Beruflich Dokumente
Kultur Dokumente
Communication 2016
~ INTRODUCTION ~
Good communication skills are essential in the medical profession because doctors are
dealing with humans, autonomous and social individuals. Today’s doctors are facing more
and more demanding patients in their need to maintain health. Doctors need to be able to
communicate effectively and sensitively with their patients and with their colleagues. There
is no doubt that the ability to communicate is by far the most precious skill that a doctor can
learn. Even in present-day complex and sophisticated world of medicine, the skills to
communicate effectively remain to be of prime importance for developing a successful and
gratifying medical profession and practice.
The Block Medical Communication (MC) has been designed to provide the medical
students with enough opportunity to learn communication skills needed in medical
profession. The first part of the Block curriculum deals with basic concepts of
communication skills required to build effective interaction between doctor and
patient/relative such as basic concepts in medical communication, taking history, reviewing
the system, and approaching to specific patients such as different cultural background,
paediatric, psychiatric and obstetric patients. There are also time allocation for student to
rehearse their skill in communication through role play in basic clinical skill, comprising the
skills in opening the session, gathering information, building relationship, giving explanation
and planning, closing the session, and imparting bad news. In the later part of the
curriculum, the programs concern with other aspects of communication skills such as writing
medical notes and letters, techniques of paper presentation and discussion, communication
in health promotion and education, and scientific writing. The forms of the teaching -
learning activities include reading assignments, lectures, small group discussions, and
exercises on self-assessment items to test students’ understanding on the main contents of
lectures and reading material.
On having completed the Block’s programs at the first semester, we hope that the
students will be reasonably proficient in the skills of effective communication that they can
use throughout all stages of their medical training – especially the later clinical stages, as
well as throughout their future medical career after qualification.
This small Study Guide manual has been written to aid students to get through the
various teaching-learning activities without too much difficulty. As it contains all the
necessary information such as time-table of learning activities, subjects/topics and tasks or
assignments, the students will know in advance what to learn, when and how to do it and
what to expect from them. In short, with this manual at hand, the students should be able to
prepare themselves properly before participating in each teaching-learning activity.
We hope that this manual is useful not only for the students, but also for the lecturers
and facilitators.
Team of Planners
Block Medical Communication
Aims:
To introduce to the students the basic principles and skills of communication essential in
medical profession: taking patient’s history, approaching patient with specific clinical
situation or entity, and communicating with professional associates.
Learning Outcomes:
1. Understand and apply the basic principles of effective communication with patient
and family
2. Understand and apply communication strategy for health promotion and education to
lay community
3. Communicate effectively with professional associates in scientific meeting
4. Write professional letters, notes and curriculum vitae
5. Apply basic principles of scientific writing in professional communication
6. Apply specific approach or communication strategy to patient with specific clinical
condition or entity
Curriculum contents:
1. Principles of communication between doctor and patient/family
2. Concepts of history taking and review of the body systems
3. Skills in communicating with patients
4. Communicating with patients from different cultural backgrounds
5. Approaching patient with specific situation or entity:
a. Questioning about sexual history and examining obstetric patient
b. Communicating with child patients and their parents
c. Communicating with patients with psychological problem and disorder
6. Concepts and skills of paper presentation and discussion
7. Concepts and skills of communication in health promotion and education
8. Writing medical letters, notes and curriculum vitae (CV)
9. Concepts and skills of scientific writing.
Studying medicine is very hard and therefore severely demands that you have a strong
determination to study, attend lectures and discussions as scheduled, read learning
materials diligently and critically, and execute your assignments properly and on time.
Although studying manner differs from one individual student to the other, there are things
that have much in common to achieve success.
Here are some general “tips” for you to comply in order to reach success in your studies
at this Faculty, including the Block Medical Communication.
1. Keep your enthusiasm high for your tasks
Your high scores you were able to obtain at High School that enabled you to enrol to
this Faculty of Medicine tell that basically you have the basic potential to reach
success in your present studies. Different from the school study, however, at
university you are faced with more complex work, more wide and critical reading,
and you must focus on issues in a more detailed and searching way. This means
you should be able to manage yourself and your time wisely. Being a last
minute crammer for lectures and assignments is a serious disadvantage and reflects
poor self-motivation.
2. Increase your proficiency in reading, writing and speaking
You are given a great deal of reading material, so you have to be selective with
which to read in-depth or superficially, know which is important and which is not, see
beyond the details to the underlying principles, pay attention to similarities and
differences, to note exceptions to general rules, to understand cause and effect
relationships, tie in what you are reading with what you already know, etc. Similarly,
you have to keep-up your writing and speaking ability to such a level required for
university studies (in Bahasa Indonesia and/or in English). It is for all these purposes
that this Faculty includes Academic Reading, Critical Thinking, Speaking in
Conferences, and Scientific Writing courses in this Block and in a few other blocks.
There are also both General English and Medical English courses offered by this
Faculty. You must remember that reading, writing and speaking are three main
elements of communication skills of great importance in almost all
professions, including medicine in particular. So why not make the best out of
these courses!
