotherapists and people with back pain?'
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Patient interview
Home visit
Observation of initial back pain consultation
Physio interview
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Wessex Medical Research: Student Innovation Grant 2009
“Piloting an analysis of verbal communication using Synote in consultations between physiotherapists
and people with back pain.”
Christopher WhittleUniversity of Southampton
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Synote
http://www.synote.org/synote/
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Analysis
• Grounded theory approach
• Data managed through ‘Framework’
27 home visits 25 initial consultations 25 interviews with physiotherapists 25 interviews with patients
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Expectations data
• Knowledge:TechnicalLife
• Skills:TechnicalInterpersonal
• Personal attributes:AppearanceManner
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Opening questions
• ‘How can I help you today?’
• ‘Do you want to tell me your story’
• ‘I’ve had this referral through. Tell me what’s happened’
• ‘What problem are you having at the moment?’
• How long have you had back pain for?
• It’s your back pain that you’re here for is it?’
• The referral says you’ve got back pain. Is this correct?
• ‘What we’ll do today is just have a bit of a chat about your back pain I believe it is. All right?
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Clinical implications
• How do you open your clinical encounters?
• How often do you interrupt your patients?
• Do you tailor your communication to take account of gender and age?
• When was the last time you told a ‘little white lie’?
• Have you spent time evaluating your communication skills?
• How will you maximise your non-specific treatment effects?