GENERAL DIALOGUE

Greetings : hi , I m S , 1of the dr in dept. May i confirm ur name plz ? How may I call you ? Ok , Nice to meet you/ thank you for making time to
talk to me / thank you for seeing me.

Open Q : ok so tell me , what made you come to the hospital ? What happened? ( NEW PT) /// I understand u came with ddd , can u explain a
bit more about that

If pt came for f/u >>. I understand that you are here for ur follow up or inv. report ...

I learned that u were admitted to the hospital recently , may i know what happened

When pt says PAIN : I can see u r quite distressed , can u tell me more about your pain /// u did a very good thing
seeking Medical attention. Can u tell me more about ur pain.

Closed Q :: After elaborating presenting symptoms , " Now I'm thinking about other symptoms , besides x, y , z , hv u noticed anything else?

I M ASKING YOU ALL THESE Q to get a better idea about ur symptoms/ problm

P3MAFTOSA : let me ask u some gnrl questions . How's your health been generally for the last few months?? Hv u lost any weight
unexpectedly?? How's your appetite these days?? Do u hv any medical condition? Hv u ever been to the hospital ?? Hv u had any operations??
Do u take any medication?? Anything over the counter?? Do u hv any allergies / are u allergic to anything?? Can i ask u , if there's anything that
runs in the family?? Anything related to the ( here mention the system involved like for MI case , say heart ; headache case , brain etc)

Can i ask you wt u do as a job ?? Do u like ur job ? Is there any stress at work??? Who else live with you at the moment , at home?? Hv u been
abroad in the last few months??

Can i ask you if you drink alcohol at all ? Smoking ?? How about recreational drugs?

Whn pt gives an information >>> oh thank you for telling me

Psychosocial ::: how is it affecting ur life/ ur work ?? ( This really affected me) >>> oh i wish u didn't hv to go through this hard time/ / i
understand it's been really difficult for you , do u hv fmly or frnds to support u through this

Thank you for answering my questions.

ICE ::: do u hv any thoughts about wt it might be?

You told me u r worried about xxxx , but i was wondering if thr's anything else dt might be worrying u?

Anything in particular that you might be hoping from me today

( transition from ICE to D/D) See it can be ankle sprain ( wtevr pt said abt Dx in ICE) , But it sounds more like a condition that we call Gout . ( Now
explain abt gout) or it can also be pseudogout

Now I'd like to do gnrl physical Ex , also examine ur toe/ tummy/ eye/ knee

Explaining Dx :::[ There's a couple of things dt could be causing it . But the way u described it , it sounds like xyzz, also coud be agh , df, cc ,] so
we'd like to investigate further.

So we'd like u to go through b, c , d investigation . Then hopefully we can pinpoint wts causing ur symptoms. Does that sound like a good plan?

F/u ::: so we r going to follow u up on this and hopefully we'll be able to prevent this from coming back.

WHEN SUSPECTING CANCER :::

You r concerned about cancer , well , that's a valid concern , the symptoms u hv described to me so far , are quite no specific. Which means that
I'd like to ask more questions , do more Examination, run some tests . Then we'll get a better picture of wts going on. Now there's lots of causes
of ur ( symptom such as pain) that r more likely than cancer. I assure you , we are going to investigate thoroughly.

*** A great phrase from yesterday in response to a patient asking if their condition was serious: "it's not a serious illness, but as it is affecting
you so much, we have to take it seriously" A really patient centred approach - well done!

*** NEVER SAY " DON'T WORRY"" . u can say " i can see u r worried"

*** When pt wants to complain>> ( lean in a bit towards pt to show sincerity ) i can see u r disappointed/ upset , i sincerely apologise. Is there
anything i can do to rectify the situation.we value your opinion . We'll be discussing ur valuable feedback on the monthly meeting , we'll arrange
training so that this doesn't happen again. If u would like to speak with our Consultant, i can arrange a meeting .

If pt still want to complain>> PALS

*** If pt says i m Confused>> my apologies if i wasn't clear.. is thr anything i can clarify for u

######## whn u go into xm room , forget examiner after showing id .... Think as its ur clinic

Whn u need see Q , use pen >>> say " excuse me for a moment , i m going to see my note , i'd like to use the pen

** Whn u messed up pt's name>> ( show u r embarrassed by looking down) thnk u for correcting me , i apologise for my mistake

** Whn u need a bit time to think >> fill the gap with saying " do u need any clarification upto this point, of , do u hv any Q for me

** Whn pt dissatisfied with care>>> i apologise for making u feel this way, was there something dt happened during the care , // i'll investigate
further , look into records to know the root of the problem . If pt still dissatisfied , say ok I'll ask my seniors to look into the matter , /// i m going to
chk it with my consultant ( don't be too quick to involve seniors)

I'll chk in with the nurse/ therapist , to understand if there's a misunderstanding with ur original plan of Tx

** Don't cl overweight/ fat >> say " u r on the higher side of wt, if u'd like , we can arrange a meeting with the dietician so u can manage ur diet"

** Happy pt ( pg , getting married) >> Congratulations , did u think of a baby name yet ... I m really happy for you ( married)