3. Have flexibility in thinking and learning
As a medical student, you are dealing with large bodies of information with which
you gradually have to become familiar. In our medical school curriculum system, the
first seven semesters are devoted to integrated learning of basic biomedical and
clinical sciences, while the later five semesters are concentrated more on clinical
studies with real patients. Generally, the teaching-learning activities of the early
seven semesters consist of lectures, discussions on specific learning tasks or
problems, and in some topics simulations/role-plays. Since early in your studies, you
are introduced to the relation of biomedical knowledge to their clinical implications. In
some of the learning tasks or model cases in the earlier semesters, you may not yet
familiar with certain terms regarding diseases or other clinical disorders mentioned in
the tasks/simulated cases. Each lecture takes only one hour for a topic, in which the
lecturer explains more about concepts and principles rather than on details of factual
information. In consequence, therefore, it is your responsibility to find out explanation
to unknown terms or diseases and you have to read more extensively to get more
information from your reading resources. In fact, unlimited amount of information is
in existence in the library and on the internet about almost anything. Therefore, the
~ LECTURERS ~
~ FACILITATORS ~
Regular Class
NO NAME GROUP DEPT PHONE ROOM
Dr.dr. I Made Jawi, M.Kes 2nd floor:
1 A1 Pharmacology 08179787972
R.2.01
dr. Ni Ketut Putri Ariani, 2nd floor:
2 A2 Psychiatry 082237817384
Sp.KJ R.2.02
dr. Anak Agung Ayu Yuli 2nd floor:
3 A3 Interna 08123803985
Gayatri, Sp.PD R.2.03
dr. I B Darma Putra, Sp.B- 2nd floor:
4 A4 Surgery 08123600552
KBD R.2.04
dr. I Gde Haryo Ganesha, 2nd floor:
5 A5 DME 081805391039
S.Ked R.2.05
dr. Gusti Ngurah Mayun, 2nd floor:
6 A6 Histology 08155715359
Sp.HK R.2.06
dr. I Ketut Wibawa Nada, 2nd floor:
7 A7 Anasthesi 087860602995
Sp.An R.2.07
dr. I Wayan Weta, MS, 2nd floor:
8 A8 Public Health 081337003560
Sp.GK R.2.08
dr. Ni Luh Ariwati A9 2nd floor:
9 Parasitology 08123662311
R.2.21
dr. Putu Patriawan, Sp.Rad, 2nd floor:
10 A10 Radiology 08123956636
MSc R.2.22
English Class
NO NAME GROUP DEPT PHONE ROOM
dr. I Wayan Surudarma, 2nd floor:
1 B1 Biochemistry 081338486589
M.Si R.2.01
dr. I Wayan Losen 2nd floor:
2 B2 Interna 08123995536
Adnyana, Sp PD R.2.02
Dr. dr. Sianny Herawati, Clinical 2nd floor:
3 B3 081236172840
Sp.PK Pathology R.2.03
dr. Yuliana, M.Biomed 2nd floor:
4 B4 Anatomy 085792652363
R.2.04
dr. Made Agus 2nd floor:
5 B5 Microbiology 08123921590
Hendrayana , M.Ked R.2.05
dr. I Nyoman Semadi, 2nd floor:
6 B6 Surgery 08123838654
Sp.B, Sp.BTKV R.2.06
dr. I Wayan Eka Sutyawan, 2nd floor:
7 B7 Opthalmology 081338538499
Sp.M R.2.07
dr. Kadek Budi Santosa, 2nd floor:
8 B8 Surgery 081339977799
Sp.U R.2.08
dr. Sri Laksminingsih Sp. 2nd floor:
9 B9 Radiology 08164745561
Rad R.2.21
dr. I Gede Suwedagatha, 2nd floor:
10 B10 Surgery 0811387720
Sp.B (K) Trauma R.2.22
~ TIME TABLE ~
Regular Class
~ TIME TABLE ~
English Class
SP 3 SP 6
Meeting of student representatives and facilitators will be held on the 2nd of March 2016.
This meeting will be organized by the planners and attended by lecturers, student group
representatives and all facilitators. Meeting with the student representatives will take place
at 12.00 until 12.15 pm and meeting with the facilitators at 12.15 until 12.30 pm. The
purpose of the meeting is to evaluate the teaching learning process of the Block. Feedbacks
and suggestions are welcome for improvement of the Block educational programs.
~ ASSESSMENT METHOD ~
Cognitive assessment will be carried out on Monday, 24th of March 2015. The test is a
computer based test and will consist of 100 questions with 100 minutes provided for
working. The assessment will be held at the same time for both Regular Class and English
Class. SGD’s, role playing’s and student projects’s mark will be included in the final score as
describe below. The overall passing score requirement is 70. More detailed information or
any changes that may be needed will be acknowledged before the assessment.
Skill assessment will be carried out at the end of the semester using Objective
Structured Clinical Examination (OSCE). The assessment will be based on Calgary
Cambridge Observation Guide (CCOG) check list. The passing score requirement is 70.
SGD will be reviewed everyday by facilitator with a standard SGD assessment and it
contributes 5 % to the final score. Student projects and role playing, as a sumative
assessment account for 15% of the final score.
