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Communication for Anesthesiologists. Gordon MD 12 Nov 09. Anesthesiologists and Perioperative Communication Kopp, Vincent J. M.D. Shafer, Audrey M.D. Anesthesiology:August 2000 - Volume 93 - Issue 2 - pp 548-555.

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Anesthesiologists and Perioperative CommunicationKopp, Vincent J. M.D. Shafer, Audrey M.D.Anesthesiology:August 2000 - Volume 93 - Issue 2 - pp 548-555

  • Anesthesiologists, other health professionals, and patients communicate on multiple levelsevery day
  • Participate in activities involving complex social transactions with medical, legal, ethical, and personal significance
  • Good communication is as important to protecting professional integrity as it is to patient safety and satisfaction.
  • It is as important for anesthesiologists to pay attention to the structure and function of professional communication as it is to learn the pharmacokinetics and pharmacodynamics of drugs
slide3

Anesthesiologists and Perioperative CommunicationKopp, Vincent J. M.D. Shafer, Audrey M.D.Anesthesiology:August 2000 - Volume 93 - Issue 2 - pp 548-555

Clear, succinct, respectful communication is essential to working in the compressed time frame presented by anesthesia practice

Manners, habits, appearances, and interpersonal skills affect the impression the anesthesiologist makes on patients or other colleagues (non-verbal communication)

Becoming aware of one\'s individual patterns of language and behavior is the starting point for improved professional communication

slide4

Anesthesiologists and Perioperative CommunicationKopp, Vincent J. M.D. Shafer, Audrey M.D.Anesthesiology:August 2000 - Volume 93 - Issue 2 - pp 548-555

Communication and the Hippocratic Ethic

  • Patient submissive in need
  • Physician empowered by knowledge
  • With this power comes responsibility
  • Exercise power with tact and respect
  • To do no harm means to speak and act with restraint
slide5

Anesthesiologists and Perioperative CommunicationKopp, Vincent J. M.D. Shafer, Audrey M.D.Anesthesiology:August 2000 - Volume 93 - Issue 2 - pp 548-555

Intraop

  • Show respect for patient as sensate being
  • Communication of respect builds trust
  • Always speak as if the patient will remember
  • Peds induction: soft, hypnotizing tone plus gentle touch
slide6

Anesthesiologists and Perioperative CommunicationKopp, Vincent J. M.D. Shafer, Audrey M.D.Anesthesiology:August 2000 - Volume 93 - Issue 2 - pp 548-555

The “Captain Effect”

“It is probable that the tendency of some anesthesiologists not to bother or contradict surgeons, or the reluctance of some nurse anesthetists or residents to call their supervisors, has led to catastrophe…”

- Gaba

slide7

Anesthesiologists and Perioperative CommunicationKopp, Vincent J. M.D. Shafer, Audrey M.D.Anesthesiology:August 2000 - Volume 93 - Issue 2 - pp 548-555

Breaking Bad News

  • Face patient and/or family
  • Be honest and informative
  • Convey a sense of caring
  • Say “dead” and “died,” not “expired” or “passed away”
  • Poor communication skills increase litigious actions
  • Attention to physical setting
  • Formal introductions
  • Genuine reactions to survivors reactions and needs
  • Keep open channels for communication
  • Offers of appropriate social and clergy services
slide8

Anesthesiologists and Perioperative CommunicationKopp, Vincent J. M.D. Shafer, Audrey M.D.Anesthesiology:August 2000 - Volume 93 - Issue 2 - pp 548-555

Facility with a variety of communication skills signifies highly developed professionalism.

Literal meaning of “profession” = “speaking forth”

slide9
Assessment of Competency in AnesthesiologyJohn E. Tetzlaff M.D.Anesthesiology:April 2007 - Volume 106 - Issue 4 - pp 812-825

Outcome Project – General Competencies:

Interpersonal and Communication Skills

Residents must demonstrate interpersonal and communication skills resulting in effective information exchange and teaming with patients, and professional associates

slide10
Assessment of Competency in AnesthesiologyJohn E. Tetzlaff M.D.Anesthesiology:April 2007 - Volume 106 - Issue 4 - pp 812-825

Outcome Project – General Competencies:

Interpersonal and Communication Skills

Residents are expected to

  • Create and sustain a therapeutic and ethically sound relationship with patients
  • Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills
  • Work effectively with others as a member or leader of a healthcare team or other professional group
slide11
Assessment of Competency in AnesthesiologyJohn E. Tetzlaff M.D.Anesthesiology:April 2007 - Volume 106 - Issue 4 - pp 812-825

Outcome Project – General Competencies:

Interpersonal and Communication Skills

Assessment

  • The Objective Structured Clinical Examination (OSCE) is a reliable means of measuring communication skills
  • Case presentation a less demanding alternative than OSCE for measuring verbal communication
  • Mock orals also useful assessment tool
  • Properly structured peer review
slide12
Communication skills for anesthesiologistsAndrew F. Smith MRCVFRCA, Make P. Shelly FRCACAN J ANESTH 1999 / 46: 11 / pp 1082-1088
  • Gone are the days when newly-qualified but unpersonable doctors could be directed into anesthesiology on the grounds that this did not entail direct contact with patients
  • Poor communication is implicated in complaints by patients and medical misadventures, and bedevils professional

and personal relationships

can j anesth 1999 46 11 pp 1082 1088
CAN J ANESTH 1999 / 46: 11 / pp 1082-1088

Benefits of improved physician-patient communication

Patients

satisfaction

Staff

enhance our personal and professional self-esteem and

work satisfaction

Healthcare organizations

enhanced reputation

decreased litigation

can j anesth 1999 46 11 pp 1082 10881
CAN J ANESTH 1999 / 46: 11 / pp 1082-1088

Tools of the trade: communication skills

ESTABLISHING RAPPORT

a state of rapport occurs when one person

appreciates that another\'s world may be

different but tries to understand that world

empathy goes further; it implies entering the other\'s world, not just appreciating that it is different

