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1.Communication Skillsfor Medicine

Margaret Lloyd Cs, 3 rd.Ed
2. Skill for Comm M with Patients
Jonathjan Sylverman, Suzzane K. Cs
3. Buku Prof Deddy Mulyana.
Challenging
Consultations
special problems in doctor-patient communication

Irwanto Ichlas
18 November 2013
Key Topics
We will look at ways of communicating effectively with
patients who :

1. Are
withdrawn 3. Are angry
2. Are anxious and aggresive
and difficult to
communicate

5. Are
4. Have informed/kno
hearing and / wledgeable/ex
or speech perts about
problems their medical
conditions
The Uncommunicative Patient
Note these possibilities :
- People have different communication style with us
- It’s his/her usual manner OR the uncommunicative
tendency only appears in some particular events
(talking with unfamiliar/new person)

**Everybody has encountered the state of being

uncommunicative sometimes. To have more
understanding about others, try to ask yourself and
reflect what the things that make you feel less willing
to communicate.
Influencing Factors in
Communication
Many factors affect someone’s ability to talk with new
people including :
 Personality or general disposition – outgoing, shy,
self-conscious, emphatic?
 Previous experience of meeting people
 Someone’s state of mind – angry, ancious,
depressed
 Reputation of the other person – what we have
heard about that person? What pre-conception do
we have?
Influencing Factors in
Communication
 Physical appearance of the other person –
smart, attractive or physically unattractive?
 The other person’s behavior – aggresive or
overpowering or fussy?
 The context and geography of the meeting –
welcoming/friendly/noisy/private? Are the
chairs too close/far?
 Reluctant Patient
They may be :
• Naturally shy
• Have a particular embarrasement;
feel intimidated by the questions
(sexuality, Income, social status etc.)
• Feeling sad or grieved
Reluctant Patient
A Counselor/Therapist has to figure and consider why the
patients appear to be uncommunicative, such as :
- Layout of the consultation room
- Some of the counselor’s behavior that might be
found disturbing or intimidating the patient;
questions, gestures,

** Cultural differences will influence the style of

communication for both counselor and patient
 The Depressed
Patient
• Spare more duration of consultation time
• Observe the patient carefully (verbal and non-
verbal cues)
• Show emphaty with your body language
• Explain the purpose of the “interview” /
consultation session
• Use more closed questions than open questions
when appropriate and possible
The Anxious Patient
• Anxiety is a normal and healthy response in some
particular case as a response to life events.
• Relate your anxiety experience can help you to
emphatise with an anxious patient.

The signs of anxious patient :

- Physical sign of anxiety : sweating, flushing,
trembling, fidgeting
- Speak rapidly uncontrolled
- Make excessive demand for reassurance from
counselor
The Anxious Patient
Why the Patient anxious ?
- The patient’s usual behaviour; he/she has an
anxious personality
- The patient is suffering from a chronic anxiety state
- A response to his/her illness – to receive medical
care
- Anxious about other problems in their life-events
(past / present event or anxious about the future
event in life)
 The Anxious Patient
Guidelines for helping anxious patient
- Be calm and prepared to spend more time for the
counseling session
- Explain that anxiety is appropriate to be felt by
most patients; normal experienced by people
- Try to keep the patient to the point by summarising
what he has said and clarify if it is what he/she
meant to say
- Be specific about what you may want he/she does
during and after the session
The Angry and Aggresive Patient
• Violence might be directed to health care staffs everywhere
when patients are angry.
• Break the anger verbally and reduce the threat of harm to
everyone including the patient himself.