Abstracts of Lectures
The lecture will begin with explanation of the definition, methods, and purposes of
communication, especially as related to the field of medicine. By having a good
communication with the patient, a doctor is more likely to: (1) make an accurate,
comprehensive diagnosis of the patient’s problem (2) detect the patient’s emotional distress
(3) have the patient more satisfied with the medical care and less anxious about his/her
problem (4) have the patient agree and follow the advice given. Some studies have shown
that patients preferred doctors who: (1) were warm and sympathetic (2) were easy to talk to
(3) introduced themselves (4) were self-confident (5) listened to the patient and responded
to their verbal cues (6) asked questions that are easily understood and were precise (7) did
not repeat themselves. These basic communication skills of a doctor can be learned and
retained, hence this topic of lecture.
The outcome of the doctor-patient communication is influenced by several factors,
namely factors related to the patient, factors related to the doctor, and factors related to the
environment. Factors related to the patient include physical symptoms, psychological
conditions, and previous and current experiences of medical care. Factors related to the
doctor include past training in communication skills, self-confidence in ability to
communicate, personality, and physical and psychological conditions. The interview
setting/environment requirements include privacy, comfortable surroundings and appropriate
seating arrangement. General guidelines for conducting an interview with a patient are
explained in detail, which include the beginning, main part, and end of the interview. The
most basic skills of communication, which include the skill of questioning, listening, and
facilitating the patient to tell more significant information, are explained. It is important to use
open questions in most parts of the doctor-patient communication to obtain sufficient, clear
and accurate information from the patient. Closed questions are used in certain specific
situations such as in an emergency.
Dr Ratna Saraswati
The review of the system may uncover problems that the patient has overlooked,
particularly in area unrelated to the present illness. Some clinicians do the review of the
system during the physical examination, for example: asking about ear as they examine
them. If the patient has only few symptoms, this combination may be efficient, however in
multiple problem, the flow of history taking and the examination may be disrupted.
Standard series of review of system question including the organ and system below:
general
skin
head, eyes, ears, nose, throat (HEENT)
neck
breast
respiratory
cardiovascular
gastrointestinal
peripheral vascular
urinary
genital
muskuloskeletal
psychiatric
neurologic
hematologic
Communication between doctor and patient is central to clinical practice. As a doctor, we will
perform more than hundred thousand consultation in a professional lifetime. So we have to
struglle to get it right. Communication is also a core clinical skill, an essential component of
clinical competence. It is not an optional extra. Communication skills need to be thought and
learned. By skills training there will be prize for us. It would be more effective consultation,
improve health outcome, and a collaborative partnership.
There would be three broad types of skills in communication, content skills, process
skills and perceptual skill. Those skills are inextricably linked and considered in unity. A
content skill is the skill in determining the substance of questioning and responding to the
patient. Process skill is the way we communicate and a perceptual skill is our internal
decision making, clinical reasoning and problem solving.
We will emphasize the learning process in process and perceptual skill. Process skills will
address two main issues, the structure of medical interview and individual skills needed.
There are teaching tools to provide structure and individual skills needed. There are
numerous guides and check-list has been available, one of them is Calgary Cambridge
Observation Guide (CCOG). As guidance, it has already made significant advances. It has
structure which is more patient centered; provide us with the list of skills, and it also
emphasis explanation and planning.
This guide will give us a simple five-point plan within which the individual skills are
structured. This plan by intuitive and logical sense attempted to accomplish in everyday
clinical practice. This structure was first proposed by Riccardi and Kurtz in 1983 and similar
to that adopted by Cohen-Cole in 1991. The tasks are initiating the session, gathering
information, building relationship, explanation and planning and closing the session. Each
step will be expanded into expanded framework in which individual skills are structured.
Medical interview is indeed very complex and cannot be summed up in a view broad
generalization. However, it doesn’t need suggested that we have to employ each skills on
every occasion. We have to tailor to the circumstance of the interview – they will not be
used in every consultation. However, familiarity with all of the skill will undoubtedly be of
benefit.
Every patient is a unique individual, relationship building with these unique individuals
enables the patient to tell their story and explain their own concerns. It promotes adherence
and help prevent misunderstanding or conflict. As an essential means in achieving all three
goals of medical communication: accuracy, efficiency and supportiveness, relationship
building is central to the success of every consultation. In building the relationship with the
patient there are at least 3 points must be concerned: non-verbal communication,
developing rapport, and involving the patient.
Dr. Ratnayanti
At some point, perhaps in the same interview or perhaps in a subsequent one, there will be
a need to explain and discuss with the patient what has been found and what investigations
and treatment are planned. It is important to remember that most treatment involves the
cooperation of the patient. The way by which the information is given has been shown in a
number of studies to have a major effect on the patient care. Certain skills are involved in
giving information which doctor may not be aware of. Firstly, more is needed than simply
telling what is wrong and what should be done. Secondly, it is often wrong to assume that
patients are not capable of understanding explanation of their medical problem because of
lack of knowledge. Thirdly, it is wrong to assume that patient will become anxious if the
details of their problem and its management are explained to them. There is considerable
evidence now that the majority of patients want to know what is wrong with them even if the
news is not good.
Before giving information, try to find out what the patient already knows about his/her
problem and its possible treatment. Give important information first using short words or
short sentences and the information must be specific. Finally at the end of interview, ask the
patient to summarize what has been agreed.