can j anesth 1999 46 11 pp 1082 10882

Tools of the trade: communication skills

ESTABLISHING RAPPORT

CAN J ANESTH 1999 / 46: 11 / pp 1082-1088

non-verbal signals convey our attitudes and values to the patient even before a word is spoken

where verbal and non-verbal messages concerning interpersonal attitudes are

contradictory, observers tend to \'believe\'

the non-verbal one

it has been estimated that non-verbal elements carry most of our meaning, with only 7% of what we communicate contained in the actual words we speak

can j anesth 1999 46 11 pp 1082 10883

Tools of the trade: communication skills

ESTABLISHING RAPPORT

CAN J ANESTH 1999 / 46: 11 / pp 1082-1088

Nonverbal communication

Tone and volume of voice, intonation, emphasis, facial expression and gestures

Maintaining eye contact

Sit beside the patient, at their eye level or at an angle to them

Physical closeness and touch

Mirroring

can j anesth 1999 46 11 pp 1082 10884

Tools of the trade: communication skills

ESTABLISHING RAPPORT

CAN J ANESTH 1999 / 46: 11 / pp 1082-1088

Listening

Develop an attentive frame of mind

Focus attention outwards

Encouraging

“Have I got this right?”

Summarizing

Silence

can j anesth 1999 46 11 pp 1082 10885
CAN J ANESTH 1999 / 46: 11 / pp 1082-1088

Tools of the trade: communication skills

Asking Questions

To guide or prompt

Leading questions

Closed questions

Open questions

can j anesth 1999 46 11 pp 1082 10886

Tools of the trade: communication skills

Understanding a different model of the world

CAN J ANESTH 1999 / 46: 11 / pp 1082-1088

Acceptance of the patient\'s viewpoint is an important element in creating rapport

It is important to accept what people say as representing how they see the world, even if it comes across as threatening, bizarre or apparently stupid.

In the early stages of the conversation, the patient deserves to be listened to without hindrance.

can j anesth 1999 46 11 pp 1082 10887
CAN J ANESTH 1999 / 46: 11 / pp 1082-1088

Tools of the trade: communication skills

Developing self-awareness

Before you can help others, you need to be aware of yourself

Whatever your own feelings, it is important not to let them interfere with the job in hand

Reaching conclusions about the people we meet based on inadequate evidence can be unhelpful. We need to deal in facts, not assumptions.

can j anesth 1999 46 11 pp 1082 10888
CAN J ANESTH 1999 / 46: 11 / pp 1082-1088

Applying the skills: framework and specific tasks

Interview: \'a conversation with a purpose\'

Focusing on the purpose of the interview will help direct it

Remembering that even the simplest interview should have a

beginning,

a middle

and an end

provides structure

can j anesth 1999 46 11 pp 1082 10889
CAN J ANESTH 1999 / 46: 11 / pp 1082-1088

Applying the skills: framework and specific tasks

Beginning

Physical setting

comfortable

no interruptions

privacy

Plan and goals are essential

Introduction

Purpose

How long

“What have you learned so far?”

can j anesth 1999 46 11 pp 1082 108810

Applying the skills: framework and specific tasks

Middle – Getting down to the task at hand

CAN J ANESTH 1999 / 46: 11 / pp 1082-1088

Dealing with feelings

Fundamental: Acknowledge the feelings

One of the main reasons for trying to focus on the patient while listening to them is to help distinguish the patient\'s problems from the doctor\'s

can j anesth 1999 46 11 pp 1082 108811
CAN J ANESTH 1999 / 46: 11 / pp 1082-1088

Applying the skills: framework and specific tasks

Middle – Getting down to the task at hand

Dealing with feelings

Anger

Priority is to stay calm and not become angry

Acknowledge the anger

\'You are obviously feeling angry about this..’

Uncertainty

Anxiety

Frequent specific fears related to anesthesia:

waking up when should be asleep (awareness)

staying \'asleep\' when should be awake (death)

perception of loss of control

one study found that 45% of patients

admitted to concerns about the qualifications

of their anesthesiologist when asked directly

can j anesth 1999 46 11 pp 1082 108812
CAN J ANESTH 1999 / 46: 11 / pp 1082-1088

Applying the skills: framework and specific tasks

Middle – Getting down to the task at hand

Imparting information

ask the patient first what they already know

patient should be given time to react and

opportunities to ask questions

can j anesth 1999 46 11 pp 1082 108813

Applying the skills: framework and specific tasks

Middle – Getting down to the task at hand

CAN J ANESTH 1999 / 46: 11 / pp 1082-1088

Explaining complex concepts simply

Summary of the main points and then

more detail can be added as the patient wants

Jargon is a major communication barrier

Check understanding from time to time

can j anesth 1999 46 11 pp 1082 108814
CAN J ANESTH 1999 / 46: 11 / pp 1082-1088

Applying the skills: framework and specific tasks

Middle – Getting down to the task at hand

Breaking bad news

Allow emotions to be expressed

Acknowledge any distress

Explore concerns

“You seem upset.

Can you talk about what’s making

you feel like that?”

Deal with grief

can j anesth 1999 46 11 pp 1082 108815
CAN J ANESTH 1999 / 46: 11 / pp 1082-1088

Applying the skills: framework and specific tasks

Ending

Summarize

Check outcome satisfactory

“Good bye”

Follow up plan

Record

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