Prevention is best :
- Don’t be combative
- Be “street-wise”, not to work alone in the setting where
there’s potential threat
- Keep the patient from any easy-reach object that may be
used to threaten others
- Ready to contact the security guards
The Angry and Aggresive Patient
Guidelines for dealing with the angry/aggresive
patient :
 Show willingness to talk and listen
 Keep a safe distance – not to far/close
 Do not interrupt or threathen the patient in any
way
 Ask open questions, encourage patient to talk;
talking is better way in expressing anger rather
than aggresive behavior
 Do not make agreements or promises
The Angry and Aggresive Patient
 Help the patient to feel that he or she has
choices; sometimes people get frustrated by the
thought of having no choice
 Do not talk from behind or touch or block their
movement (might be threatening)
 Do not take personal offence
 Never let down the guard until the incident is
over
 Supervise the security staffs
The Angry and Aggresive Patient
Sign of distress :
 Speech : becoming louder, quicker or becoming quiet
 Facial expressions : changing, flushed, loss of eye-
contact
 Manner : impatience
 Body language : closing in or sudden/expansive
movements
Developing Awareness
• Acknowledge our limitations and be prepare to
challenge them occasionally
• Learn and practice skills – help us to manage
unpleasant emotions during consultation
• Keep practicing communication techniques and
learn from your or others experience
Developing Awareness
• It is important to position yourself in the
patient’s position (For example : how would you
react to bad news, sadness, unworthy feeling,
and etc.)
• Remember that people will potentially behave
differently when taken out of their normal
environment (in the consultation setting in the
hospital/clinic). They may feel stress or nervous
 Patient with Hearing
/Speech Problem
• Do not ignore the person – not let he/she feels
unimportant. Learn the disability; is it
auditory/verbal/cognitive-related/learning or
organic problem?
• Do not make an assumption about what he/she is
trying to say
• Use other form of communication such
as sign language, pointing written
words/symbols, writing
Patient with Hearing/Speech Problem

• Use an interpreter
- be aware of confidentiality issue
- be aware if interpreter editing too much of
what the patient said. Alternative is, ask the
interpreter to leave when talking about sensitive
issue
• Check the Patient’s understanding
Communication problems which may be
experienced by people with disability

1. Person
struggles to 2. This creates
make embarassment
him/herself
understood

3. Others
4. Person feels
withdraw or
rejected and
avoid social
misunderstoo
contact with
d
the person
Patient with Dementia
• Patient may need to be
reminded about appointments
and routines
• Remember that social contact is
important for them
• The carers also need positive
encouragement as they become
easily frustrated in their efforts
to communicate with dementia
patient
 Accept help from Parents or
Carers
• If you are communicating with children
with children who have
auditory/visual/speech difficulties, you
can use the parent’s or carer’s
knowledge about the child to help you.
• They can act as translators or
interpreters.
• It is sometimes helpful to use animal
noise to communicated.
• You will need to be patient until the
child learns to feel comfortable enough
with you before he/she is willing to talk
with you about medical issues.
The Informed Patient
• Traditional approach of doctor-patient relationship :
doctor is the expert and patient were almost fully
dependent on the doctor for all the information
about the illness, treatment and prognosis of the
condition
• Developments in information and technology has
changed the doctor-patient consultation. The most
influencing aspects are : internet access, the
influence of patient support and advocacy groups,
increased awareness of health related issues on
newspaper and magazines
The Informed Patient
 In the modern era, doctors need to adapt their
style of communication and consultation to take
into account the informed patient.
 Requires a higher level of professionalism and a
willingness to work more collaboratively with the
patient.
 Developing a more positive connection and
collaborative working relationship with patients.
The Informed Patient
Instead of asking “what is the problem?”, doctor can ask “How
best can I help you today?”
The more open-ended opening line is better rather than directly
“assuming” the patient is seeking help for particular problem.

When you do not know the answer of patient’s question, you

can answer :
“That’s an interesting question. I can see there’s a dilemma here
but I do not currently have sufficient information myself to give
you the best advice. Would it be helpful if I looked this up for you
in the medical literature and had a chat with a specialist
colleague who works in the hospital and I could then get back to
you?”
The Informed Patient
• Doctor can not simply hide behind old
knowledge or ignore the fact that some patients
know more than we do about their condition
because of the broad information access they
can get.
• Instead of feeling threatened or insecure, we
should adapt the consultations style.
• We need to find out and understand what the
patients want specifically from us, it shows we
try to establish a more collaborative and
professional relationship with patients.
Videos
• Health care staffs communication with patient
http://www.youtube.com/watch?v=iyivrUPbo3Q

• Poor communication with patient

http://www.youtube.com/watch?v=W1RY_72O_L
Q
 Key Points
• Try to understand the underlying reasons for any
withdrawn, anxious or angry behavior then
adapt the communication style
• Be aware that “appropriateness” and
“normality” are not fixed; they depend on
culture and life experiences of both parties
• Do not do anything that potentially escalate
threat of violence by an angry patient
• Be attentive and concerned to prevent situations
from becoming worse
Key Points
• Do not avoid disabled-patients
• Use an interpreter when necessary – it is
important to ask he interpret exactly what i said
• Allow more time for communicating with
patients who have difficulties
Thank You!

Any question???