Communication Skills

in Medicine
Tjakra W. Manuaba
Dept of General Surgery
School of Medicine. University of Udayana
Sanglah Academic Hospital. Bali

An inquiring, analytical mind;

an unquenchable thirst for new
knowledge; and a heartfelt
compassion for the ailing these
are prominent traits among the
committed clinicians who have
preserved the passion for
medicine
Lois DeBakey

What is Communication
Is the act by which information is shared
between humans. Such encounter might
cover:
Desires
Needs
Perceptions
Knowledge
Affective states

The ability to communicate well

with patients to build up a
trusting relationship within which
curing relieving and comforting
can take place, is a great challenge
Why good medical communication
is important? better care for our
patients
Sir Charles Fletcher

Medical Communcation
Medical communication is the usual
communication encounter between doctor
and the patient
It can be classified according to the
purpose of the interview into 4 types
History taking
Consultation
Obtaining Informed Consent

Breaking bad news

DOCTORS PATIENTS RELATIONSHIP.

Not anymore paternalism

Should be partnership basis.
Doctor-Patient collaboration vs health
problem
Equal

Reassurance

To solve problem

To form & maintain

relationship

Communication
To alleviate distress
To give
information

To Convey Feelings

To persuade

To make Decision
Communication Purposes (Lloyd & Bor, 1996)

By Understanding The Whole

Process in Medical Communication

BETTER COMMUNICATION

-Clearer
-More effective & efficient communication
-Honesty & openness.
-Trust
-Mutual respect
-Politeness
-Adherence
-Collaboration.
-More accurate information
-Prevention of violent situation
-Informed consent
-Legal aspects

Bad News
Inevitable part of medical practice
Not widely taught in medical schools
Studies how patients/ families cope with bad
news not the process of breaking bad news
Bad news is a relative concept & should
depend on patients interpretation of
information & their reaction to it where
patients feel the news will adversely affect
their future

BREAKING BAD NEWS.

CONDITIONING
PLANNING
EXPLANATION

Conditioningfamilies
step by step.
Family learns to accept
the bad situation

Why is it difficult to break bad News

The messenger may feel responsible and fears being blamed
Not knowing how best to do it
Possible inhibition because of personal experience of loss
Reluctance to change the existing doctor-patient relationship
Fear of upsetting the patients existing family roles/ structure
Not knowing the patient, their resources & limitation
Fear of the implications for the patient (disfigurement, pain, social and
financial losses)
Fear of the patients emotional reaction
Uncertainty as to what may happen next and not having answers to some
questions
Lack of clarity about ones own role as a health care provider
Lloyd and Bor, 1996

Managing difficult situation in breaking bad news

To whom should bad news be given

Who should give bad news
When should bad news be given
How much bad news should be given
Should you give hope and reassurance along
with bad news

How to give bad news

Personal preparation
The Physical Setting
Talking to patient and responding to concerns
Arranging for follow-up or referral
Feed and handover to colleagues

KEY CORE SKILL FOR BREAKING BAD NEWS

EXPLANATION & PLANNING.

Preparation
Summarizing
Negotiating the Agenda
Listening
Picking up Cues
The use of Silence
Discovering the patients concern and ideas
Encouraging the expression of feeling
Picking up the non verbal cues

Conclusions
Doctors do need communication skill
If Doctors have more times, bad news
should be given step by step by
conditioning patients and family
Doctors should convey bad news
without delay
Bad News should be carefully and
systematically prepare, by learning the
background of the patient and family

Thank you