** Whn Q said to address concern >>> ask pt " do u hv any concerns/ Questions / need any clarification

** Pt was admitted to hospital , now with new problem>>> ask wt happened , anything new happened

[[[ Pt was admitted with cellulitis , now has leg pain :: 1st d/d cellulitis again , so ask , is the leg swelling same as whn u were dx with cellulitis.
Was thr any new medication , ok let me chk if u r having any side effects from the medication ]]] ( verbalize whn u r looking through
BNF , I'm gonna chk tab. Aspirin , ok it's taking a bit time , sorry , ok here i found it ... So u hv x > no .
Ok how about y > yes ...so it seems like this medication CAN BE contributing to ur symptoms ) u r nt
sure of the cause , so say "" its better to go through some inv. to confirm the cause of ur symptoms ,
such as swollen leg can be caused by kd prblm , so I'd like to chk ur kd function , ur albumin lvl shld
also be chked

** Whn telling pt abt inv. dt u need to do >>> say name of inv. + Say cause of giving it ( we need to
chk ur kd function , bl albumin lvl bcz these can cause lev swelling

** If u need to stop a mdcn dt was prescribed by a specialist >>> it'd be gd to stop this medication but
I'll chk in with my seniors // I'll speak with my consultant , perhaps he can take a look at the care plan
& mk necessary arrangements. This medication may need to be stopped. But we can always arrange
for a cardiologist's opinion if u like .

#### WHN 2 MIN BELL >>> MUST DO SAFETY NETTING.

** Whn pt ask Q >> that's a good Q... Thank you for asking me

** Whn finished station : offer leaflet for more info... You can cl us if u want to know anything, shake
hands if possible ,

** Don't let any movement by pt go unnoticed >> say r u ok ? Would u like a glass of water/ tissue , if they SNEEZING SAY BLESS YOU

** Don't slam the door in ur exam room

### If a patient is likely to have difficulty retaining information, you should offer them a written record of your discussions, detailing what
decisions were made and why.

### HOW TO CHECK PT UNDERSTANDING ( TEACH BACK METHOD)

This is a new diagnosis for you, so I want to make sure you understand. Will you tell me in your own
words what congestive heart failure is?”

Teach-back steps:

I explain the concept to my patients, avoiding medical jargon.

I assess my patients’ understanding by asking them to explain the concept in their own words.

I clarify anything my patients did not understand and reassess their understanding.

If my patients still do not understand, I find a new way to explain the concept.

I repeat the process of explaining and assessing for understanding until my patients are able to
accurately state their understanding.

10 element of teach back

Use a caring tone of voice and attitude.

Display comfortable body language and make eye contact.

Use plain language.

Ask the patient to explain back, using their own words.

Use non-shaming, open-ended questions.

Avoid questions that can be answered with a simple yes or no.

Emphasize that the responsibility to explain clearly is on you, the provider.

If the patient is not able to teach-back correctly, explain again and re-check.

Use reader-friendly print materials to support learning.

Document use of, and the patient response to, teach-back.

***** When you use teach-back, be sure to:

Re-phrase if the patient does not understand. Do not simply repeat.

Ask for teach-back until you are comfortable the patient really understands.
If the patient is not able to teach back after several times, consider other strategies like...

including a family member,

taking a break or scheduling another opportunity, or

asking another member of the health care team to explain.

**** Examples:

I want to be sure I explained everything clearly. Can you explain it back to me so I can be sure I did?

What will you tell your husband about the changes we made to your medicines today?

We’ve gone over a lot of information. In your own words, please review with me what we talked about.

**** Do u live with someone / hv frnds , if they ask u abt ur Tx , how will explain to them wt i just told u
? ( Pt'll say in his on words)

*** In order to be sure I was clear, can you repeat back to me the signs and symptoms of high and low
blood sugar?" This is a non-judgmental, open-ended question that invites the patient to use her own
words to explain what she understands.

*** open-ended question “can you review with me about high and low blood sugars?”

Example re Explain :::

" Whn u r chking ur bld , every morning & evening bfr u hv brkfast or lunch , u wanna see wt the no.
is , if its below 70 , u hv low bl sugar , u need to watch out for these symptoms (( points at the leaflet)
dizzy , heart pounding , swwaty... And here's wt u need to do if u hv low sugar , u need to eat
something sweet like juice , candy , a snack , if its near ur meal time thn just go ahead &hv meal.... If
its nt ur meal time , & u r having this symptoms , eat a snack and after 15 min chk ur bl sugar.

****"Finally, to be sure to effectively provide consistent, key, plain language messages consistently
across the care continuum:

Take responsibility for explaining clearly.

Avoid asking questions that can be answered with “yes” or “no.”

Ask patients and families to explain key information back, using their own words.

Do this for each concept—“chunk and check.” This means checking for understanding for each
important concept before moving on to the next.

**""*. Whn u need to chk BNF

So how I will tell the patient about opening the BNF

: Excuse me I am going to have a look at my book so please bear with me...: And get used to this sentence because
you will say it more than 20 times per day when you work in NHS inshAllah