Medical Communication/counselingTraining for the “Trainers”

คณะแพทยศาสตร์ มหาวิ�ทยาลั�ยสงขลัานคร์�นทร์

17-18 ธั�นวิาคม 2558

What is counseling?

• The means by which one person helps another to clarify their life situation and to decide upon further lines of action.

• Two way communication• Make the counselee realized his/her

own situation• Help him/her to find the suitable

solution to cope/correct the problems

What is counseling?

So as Medicine, counseling is both art

and sciences

• Directive counseling• Advocacy counseling• Informative counseling• Supportive counseling

Riccardi VM, Kurtz SM. Communication and counseling in health care. Springfield. Illinois 1983.

Types of counseling

• AdviceCounselor : tells the best option

Counselee : expected to be compliance

Use : traditionally and currently in routine medical practice when a single option is clearly the best (or the least hazardous); emergency surgery

Directive counseling

• Facilitate an action based upon choicesCounselor : tells all available options

Counselee : exercises his/her own informed decision making process

Use : increasingly with more choices available and none may be better than the rest; cancer treatment options, amniocentesis, selective abortion

Advocacy counseling

• Relate factual data or explanation on how to do something without asking for decision

Counselor : explain only

Counselee : expected to comprehend

Use : telling the diagnosis, explaining about medications

Informative counseling

• Giving aid or feedback to assist in coping and realistic adaptation to a given situation

Counselor : listen and provide emotional support and compassion

Counselee : allowed to vent and adjust at his/her own pace

Use : at all time usually with bad news

Supportive counseling

Effective Counseling

Patients’problem

Knowledge Techniques

AttitudeAwareness

Characteristics

CounselorCounselor CounseleeCounseleeContent

Technique

Environment

Component of Counseling

Environment

Privacy

Avoid interruption

Adequate lighting and temperature

Consider the arrangement of seat

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• I. Attitude• II. Skills• III. Manner / charisma

Being a good counselor

AttitudeFaith

EmpathyOptimism

Realistic understandingUnbiased view

SkillsVerbal

Non-verbalCounseling technique

CharismaMaturity

PolitenessCourtesy

SensitivityRespect

CounselorCounselor CounseleeCounseleeContent

Technique

Environment

Component of Counseling

• Medicalinformationdiagnosis, burdenprognosisoptions• Psychological

normal coping mechanism help / service

Content

• Contents vary depending upon the types of counseling for each session / moment

• Consider how much to give and how many times “give small bites if you can”

• Frequently what you plan to do is not what is eventually done !

Content

• Keep in mind of the followings:- Always tell the truth- Use language patient understands- Prioritize what you will say

- Use wording that minimizes reaction but convey similar meaning- Give time period in range

Content

Effectiveness of counseling depends on- Basic/current knowledge about the

situation- Education- Beliefs/culture- Concern- Readiness to listen

Counselee

• Communication SkillsListeningObservingEncouragingQuestioningProbingSilencing

ReflectingParaphrasingRefraining

ReframingInterpretingClarifyingSummarizing

Techniques/Skills

• Questioning• Probing• Repeating (Reiterating)• Paraphrasing• Reflection (Interpreting)• Reframing• Summarizing• Encouraging

Verbal Non-Verbal

• Vocal quality• Speed of voice• Volume of voice• Listening• Silencing• Touching• Refraining• Interrupting• Observing• Facial expression