What can studying communication skills offer us as medical practitioners?

1. Communicationinmedicalpractice. Formationofthemedicalstaffanditsimpactontheeducationoftheindividual. Relationsbetweenthemedicalstaffofvariousunits.

2. What can studying communication skills offer us as medical practitioners? • Increased Job Satisfaction • Decreased Conflict Within The Consultation • More Accurate And Efficient Interviews • Better Clinical Hypothesis Generation • Increased Patient Satisfaction • Increased Patient Understanding And Recall • Improved Compliance And Disease Outcome • Decreased Medico Legal Complaints • Actual Savings In Time • More Structure And Control Of The Difficult Consultation

3. Treatment Outcome: • Effective diagnoses and treatment depends not only on identifying physical symptoms of illness, but also on the ability to detect and respond to verbal and non-verbal cues, to elicit all relevant information (physical and psychosocial), relevant to diagnoses and treatment. Patient’s Adherence: • A poor communication skill is related to poor compliance. Communication skill training has a positive influence on patient compliance with prescribed medication. Effective communication enables health professions to pass on relevant health information, and to motivate patient to pursue healthier lifestyle. This is a very important part on health promotion. • Competence & Self-Assertion: • Research has also shown that better communication can also contribute to the clinical professional and personality (self-confidence) aspects.

4. Patient’s Satisfaction. • Many researches have also shown a significant relationship between the clinician’s interpersonal skills and patient’s motivation and satisfaction. When the medical specialist dominates the interview, verbally and emotionally, the result is always leads to dissatisfaction of the patients and their relatives. This may also be related to the patient’s expectation. • Patient’s satisfaction plays a major role in assessing quality medical care in the newly adopted health system (manages care) in the USA. • CognitiveSatisfaction: Howsatisfiedisthepatientwiththeirunderstandingofthediagnoses, treatment, andprognoses. ThisisrelatedtotheVerbalBehavior. • EmotionalSatisfaction:Thisisrelatedtothenon-verbalbehavior. Theabilitytoshowcareandconcernbytoneofvoice, eyegaze, facialexpression, bodymovementandposture.

5. INTERVIEWING AND COMMUNICATION SKILLS CORE COMMUNICATION SKILLS: Core communication skills covers three dimensions: • interpersonal skills • Information gathering skills • Information giving skills and patient education Advanced Communication Skills • Skillsformotivatingpatientadherencetotreatmentplans • Otherapplicationsofcorecommunicationskillsinspecificsituations.

6. Information gathering skills • A criticalpartofallinteractionsinvolveselicitinginformationfrompatient. Thecoreskillswhichareneededtofacilitatetheprocessofinformationgatheringareskillswhichhelptofacilitatethepatients’involvementinthemedicalinterviewinawaythatenablestoarriveatanaccuratediagnosisof a patient’sproblemorsymptoms. • Usinganappropriatebalanceofopentoclosedquestions • Open questions invite an extended answer, not a “Yes/No” response. Generally questions such as “Please tell me about your pain” are better at eliciting information than closed questions such as “Is it a stabbing pain?”. Open questions are particularly useful patients are being asked to describe their problem; which they should be allowed to do minimal interruption early on in the consultation.

7. Silence • Youneedtolearntousesilenceappropriatelyas a waytoencourageexpressthemselvesmorefully, raisedifficulttopicsandrememberimportant Clarifyingpatientexpectationsabouttheconsultation • Youneedtoclarifywiththepatientwhattheirexpectationsareconsultation, andshouldavoidmakingprematureconclusionsaboutthereasonperson’svisittothepharmacist. Thismayhelpstorevealcaseswherethesymptomthepatientisnotinfactthepatient’smainconcern, andwillalsohelptoavoidinaccuratediagnosisofthepatient’scomplaints. Clarifyingtheinformationgivenbythepatient • Youneedtoclarifythemeaningofwhatthepatientissayingandthepharmacistperceivesfromthepatient’s non-verbalcommunicationinordertohe/sheunderstandsthepatientfully.

