Communication

1. Communication HINF 371 - Medical Methodologies Session 11

2. Objective • Understand the importance of communication in achieving better outcomes

3. Reading • Mar CD, Doust J, Glasziou (2006) Chapter 2: Communication in clinical care, health promotion and disease prevention, Blackwell Publishing and BMJ Books, USA • Redelmeier, DA; Schull, MJ; Hux, JE; Tu, JV; Ferris, LE (2001) Problems for clinical judgment: 1. Eliciting an insightful history of present illness, Canadian Medical Association Journal, Vol: 164, Issue: 5, p:647-652 • Redelmeier, DA; Tu, JV; Schull, MJ; Ferris, LE; Hux, JE (2001) Problems for clinical judgment: 1. Obtaining a reliable past medical history, Canadian Medical Association Journal, Vol: 164, Issue: 6, p:809-813 • Rob Buckman (1999) Communication Skills in Clinical Practice (video recording): a video guide

4. Tasks of Communication • Define the reasons for the patients’ attendance • Nature and history of the problem • Their etiology • The patient’s ideas, concerns and expectations • The effects of the problems • Consider other problems • Continuing problems • At-risk factors • Achieve a shared understanding of problems • Involve patients in choosing and implementing management • Encourage the taking responsibility for health • Use time and resources appropriately • Establish or maintain a relationship with the patients that helps to achieve these tasks Why did the patient come? What other medical problems can be dealt with? Can health promotion or disease preventions be offered? Can patient be made more self-sufficient?

5. Good Communication • = better two way understanding • Patient centred vs disease centred • Enablement= accepting patient preferences as face value • Listing their problems • Arranging them by priority • Deciding which problems need adressing in this consultation • Deciding if they had been met afterwards • Motivational interviewing: understanding patients agenda, ensuring it is clearly foremost, ye providing enough information to alter that agenda • Continuity • Safety Net: formal follow-up, explicit invitation, informal blanket invitation, implicit invitation

6. Ambigous language Libido, neoplasm, Leading questions Better= improved or normalized? Tacid Misunderstanding How questions are asked – sequencing How cultural norms impact Context of the question based on the responders perception Telescopic effects Estimating the past Estimating event frequency in the past Communication ErrorsComprehension PATIENT DRIVEN PHYSICIAN DRIVEN

7. Failure of Memory Technical details fade faster than emotional Provide ways to improve memory Diary Recording devices Agree on questions for next visit Write down key points Automative Shortcuts Complex question = estimated answer, gut feel False memories Events with strong memories remembered Embellishments Corroborate Inhibition of memory Weaker memories are suppressed by stronger ones Cues has the potential to cause distortions Communication ErrorsRecall PATIENT DRIVEN PHYSICIAN DRIVEN

8. Inconsistent Expectations People express emotions when discrepancy between expectations and perceptions Expansion of context is necessary Halo effects Reflecting emotions to the whole person or event Subjective evaluations are influenced by extragenous factors Extremes of success or failure Persistence of beliefs Communication ErrorsEvaluation PATIENT DRIVEN PHYSICIAN DRIVEN

9. Extraneous Distractions Room, positions Current mood Ignoble failures Discrimination Heart sink patients Self-expression Fear of embarrasment Embellish position Distortions to be percieved better Context dependency More stressful environment reduces the likelihood of remembering Communication ErrorsExpression PATIENT DRIVEN PHYSICIAN DRIVEN