In the practice of medicine, breaking bad news is often inevitable. Good patient’s cure or
successful surgery on a benign tumor does not pose any problem to tell the patient or
family, but to tell a patient that he/she has cancer or incurable disease is not easy. The
patient’s expectation and the doctor’s finding of the disease may not always agree with each
other, and on many occasions they may be contradictive. It is in such a difficult situation that
the doctor most needs to communicate effectively and sensitively with the patient to reach
similar understanding of the disease the patient suffers, and that they have to work together
to deal with the problem. The need to build good doctor-patient relationship on one hand
and the evidence of the disease on the other hand shape the main outcome of the doctor-
patient communication. It may not be sufficient to have the relationship based on equality or
partnership alone. In the case of Post Traumatic Stress Disorder (PTSD), in which
It is important to allow the patient to explain their cultural backgrounds, values, beliefs and
expectations when these may be relevant to the consultation. Heightened awareness of the
cultural issues can help you make a more accurate assessment of the patient's behavior,
improve your professional relationship with the patient, and decide proper treatment.
The doctor needs to accept other people's cultural and racial ideas as different, but
equally important. Important issues can be overlooked if either the doctor or the patient fear
misunderstanding and rejection of cultural values.
The patients may be part of a particular culture, but they will have adopted some
aspects of it and rejected others. The doctor must carefully assess each patient's individual
and cultural needs before deciding on an appropriate treatment.
Matching patient and doctor according to race or culture is not always helpful.
Dr. Yuliana
Physicians almost often deal with writing notes and letters. There are two kinds of
letters: formal/business and private letters. In the medical profession/practice there are
several kinds of formal letters, for example: referral letter, accompanying or covering letter,
letter of introduction, notes on one’s being fit for employment and notes on one’s being unfit
for duty or requiring hospitalization. In letter writing there is basic rules/formats that should
be considered although they are not very strict rules. There may be differences between
British and American practice and traditional and modern practice of letter writing. Generally,
the guidelines for letter writing relate to writing name of the sender and addressee, address
on the envelope and letter; date, greeting, main content and letter ending. Although there
are many styles, the main principle of writing business letter is to write clearly, simply, and
briefly. The principle of writing Curriculum Vitae or “resume”, which is a summary or outline
of educational and professional background and personal information, will also be taught to
students. It should contain the essential details such as name, address (personal and work),
telephone number, date of birth, professional interests, current position/employment,
educational background, professional experience, publication in journals, bulletins etc and
papers delivered at conferences. The layout of curriculum vitae is not strict but there may be
certain personal information needed when applying for a post.
Until recently, scientific writing especially aiming for publication has been a much–
neglected subject in Indonesian medical education and studies have shown that such high-
level intellectual skills cannot be achieved overnight or in a fixed time period and the
instruction should go deeper than mere instruction in English as a foreign language. Our
new curriculum has taken a new initiative to overcome at least the ‘cognitive burden’ of
scientific writing, a common problem for novice.
The course of scientific writing is divided into 2 parts: foundational or general
consolidation English and essentials of writing biomedical papers. The foundational English
will deal with highlighting the problems of accumulating a working vocabulary, common
errors in English and word choice in academic writing. The second part of the course will
focus on problems related to plagiarism, expressions to avoid, constructing effective
sentences, deductive paragraphs, the basic principles of writing a biomedical research
papers aiming to achieve a clear and coherent biomedical communication and the general
anatomy of biomedical research paper.
Learning activities designed to strengthen the acquisition of the general knowledge
and skills of scientific writing include 2 lectures, independent learning and exercises,
facilitated small group learning, plenary sessions and feedbacks, self assessments and
student project report. Summative assessment based on the defined learning outcomes will
be conducted at the end of the curriculum block on medical communication scheduled for
November 8, 2010.
By the end of this course, the students are expected to be able to make a good paper
presentation in a scientific meeting. They are expected to be able to collect necessary
information and references to organize the paper. They should also be able to develop the
appropriate audio visual aids to support the presentation and know the necessary steps of a
good presentation. These steps include opening remarks, entering the main section,
summarizing, closing and thanking the audience. They should also be familiar with
statements or expressions commonly used in an informal conversation following the
presentation.
The topic deals with problems related to health communication in Health Promotion and
Health Education covering some principles of imparting health related information to the
community at large. The principles include cultural characteristics of the audience, such as
level education, gender, beliefs, tradition, socio-economic status etc. This will be enforced
by examples in the real-world settings. The examples include the importance of preparing
the content of the talk in a languange easly understood by common people. It should not
consist of seemingly scientific jargons that are not familiar by the community. The procedure
of imparting the information should always be kept simple.
The whole activities will be preceeded by a general introductory lecture. The lecture consist
of some aspects of Health Promotion and Health education such as it’s definition, factors
affecting health status, health behavior, decision making process, theories of behavior
changes. It also includes some communication media and method that are commonly used
in delivering information to the community. At the end of the course the students are
expected to be able to apply those principles and theories in their practice.
LEARNING TASKS
Day 1
Basic concepts of communication
with patient and family
Learning Task:
1. In your opinion, what has caused the low patients’ satisfaction regardless of
dr. Made’s excellent expertise?
2. What are the purposes of communicating in general? How do you relate
them with the context of doctor-patient interview?
3. In your opinion, is it necessary or not necessary to study communication
skills in your medical education? Explain your answer clearly!
4. What is the most suitable seating arrangement for a doctor-patient interview?
Explain why.
