Skills for Communicating with Patients

Höfundar: Jonathan Silverman; Suzanne Kurtz; Juliet Draper (Útgáfa: 3)
Skills for Communicating with Patients

Kaup valmöguleikar

Skills for Communicating with Patients, Third Edition is one of two companion books on improving communication in medicine, which together provide a comprehensive approach to teaching and learning communication skills throughout all levels of medical education in both specialist and family medicine. Since their publication, the first edition of thi

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Útgefandi
Taylor & Francis
ISBN
9781908911162
Print ISBN
9781138443594
Format
ePub
Útgáfa
3
Höfundar
Jonathan Silverman; Suzanne Kurtz; Juliet Draper
Tungumál
English
Útgefið
2016-03-09
Prent takmörkun á líftíma
100

Kaflar

  • Cover
  • Title Page
  • Copyright Page
  • Table of Contents
  • Foreword
  • Foreword
  • Preface to the third edition
  • Preface to the second edition
  • About this book
  • About the authors
  • Acknowledgements
  • Dedication
  • Introduction
  • An evidence-based approach
  • A skills-based approach
  • A unified approach throughout undergraduate, residency and continuing medical education
  • A unified approach to communication skills teaching in specialist and family medicine
  • A unified approach to communication skills teaching on both sides of the Atlantic and beyond
  • Who is the intended audience for this book?
  • Learners at all levels of medical education
  • Facilitators and programme directors
  • Medical education administrators, funding agencies and medical politicians
  • How have we addressed style issues in a book intended for the European, North American and wider international market?
  • 1 Defining what to teach and learn: an overview of the communication skills curriculum
  • Introduction
  • More effective consultations
  • Improved health outcomes
  • A collaborative partnership
  • Plan of chapter
  • Types of communication skills and how they interrelate
  • Example 1
  • Example 2
  • Example 3
  • The problem of separating content and process skills in teaching and learning about the medical interview
  • Confusion over process
  • Confusion over content
  • Marrying content and process
  • An overall curriculum of doctor–patient communication skills
  • The Calgary–Cambridge Guide (as presented in the 1998 editions of our companion books)
  • The enhanced Calgary–Cambridge Guides*
  • Three diagrams: the framework of the enhanced Calgary–Cambridge Guides
  • The basic framework
  • The expanded framework
  • An example of the interrelationship between content and process
  • Calgary–Cambridge Guides: communication process skills
  • CALGARY–CAMBRIDGE GUIDES COMMUNICATION PROCESS SKILLS
  • Initiating the session
  • Preparation
  • Establishing initial rapport
  • Identifying the reason(s) for the consultation
  • Gathering information
  • Exploration of patient’s problems
  • Additional skills for understanding the patient’s perspective
  • Providing structure to the consultation
  • Making organisation overt
  • Attending to flow
  • Building relationship
  • Using appropriate non-verbal behaviour
  • Developing rapport
  • Involving the patient
  • Explanation and planning
  • Providing the correct amount and type of information
  • Aiding accurate recall and understanding
  • Achieving a shared understanding: incorporating the patient’s perspective
  • Planning: shared decision making
  • Closing the session
  • Forward planning
  • Ensuring appropriate point of closure
  • Options in explanation and planning (includes content and process skills)
  • If discussing opinion and significance of problem
  • If negotiating mutual plan of action
  • If discussing investigations and procedures
  • Calgary–Cambridge Guides: communication content
  • The need for a clear overall structure
  • Choosing the process skills to include in the communication curriculum
  • The research and theoretical basis that validates the inclusion of each individual skill
  • Underlying goals and principles of communication that helped in choosing the skills
  • Skills and individuality
  • Relating specific issues to core communication skills
  • Summary
  • 2 Initiating the session
  • Introduction
  • Problems in communication
  • Objectives
  • Skills
  • ‘What’ to teach and learn about the initiation: the evidence for the skills
  • PREPARATION
  • ESTABLISHING INITIAL RAPPORT
  • Greeting the patient and introducing yourself
  • Clarifying your role and the nature of the interview
  • Obtaining the patient’s name
  • Demonstrating interest and respect, attending to the patient’s physical comfort
  • IDENTIFYING THE REASON(S) FOR THE CONSULTATION
  • The opening question
  • New consultations
  • Follow-up visits
  • Listening to the patient’s opening statement
  • Learning how to listen at the beginning of the consultation is the first step to an efficient and accurate consultation
  • Listening rather than questioning allows doctors and patients to achieve more of their objectives for this part of the consultation
  • What is the evidence to support listening?
  • What are the specific skills of attentive listening?
  • What are the advantages of attentive listening?
  • Screening
  • The balance between listening and screening
  • Agenda setting
  • Summary
  • 3 Gathering information
  • Introduction
  • Problems in communication
  • Objectives
  • The content of information gathering in medical interviews
  • The traditional medical history
  • Origins of the traditional method
  • Strengths
  • Weaknesses
  • The disease–illness model
  • Definition of disease and illness
  • Why doctors need to explore both perspectives