8. Sequencing of events • After eliciting a broad description of the patient’s situation, students need to help the patient to sequence events and experiences in order to develop a logical of the patient’s situation. Directing the flow of information • While it is important that patients be allowed the opportunity to communicate at the same time the student needs to learn to maintain control of the interview, by guiding the interview content towards a diagnosis of the problem. Summarizing • Since a lot of information can be exchanged in consultations, you should be able to summarize the main issues raised during the consultation and should ensure that a shared understanding of these.

9. Information giving skills and patient education • Themedicalinterviewusuallyinvolvesthepharmacistinprovidinginformationtothepatientabouttheirillnessorproblem, andwhenappropriatehe willgiveinformandadviseabouttheproposedtreatmentplanortreatmentoptions. • Providingclearandsimpleinformationbymonitoringjargon, andbycheckingthepatient’sunderstandingbefore (“Whatdoyouknowaboutasthma?”) andduring (“Have I mademyselfclear?”) theexplanationprocess. • Usingspecificadvicewithconcreteexamples.Abstractorgeneraladvice/informshouldbeexemplifiedintermsthatmakesensetothepatient “Don’tuseacidicfoodsforexamplesteerclearoffriedthings”. • Puttingimportantthingsfirst. Researchsuggeststhatwhatissaidfirstisremembered. A pharmacistshouldsayfirstwhatitismostimportantforthepatienttorecall

10. Usingrepetition. Repetitionshouldbeusedcarefullyto a levelappropriatetopatient. Oftenitisbesttorecycleinformationusingslightlydifferentwords, incasetheformulationhasbeenonlypartlyunderstood. • Summarizing. Thisisanimportant interview-closing skill (seeabove). Sumshouldbebrief, andrepeatthemainpointsagreedinlanguage, whichisunambiguousclear. Patientsmayalsobeinvitedtorepeattheinstructiontoensurethattheysharedunderstanding. • Categorizinginformationtoreducecomplexityandaidrecall. Wheretheinformationtobeconveyediscomplex, orwherethereis a lottobesaid, itshouldbeclearly b downintomanageableunitswhichareclearlysignaledtothepatient, usingmarkers s “therearethreethingsweneedtothinkabout ... firstly/secondly/thirdlyetc”.

11. Usingtools:Complexinformationcouldwellbeaccompaniedby a seriesofheadinganddiagrams. • Checking patient understanding of what has been said. Repeating instructions, using diagrams, written instructions, and sometimes-technical aids to explain difficult concepts are useful. The student must be competent in summarizing the information given and in checking patient understanding by asking the patient to repeat what heard and understood.

12. Skills for motivating patient adherence to treatment plans Thelistbelowincludesskillsforthepromotionofbehaviour. Realisticcompliancewithtreatmentplansmayrequirepatientstomakesignificantchangesintheirdiet, lifestyleordailyroutineon a shorttermorlongtermbasis. • Providing a rationaleforbehaviorchange • Providingexamplesofrolemodels • Allowingopportunitiesforverbalrehearsalofthedetailsofthetreatment • Feedback (positivereinforcementofconstructivebehaviourchangesalreadyachievedsinceearlierconsultations) Finally, pharmacistsshouldbeawareabouttheclincial, communicationandinterpersonalskillsthatarerequiredwhendealingwithdifficultpatients,(e.g., overdependent, dramatizingandexaggerating, aggressive, andantisocoialpersonalit.

13. Interpersonal skills • Appropriate physical environment • The need to establish an appropriate physical environment to enhance privacy and attentiveness. Small things like arranging seating in a manner which neither threatening nor distant, or having a curtain to create a sense of privacy will in outcome of the interview.