5. It is said that to have a good beginning of the interview with patient will give a
profound effect on the good outcome of the interview. How do you make such a good
beginning of the interview?
6. Why do you use open questions in most part, especially at the beginning, of
the interview with the patient? Give examples of open questions!
7. Discuss about all the key elements of listening skills and give examples of
various ways to prove that you are listening attentatively to your patient!
8. Explain about the most important things to do at the beginning, main part,
and end of the interview with the patent!
9. How can family of the patient help in the diagnosis and care of the patient’s
problem?
Day 2
Basic concepts of history
taking
Dr Ratna Saraswati
1. When performing history taking of your patient, how would you determine the scope
of your question?
2. What kind of relevant personal data that you need to identify your patient at the first
time?
3. Give examples of chief complaint (try to have different one for each student)
4. Identify the information that you need to ask from your patient, regarding:
a. the present illness
b. the patient past history
c. the family history
d. the personal and social history
Day 3
Review of The Systems
Dr Ratna Saraswati
1. List some problem that you need to ask while reviewing of each system below:
a. general
b. skin
c. head, eyes, ears, nose, throat (HEENT)
d. neck
e. breast
f. respiratory
g. cardiovascular
h. gastrointestinal
i. peripheral vascular
j. urinary
k. genital
l. muskuloskeletal
m. psychiatric
n. neurologic
o. hematologic
p. endocrine
Day 4
Skills in communicating with
patients: Initiating the session
and Gathering Information
Udayana University Faculty of Medicine, DME 25
Study Guide Medical
Communication 2016
Scenario
Wawan then visited another doctor two days later because his complaint was not relieved.
He went to dr. Sagita which practice about 2 blocks away from the first doctor. The doctor
was friendly and appealing. The consultation also went well. But unfortunately she
dominated the conversation. Several times Wawan wanted to explain his complaint in detail,
but he hardly had chance to speak or cut the doctor’s words. He was sprayed with
questions by the doctor such as what is the problem? Since when? Is he has stuffy nose?
Did he take any medication? And other questions. Everything was asked so quickly and he
felt just like filling out a questionnaire.
Learning Task
1. In above scenario which step is not properly carried out by the doctor?
2. In gathering information there are several components should be done. Mention
those components!
3. Give example of expression of each component in gathering information!
4. In gathering information section, there are several key steps which differentiate
patient centered interview with doctor centered interview consultation. Mention the
key steps!
ROLE PLAY
General Instruction
1) Prepare the role play session; the role play is preferable in Bahasa. One student
play as the doctor, the other as a patient and an observer. Use the scenario or case
provided for this role play session. The tutor will observe the role play.
a. The doctor have to initiate the session
b. The observer and tutor observe and prepare the feedback based on Calgary
Cambridge Observation Guide (CCOG).
2) After the role play :
a. The doctor should make a self reflection on their own performance
b. The patient, observer, and facilitator then give their constructive feedback on
the doctor performance.
Day 5
Skills in communicating with
patients: Building relationship
2. After the examination, the doctor and patient sat back to their sit. How is it doc? How
is my condition? The doctor kept silent for a while. He frowned his forehead and laid
his head back then took a deep breath. He took a very thick book and opened the
page in a hurry.........
3. At the end, the doctor wrote a prescription. He still checked his watch once in while.
“Mam, don’t worry about it. Here is the prescription, you can get the drug at the
pharmacy. Take it as instructed. If something happen regarding your illness, you can
contact me at this phone number”. Said the doctor while giving his bussinesscard....
Questions:
1. What are your impressions in general to situation (1), (2) and(3)?
2. Try to criticize thoroughly about:
a. non-verbal communication and its meaning in those situations
b. the accepting response of the doctor to his patient
c. the empathy of the doctor
d. the doctor’s support
e. the involvement of the patient
ROLE PLAY : BUILDING RELATIONSHIP
Building the relationship runs in parallel to the other task of the interview. This task is easily
taken for granted or forgotten, but this task is an essential means of achieving all three
goals of medical communication: accuracy, efficiency and supportiveness. Relationship
Scenario
You are now working in a private foundation that serves the high risk population for
HIV/AIDS, especially the injection drug users. Your job is to take history and give
explanation about the disease. Today, a 27 year-old male patient comes. He had been
tested for the HIV and now brings his laboratory result. Now you are given the test result
and ought to explain the test result to the patient. Please do a role play to explain the
laboratory result to the patient which stated that he is infected by the HIV.
Day 6
Skills in communicating with
patients: Explanation and planning,
Closing the session
Dr. Ratnayanti
Learning Task
Case
A male patient, Gede, 58 yo complained of flank pain and nausea. After the clinical
radiography and laboratory investigation he was found to suffer from hydronephrosis due to
ureter stone. The doctor also suspected he had hepatoma (liver malignancy). At that
moment the doctor only gave supportive therapy and suggest further investigation for
hepatoma; The doctor also planned a surgical procedure to remove the stone if the
condition of patient permitted. The patient complained mostly about the flank pain and
wished to get the surgery to be done as soon as possible. But, after several weeks the
surgery had not been scheduled, in the mean time, patient condition was getting worse. The
patient’s family then complained to the doctor and hospital because they think the patient is
neglected for not being scheduled for the surgery. They suspected the doctor/hospital treat
them so because they were supported by government health insurance for poor people and
unable to pay for the expensive procedure.