  • An alternative template for the content of the information-gathering section of the interview
  • The biomedical perspective
  • The patient’s perspective
  • Background information: context
  • The process skills of information gathering
  • Exploration of the Patient’s Problems
  • Questioning techniques
  • What are open and closed questions?
  • When should we use open and closed methods: the open-to-closed cone
  • What are the advantages of open questioning techniques?
  • Why is it important to move from open to closed questioning techniques?
  • What is the evidence for the value of open and closed questioning techniques?
  • Eliciting the patient’s narrative
  • Attentive listening
  • Facilitative response
  • Encouragement
  • Use of silence
  • Repetition or echoing
  • Paraphrasing
  • Sharing your thoughts
  • What is the theoretical evidence for facilitation?
  • Picking up verbal and non-verbal cues
  • Clarification of the patient’s story
  • Internal summary
  • Accuracy
  • Facilitation
  • Language
  • Additional Skills for Understanding the Patient’s Perspective
  • What is the evidence to support exploring the patient’s perspective of their illness?
  • Anthropological and cross-cultural studies
  • Outcome studies
  • Satisfaction and compliance studies
  • Understanding and recall studies
  • Are patient-centred interviews longer?
  • How to discover the patient’s perspective
  • Picking up and checking out cues
  • Asking specifically about the patient’s illness perspective
  • Feelings
  • Effect on life
  • Putting The Process Skills of Information Gathering together
  • The continuum of open to closed questioning techniques
  • The complete versus the focused history in information gathering
  • The effect of clinical reasoning on the process of information gathering
  • More advanced hypothetico-deductive reasoning
  • Schema-driven approach
  • Pattern recognition
  • How do these different clinical reasoning approaches influence the process of information gathering?
  • Summary
  • 4 Providing structure to the interview
  • Introduction
  • Objectives
  • Skills
  • ‘What’ to teach and learn about providing structure: the evidence for the skills
  • Making Organisation Overt
  • Summarising
  • What is summarising?
  • Why is internal summary a key skill in structuring the consultation?
  • What is the evidence for the value of summarising in the medical interview?
  • Signposting
  • What is signposting?
  • Attending to Flow
  • Sequencing
  • Timing
  • Summary
  • 5 Building the relationship
  • Introduction
  • Problems in communication
  • Objectives
  • Skills
  • ‘What’ to teach and learn about building the relationship: the evidence for the skills
  • Using Appropriate Non-Verbal Communication
  • What is the difference between verbal and non-verbal communication?
  • Why understanding non-verbal communication can make a difference in the consultation
  • What is the research evidence that non-verbal communication makes a difference to the consultation?
  • What then are the lessons for physicians?
  • Reading the non-verbal cues of patients
  • Transmitting your own non-verbal cues
  • Use of notes and computers
  • Developing Rapport
  • Acceptance
  • The accepting response
  • Functions of the accepting response
  • Skills of the accepting response
  • Responding to overt feelings and emotions
  • Responding to indirectly expressed feelings and emotions
  • Acceptance is not agreement
  • The problem of premature reassurance
  • Empathy
  • Understanding the patient’s predicament and feelings
  • Communicating empathy to the patient
  • Support
  • What is the research evidence that rapport-building skills make a difference to the medical consultation?
  • Involving the Patient
  • Sharing of thoughts
  • Providing rationale
  • Summary
  • 6 Explanation and planning
  • Introduction
  • Problems in communication
  • Are there problems with the amount of information that doctors give?
  • Are there problems with the type of information that doctors give?
  • Can patients understand the language that doctors use?
  • Do patients recall and understand the information that we give?
  • Are patients involved in decision making and to the level that they would wish?
  • Do patients comply or adhere to the plans that we make?
  • Are there problems in the teaching and learning of explanation and planning in medical education?
  • Are these problems improving with time?
  • How does all of this relate to the growing field of health literacy?
  • Objectives
  • The content of explanation and planning
  • The process skills of explanation and planning
  • Communication process skills: the evidence
  • Providing the Correct Amount and Type of Information
  • Do patients and doctors disagree over the amount of information that should be imparted?
  • The traditional view of the doctor–patient relationship
  • An unbridgeable competence gap
  • The emotional nature of illness
  • Professional authority
  • Why has modern research been misinterpreted as confirming the traditional stereotype of information giving?
  • Early studies of recall of information
  • More recent studies
  • Confirmation of prejudices
  • What recent trends in society have influenced medical information giving?
  • Changes in society
  • Changes in medicine
  • Patient autonomy
  • What is the research evidence to suggest that giving more information is helpful?
  • Do all patients want more information?
  • What skills can learners use to help gauge the correct amount and type of information to give to each individual patient?
  • Chunking and checking
  • Assessing the patient’s starting point
  • Asking patients what other information would be helpful