14. Interpersonal skills • Greetingpatientsin a manneracceptablewithintheculturalnormsinrelationtoage, sex. etc. willhelpmaintaintheirdignityandencouragetheirparticipation. • Activelisteninginvolvesusingbothverbaland non-verbalcommunicationtechniques. Thepharmacistshouldclearlysignalthatthepatienthashis/herfullattentionbylook, byofferingacceptanceandcontinuationsignalssuchasnods, phrasessuchas “right”/”I see” etc. A willingnesstolistenactivelyishoweverbestsignaledbyuseofopenquestionstopromotefulleranswer.

15. Empathy, respect, interest, warmth and support • Theseissuesareattheheartofinterpersonalskills. Theycannoteasilybefaked, andifpharmacistdonothavethem, theycannoteasilybetaughtthingstodobywayofthem. Successinthisareaisnota matterofskillsbutofattitude. • However, healthpractitionersshouldclearlysignaltheirinterestinhowthepatient’sproblemisperceived, whetheritconcernsthem, whattheirhopesandexpectationsare.

16. Empathy, respect, interest, warmth and support • Pharmacist shouldaskquestionstodiscoverpatientperception “Doesthethoughtoftheoperationworryyou?”. • Thepharmacistshouldalsolearntoshowrespect, interest, warmthandsupport. Thiswillalsoinvolvebeing non-judgmentalinattitude. • THESE ARE THE CORE FACTORS IN RAPPORT BUILDING.

17. Ethics • Ethics are rules for behavior, based on beliefs abouthow things should be. Ethical statements involve: • 1) assumptionsabout humans and their capacities; • 2) logicalrules extending from these assumptions; • 3) notionsof what is good and desirable. • Ethical systems (sets of rules for acceptable behavior)concern the “shoulds” and “should nots” of life, the principlesand values on which human relations are based.

18. The assessment of whether a behavior is ethical • The assessment of whether a behavior is ethical is dividedinto four categories, or domains: consequences, actions,character, and motive. • In the domain of consequences,a behavior is determined to be “right” or“wrong” based on the results of the action, whereas thedomain of actions looks only at the act itself. • The domainof character looks at whether a person’s overall characteris ethical; a person who is deemed as “virtuous” has consistentlyethical behavior. • The motive domain evaluates aperson’s intentions, regardless of the consequences.

19. Language • Avoidmedicaljargon. Youshouldconsidertheeducationalculturalanddevelopmentallevelofthepatiente.g., “ Youhavegotappendicitis” isappropriateformostadultsbutnotyoungchildrenetc),. Itisalsoimportantforpharmacists tomonitortheiruseofpotentiallyfrighteningwords “Cancer”/”lump” etc. • Non-verbal communication • Skills in non-verbal communication like eye contact, physical proximity, and facial expression need to be improved to enhance patient’s satisfaction and adherence to treatment. This should convey to the patient that the Health practitioner is attentive and interested.

20. Avoid Overreacting • Some patients may appear demanding, dependent or even at times, adversarial. It is the physician's responsibility to not overreact to these situations. • This can be achieved by establishing limitations (boundaries) on what can be provided and suggesting appropriate ways for the patients to contact them.

21. Establishing Boundaries • Frequent phone calls, unscheduled visits, and unrealistic expectations, are ways in which some patients lose perspective of the shared responsibility of their care. • Pharmacists need to establish boundaries for patients in a way that doesn't belittle them.

22. Closing the interview • In addition to the skills of setting up, beginning and continuing an interview, the way of closing the interview is also important. The pharmacist should clearly signal that the interview is drawing to a close, usually by summarizing what has been said and what has been negotiated. • Basictointerpersonalskillsistoconsidertheimportanceofsuchfactorsasgender, culturalandsocioeconomicfactors, whichcouldgreatlyaffectperceptionsofnormsandstandardsofappropriatecommunication.

23. Closing the interview • It is also essential for all practitioners to realize that what is needed is not only to know how to recognize a disease, but also how to recognize and to respond to a patient’semotional response to their disease. • In their interactions with patients, it is important for the clinicians to be aware of patients’ emotional responses to their situation and at the same -aware of their own emotional reactions toward the patients.