1. Please discuss about the reason of patient and family dissatisfaction to the
doctor/hospital service regardless administration and facilities aspect!
2. Please discuss about the use of medical term during explanation and planning to the
patient and family!
Case
Kocong, 15 yo boy, had been referred to the central public hospital with Steven Johnson
Syndrome. He developed painful, massive bulae all over his skin after injection of antibiotic
by a doctor in the private practice. The parents of the boy planned to sue the doctor
because they believed there was malpractice in his son case.
5. What did the doctor missed to do during the management of the patient on the case
above?
6. Please discuss and give example of contracting in closing the session part of
anamnesis.
Day 7
Breaking bad news to patient and
family
1. How do you plan and summarize before telling the “bad news” to the patient?
2. How do you judge the verbal and non-verbal cues of the patient and family when
being told about the bad news?
3. How do you maintain your “professional authority” while breaking the bad news?
4. How does PTSD influence one’s reaction to “bad news”?
5. Please discuss how should you deliver bad news in the cases below!
Day 8
Basic Clinical Skill
Role Play
Day 9
Communication with patient
from different cultural
backgrounds
Case 1
So you are Mr. — ? Did I pronounce that properly?
How do you prefer to be addressed?
Question: How do you prepare yourself to address the issue in those questions?
Case 2
I need to ask you some questions about your health. I'll go through them, and I would like you
to answer 'Yes' or 'No' to the questions. Afterwards, we can discuss how you are doing with
the treatment and if you have any worries or questions.
Question: Do you think this type of interview is appropriate for common patients from Asian
society? Explain your answer!
Case 3
During the fasting month of Ramadhan, a diabetic moslem patient has been on medication
with oral anti-diabetic (morning and afternoon doses). The patient follows the daily fasting
and asks if the medication can be postponed until the fasting time has ended.
Case 4
In an emergency situation, a patient from a strict religious sect refused to receive blood
transfusion.
Question: As the doctor in charge of the Emergency Room, how do you respond to this
patient’s attitude? Explain your reasons!
Case 5
Doctor: I'm sorry that your daughter has to be examined by a man, but I'm afraid I am the
only doctor on duty tonight. I think she needs to be seen straight away since she is in bad
pain, so I shall have to examine her myself. I really think we have no choice at this stage. If
possible, we can try to arrange for a female doctor to follow-up, if that is necessary.
Question: What seems to be the doctor’s concern related to the cultural aspects of this
patient that made the doctor use the above expressions? Explain your answer!
Case 6
In a particular case, you may need an interpreter because your patient has little knowledge
of English, and it can be a relief for the patient to speak in their native language. Moreover,
an interpreter from the patient's own culture can identify the crucial issues and give comfort
and support.
Day 10
Communication approach with
in psychiatry
Day 11
Specific communication
approach to obstetric patient
Dr Hariyasa Sanjaya
Situation 1:
A woman with nine months old pregnancy with complaint of having pains since the
last four hours and already discharging a “bloody show” (blood and mucus from her vagina).
In brief, the mother is in the process of giving birth to a baby.
Task:
What should be your communication approach in situation above?
Situation 2:
A fourteen-year-old-girl complains of having been raped by her senior fellow
students in the school’s rest room. She is suffered from pain because of some chafed and
bruised thigh, the sign of past violence.
Task:
How is your communication approach (examination scenario) in situation above?
Situation 3:
A female student is suspected to have benign ovary tumor. She is extremely worried
about the possibility of having cancer.
Task:
How should be your examination scenario and approach in situation above?
Situation 4:
A sixty-year-old woman apparently having prolapsed uterus.
Task:
How should you deal or approach in situation above?
Situation 5:
A fifteen-year-old girl admitting never had sexual intercourse but obviuosly found to
be three months pregnant.
Task:
How should be your communication approach?
Situation 6:
A female patient with complaints suggestive of sexual transmitted disease.
Task:
How should be your communication approach in above situation?
Situation 7:
A girl presenting with hematome of her labia majora because of falling in a motor
bike accident.
Task:
How should be your approach in above situation?
Situation 8:
A man was depressed since he complained chronic sexual impotence.
Day 12
Communication with pediatric
patient and parent
Dr Siadi Purniti
A mother from a village, not having finished Elementary School, brings her 6-month-
old baby to the Pediatric Outpatient Clinic of Sanglah Hospital, with a referral letter
from a Puskesmas (Public Health Center) doctor. The mother does not understand
why the baby is being referred to Sanglah Hospital. The doctor of the Puskesmas
only stated that the baby is suffering from Congenital Heart Disease.
The students’ task
Please discuss in the small group how the doctor in the Puskesmas should ideally
have explained to the patient’s mother about the disease and the reasons to refer
the patient to Sanglah Hospital.
Day 13
Writing letters, notes, and CV
Dr. Yuliana
Day 14
Basic concepts of scientific
writing 1
Instruction
Scan the word list, and underline the words unfamiliar to you. Discuss the unfamiliar words
with your peers and group, and find out their real meaning (s).