  • Giving explanation at appropriate times
  • Aiding Accurate Recall and Understanding
  • Ley’s research into patient recall
  • Categorisation: an example of signposting
  • Labelling important information: another example of signposting
  • Chunking and checking
  • Repetition
  • Language
  • Making explanations or advice specific enough for the patient to understand or act upon
  • Using visual methods of conveying information
  • Achieving a Shared Understanding – Incorporating the Patient’s Perspective
  • Tuckett and colleagues’ research into patient understanding
  • The methodology of Tuckett and colleagues
  • What does the research of Tuckett and colleagues show about the information given by doctors?
  • What does the research of Tuckett and his colleagues show about the influence patients can have on their doctors’ information giving?
  • What are the combined effects of patients’ and doctors’ approaches to patient involvement in information giving?
  • Can doctors and patients more positively influence each other towards a shared understanding in information giving?
  • Does the research of Tuckett et al. about recall fit in with previous work?
  • Was correct sense made of the explanations?
  • Were patients committed to the doctor’s view?
  • What are the main conclusions of Tuckett and colleagues?
  • Other work to support shared understanding
  • What skills can we recommend to help learners achieve a shared understanding with their patients?
  • Relating explanations to the patient’s perspective
  • Providing opportunities and encouraging the patient to contribute
  • Picking up verbal and non-verbal cues
  • Eliciting the patient’s beliefs, reactions and concerns
  • Planning – Shared Decision Making
  • Theoretical concepts behind shared decision making
  • The mutuality model
  • The shared decision-making model
  • From compliance to concordance
  • The research evidence to support shared decision making
  • Do all patients want to be involved in shared decision making?
  • What skills can we recommend to learners to help them achieve shared decision making in planning?
  • Sharing own thinking as appropriate: ideas, thought processes and dilemmas
  • Involving the patient
  • Offering suggestions and choices rather than directives
  • Encouraging the patient to contribute their ideas and suggestions
  • Exploring management options with the patient
  • Risk communication
  • Decision aids
  • Establishing the level of involvement the patient wishes
  • Negotiating a mutually acceptable plan
  • Signposting position of equipoise or own preferences
  • Establishing the patient’s preferences
  • Negotiating differences
  • Checking with the patient
  • Options in Explanation and Planning
  • If offering opinion and discussing significance of problems
  • If negotiating a mutual plan of action
  • Discussing and offering options in management and treatment
  • Providing information on action or treatment offered
  • Obtaining the patient’s view of need for action, perceived benefits, barriers and motivation
  • Motivational interviewing
  • Accepting patient’s views and advocating an alternative viewpoint as necessary
  • Challenging and confronting patients
  • If discussing investigations and procedures
  • Summary: explanation and planning is an interactive process
  • 7 Closing the session
  • Introduction
  • Objectives
  • The process skills for closing the session
  • ‘What’ to teach and learn about endings: the evidence for the skills
  • What actually happens in the closing section of the interview?
  • What behaviours earlier in the visit prevent new problems from arising during closure?
  • What communication skills can we recommend in the earlier sections of the consultation that will aid efficient and satisfactory closure of the session?
  • What behaviours during closure are associated with inefficient endings?
  • What are the specific elements of closure itself (see Box 7.1)?
  • Forward planning
  • Contracting
  • Safety-netting
  • Ensuring appropriate point of closure
  • End summary
  • Final checking
  • Summary
  • 8 Relating specific issues to core communication skills
  • Introduction
  • Specific issues
  • Breaking bad news
  • Key skills of the Calgary–Cambridge Guides to apply with greater depth, intention and intensity
  • Cultural and social diversity
  • Common issues and barriers in cross-cultural communication and social diversity
  • Key skills of the Calgary–Cambridge Guides that need applying with greater depth, intention and intensity
  • Age-related issues
  • Communicating with older patients
  • Key skills of the Calgary–Cambridge Guides to apply with greater depth, intention and intensity
  • Communicating with children and parents
  • Key skills of the Calgary–Cambridge Guides that need applying with greater depth, intention and intensity
  • The telephone interview
  • Key skills of the Calgary–Cambridge Guides that need applying with greater depth, intention and intensity
  • Patients with mental illness
  • Uncovering hidden depression and assessing suicidal risk
  • Key skills of the Calgary–Cambridge Guides that need applying with greater depth, intention and intensity
  • The psychotic patient
  • Key skills of the Calgary–Cambridge Guides that need applying with greater depth, intention and intensity
  • Examples of specific phrasing
  • The open-to-closed cone
  • Empathy without collusion
  • Combining advocacy and support with challenge
  • Gathering information from others
  • Interviewing the older patient with mental illness
  • Medically unexplained symptoms
  • Other communication issues
  • Further reading
  • References
  • Index
  • Author index