CLOSING THE SESSION

dr. Luh Putu Ratna Sundari, M. Biomed

Introduction
 Communication problems at the end of the consultation
 To end consultation satisfactorily
 Unmatched agendas easily lead to conflict and frustration.
 Can be avoided by attention to our use communication skills
during the begginning
• In this chapter we explore to separate part but related
question:
1. What skills used can help closure more efficient.
2. What are the skills during closure that bring the
consultation to a satisfactory end?
Objectives
• Our objective for this part of the interview may be
summarized as:
1. Confirming the established plan of care
2. Clarifying next steps for both doctor and patient
3. Establishing contingency plans
4. Maximizing patient adherence and health outcomes
5. Making efficient use of time in the consultation
6. Continuing to encourage the patient to feel part of a
collaborative process.
What behaviours prevent new
problems arising during closure?
• White et all(1994) found the following behaviour to prevent
new problems arising during closure:
1. Physicians using signposting
2. Giving more information about the ttherapeutic regimen
3. Patients talking more about their therapy
4. Physicians asking for patients beliefs and being more
responsive to patients.
Communication that recommend that will
aid efficient and satisfactory closure of
the session
1. Initiating the session:
- Attentive listening
- Screening
- Agenda setting
2. Gathering information
- Sign posting
- Exploring patients ideas and concern
- Addressing patients feelings, thought and emotions
- - Discussing psychosocial issues
3. Explanation and Planning
- Information giving
- Involving patients in explanation and planning
- Checking for patients understanding
- Asking for patients questions
Behaviours that associated with
innefficient ending
1. Physicians asking open question
2. Physicians laughing, showing emotions,
3. Patients engaging in psychological discussion, being
friendly an dominant
What are the specific elements of
closure
1. End summary: summarizes session briefly and clarifies plan of
care
2. Contracting: contract withpatients re next steps for patient and
physicians
3. Safety netting: safety nets appropriately—explains possible
unexpected outcomes, what to do if plan is not working, when
and how to seek help
4. Final checking: checks that patient agrees and is comfortable
with plan and asks if any questions, corrections, etc
Summary
1. The skills of closure enable patients :
- to feel comfortable with mutually agreed plan
- to be clear about will happen next
- to move on with more confident.
2. The same skills enable doctors:
- To complete the consultation more effectvely
- To start the next interview with less unfinished business or
anxiety.