Day 15
Presentation & discussion in
scientific meeting
Prof Dr Adiatmika
Day 16
Basic concepts of scientific
writing 2
II. Words carelessly interchanged: Choose one of the words, within the parentheses
to make the best sense in the sentence, and indicate your choice by underlining it.
i. The response was blocked by phentolamine but was not (affected, effected) by
propranolol.
ii. The digoxin (amount, concentration, content, level) was increased from 0.5 to 2.5
mg/ml.
iii. Preganglionic stimulation (enhances, increases) norepinephrine release from
terminals within the superior cervical ganglion.
iv. Increased knowledge of cardiac muscle function has greatly (enhanced,
improved) our ability to detect and quantify disorders of myocardial contraction.
v. Treatment with methylprednisolone after the lesion is established significantly
(enhances, speeds) recovery.
vi. At frequent (intervals, periods) we measured pH, PO2, and PCO2 in arterial
blood, and during each (interval, period) of study we measured pulmonary blood
flow two or three times.
vii. We studied the responses of the following (parameters, variables): heart rate,
cardiac output, oxygen consumption, and systemic vascular resistance.
viii. Seventy-five percent nitrous oxide (represents, is) a sub-anesthetic
concentration in the dog.
III. Change the structure of the following sentences, so that the core message
becomes more explicit or direct.
i. A progressive decrease in the death rate occurred.
ii. Evaporation of the ethanol from the mixture takes place rapidly.
iii. Measurements of blood pH were made with a Radiometer capillary electrode.
iv. Prolongation of life for uremic patients has been made possible by improved
conservative treatment and hemodialysis.
IV. For the following 4 pairs of sentences, indicate your choice by putting a cross
(X) either on (A) or (B).
(A) These results are similar to the results of previous studies.
(B) These results are similar to previous studies.
There are three different theories put forward for the very slow relaxation of catch
muscles of molluscs. One theory holds that catch is due to some unusual property of
myosin in these muscles that produces a slow rate of detachment. In this theory,
paramyosin would have no special role beyond that of providing the long scaffolding
on which the myosin is positioned as well as the mechanical strength for the large
tensions developed. The second theory holds that tension is developed by actin-
myosin interaction but is maintained by paramyosin interactions. Because the thick
filaments are of limited length, interaction would have to occur through fusion of thick
filaments. A third theory to which I subscribe, pictures a structural change in the
paramyosin core affecting the rate of breaking ofmyosin-actin links at the filament
surface.
Brief message of
Topic sentence: .............................................................................................................
Supporting sentence 1:...................................................................................................
Supporting sentence 2: ..................................................................................................
Day 18
Communication in health
promotion and education
Dr Oka Negara
7. Some problems that possibly be faced during dispensing health information to the
community!
STUDENT PROJECTS
STUDENT PROJECT 1
You should write down the answers of the questions below on your student
workbook and should be finished and signed by facilitator in the following SGD.
Questions :
1. What is Calgary-Cambridge Observation Guide? What is the benefit of this guide?
2. There are four main problems that addressed by this observation guide. Please
mention those problems and explain them!
3. Mention the structure of this observation guide! Please explain why such structure
being chosen!
4. Mention the expanded framework of this observation guide! What do you think about
that framework?
5. The structure will give advantages for the student. Please mention these
advantages!
6. There are seventy individual skills that should be mastered. Could we make it
simpler? Is it possible to apply these all skills into daily practice?
7. Each learner should find their own way in order to assimilate these new skills and
behaviours into practice. What does it meant?
STUDENT PROJECT 2
Students have been given material about basic concepts of history taking and review of the
systems. The task for student project is to make brief summary using the frame work in
history taking and review of the systems. The summary should contain important related
informations that need to be elicited from a patient with certain complaint/disease. Each
students could choose 1 symptom/disease of interest as listed below, but every group
should have all summaries of symptoms/diseases in the end. These summaries will be
helpfull during role playing in Basic Clinical Skill, not as your interview guideline but as
internal thinking process to reveal the health problem of your patient. The summary should
be written on your workbook and will be evaluated and signed by facilitator. The Result of
Student Project will also be evaluated by the lecture in the student project presentation as
appointed in the schedule.
Example:
Dengue Fever
What/Main complaint: fever
When/Onset: more than 5 days if not treated
How/Chronologic: body temperature suddenly rising up………..
Etc....
List of symptoms/diseases:
1. Dengue Hemorraghic Fever
2. Hypertension
3. Lung Tuberculosis
4. Anemia
5. Chest pain
6. HIV/AIDS
You may look for the information in the library or through the internet. You could refer to
reliable sites to obtain information regarding the symptoms/diseases above.
STUDENT PROJECT 3
Students have already been taught about patient oriented model of medical interview which
consists of five basic steps. The aim of student project 3 is to train several skills, not only
communication skill but also, not less important skills to our professional future, such as,
team work, perfomance skills, and creativity.
Selected groups (the appointed groups are listed in the time table supplement) should make
an audiovisual recording of medical interview by following the instruction given. You
have lot of time for this project, so manage properly. The recording should be a complete
interview. Individual skills for each step, initiating the session, gathering information, building
relationship, explain to the patient, and closing the session, should be explicitly performed.
Instructions:
1) In group you should make a scenario about an ideal medical interview between the
doctor and the patient. The scenario should comprise all processess from initiating
the session until closing the session. Your group may freely decide which case or
symptom will be chosen, but it is preferable to use Bahasa Indonesia in the play. The
maximum duration of the video is 15 minutes.
2) The scenario should contain sentences from each individual skills needed.
Example:
a. Greeting: “Selamat pagi, Bu Amat!”
b. Introduce your role : “Saya dokter muda Amin, saya ditugaskan untuk
melakukan wawancara dengan ibu”
3) You may decide how many personal characters will be included in the scenario, and
all should be played by the students. You may add the family from the patient, or
mother from a child patient or other related roles.
4) The scenario should be collected to and discussed with your facilitator. After finished,
you may proceed to the recording session. You are allowed to explore your creativity
in editing the record using multimedia software available.
You should collect the record in a CD to secretary of Medical Communication after project
presentation on the pointed date. The groups should prepare for this presentation and
receive the feedback from the audience.
STUDENT PROJECT 4
You should write letters/notes and CV (Curriculum Vitae) based on the cases provided in
your learning task. Your letters and CV must be typed and saved in CD or flash disk and will
be displayed and discussed at student project presentation. You are also required to make
the written form (printed) on worksheet 8 in your workbook that will be signed by your
facilitator.
In writing letters/notes and CV, you may look at the samples in the reading resources but
you must use your imagination about information that you think are necessary to mention,
according to your purpose of writing them. Remember that business letter to a colleague, a
company, a hotel etc. are normally brief, clear and using simple words; but should mention
enough important information needed.
1. Write a referral letter to Dr. Steven Chow, senior Urologist at Mount Elizabeth
Hospital, Singapore to request for further investigation and treatment to a male patient,
aged 64 years, with history of chronic kidney failure due to stones in both kidneys.
STUDENT PROJECT 5
You should write an abstract of a review or research article in English either for English
class or Regular class. The abstract consist of 500 words maximum and should be your
original work, though translation from article in Bahasa is still permitted. This student project
is intended to give practice experience in constructing a scientific manuscript, therefore,
please avoid plagiarism due to lack of learning benefit by doing so. The hardcopy of the
abstract should be attached in your student workbook and handed to the lecture at the
plenary session of the 2nd day lecture of Basic Concepts of Scientific Writing. Soft copy is
also needed to be presented during the plenary session.
STUDENT PROJECT 6
Seminar Simulation
Students of class A and B should arrange a joint seminar simulation on the pointed date in
the study schedule. The seminar may not be about a certain topic, but should be health-
STUDENT PROJECT 7
~ SELF ASSESSMENTS ~
Building Relationship
1. Building the relationship is said like a cement that binds the consultation together.
What does it means?
2. What probably the cause of patient disastifaction with the doctor-patient
relationship?
3. According to Hall et al. (1988) the patient satisfaction was related to .............?
4. There are about three skills for building the relationship: non-verbal communication,
developping rapport and involving the patient. Try to describe those all.
5. What do you mean by non-verbal communication?
6. Differentiate verbal and non-verbal communication!
7. If verbal and nonverbal are inconsistent or contradictory, which one is the most valid
to be interpretated. Why?
8. Describe the three valuable functions of the accepting response.
9. What is your respons if the patient express his anxiousness that erection disfunction
because of high masturbation frequency done during adolescence?
10. Empathy is a two-stage process. What does it mean?
2. Explain about giving information from the view of the person/doctor giving the
information.
9. Give examples, in your own word, about how to communicate during medical
interview session. Each student should write his/her own examples on the the blank
rows below the communication check list items provided in the appendix 1.
Appendix 1
Instruction :
Write down your own example for each step of medical interview! You have to read the
example in the reference before you make your own.
Practice your own example and you should choose one as your favourite one!
No Skills
Initiating the session
1. GREET patient and obtain patient’s name
5. NEGOTIATES AGENDA taking both patient’s and doctor’s perspective into account
2 Gathering Information
6. ENCOURAGE PATIENT TO TELL STORY of problems from when first started to the present in own words
(clarifies reason for presenting now)
7. LISTEN ATTENTIVELY, allows patient to complete statement without interruption and leaves space for patient
to think before answering or go on after pausing
8. FACILITATES PATIENT’S RESPONSES VERBALLY AND NON VERBALLY (use encouragement, silence,
repetition, paraphrasing, interpretation)
12. EXPLORES CONCERNS (including worries, effects on lifestyle) regarding each problem
15. SUMMARIZES AT THE END OF A SPECIFIC LINE OF INQUIRY to verify own interpretation of what patient
has said, to ensure no important data were omitted
16. PROGRESSES, USING TRANSLATON STATEMENTS; includes rationale for next session
BUILDING RELATIONSHIP
18. USING APPROPRIATE NON-VERBAL BEHAVIOUR
Demonstrates appropriate non–verbal behaviour:
Provides support:
Deals sensitively:
Explains rationale :
Involves patient:
Negotiates plan:
Offers choices:
Safety nets:
Final check:
References:
Kurtz SM, Silverman JD, Draper J (1998) Teaching and Learning Communication
Skills in Medicine. Radcliffe Medical Press (Oxford)
Silverman JD, Kurtz SM, Draper J (1998) Skills for Communicating with Patients.
Radcliffe Medical Press (Oxford)
Curriculum mapping
~ REFERENCES ~