Introduction and techniques of communication

Why this Webinar??

• Communication between physicians and patients and their families is consistently identified as the most important and least accomplished factor in quality of care ICU

• Recent incidences of violence against Medical Practitioners are indicators of breaking of bond between Doctor and Patient

The Doctor-Patient Relationship and Malpractice Lessons From Plaintiff DepositionsArch Intern Med. 1994;154(12):1365-1370

How do you rate your doctor

Why was patient shifted to other hospital?

Journal of Bone & Joint Surgery2005:87:652-58

Discrepancies between patients assessment and physicians self assessment in Orthopedic care

• Communication skills and knowledge though very important aspect does not receive deserved attention

• These skills and knowledge are taught only in context of diagnostic interviewing

• Even providers with necessary skills do not use them adequately for lack of time without recognizing that they can not afford not to

• Our most common deficiency in our daily interviews with patients remains a failure to demonstrate an empathic response

The Main Skills for Effective Communication

• Staying Focused• Listening Carefully• Understanding Others' Point of Views• Empathy When Criticizing• Taking Ownership• Compromise if Necessary• Ask for Help• Take a Time-Out if Necessary

Dr Albert Mehrabians 7%-38%-55% rule

• Basically three elements in any face-to-face communication– Words– Tone of voice– Nonverbal behaviour (body language)

• Non -verbal elements are particularly important for communicating feelings and attitude, especially when they are incongruent: if words disagree with the tone of voice and nonverbal behaviour, people tend to believe the tonality and nonverbal behaviour

Elements of body language

• Facial expressions• Eyes• Posture• Gesture• Voice• Movements• Touch• Appearance

Osgood- Schramm model of communication 1954

Berlo's Model of Communication 1960

Source

Communication skillsAttitudeKnowledgeSocial systemCulture

Message

Content ElementsTreatmentStructurecode

Channel

HearingSeeing TouchingSmellingtasting

Receiver

Communication skillsAttitudeKnowledgeSocial systemCulture

Encodes Decodes

Models of Communication between surrogate-physician

• Directive model• Informative model• Facilitative model• Collaborative model

Skill ExampleCrisis communication Acting as a team leader and directing collegues in a

clinical emergencyInterprofessional discussions

Dealing with disagreements between clinical teams about treatment options

Communicating with patients

Focused history taking in a compromised patient Use of communication aids with an intubated patient

Family meetings•Initial consultation

•Clinical updates •End-of-life issues

•Explanation of critical care interventions and honest discussion of prognosis•Modifying expectations•Negotiating agreement on a withdrawal of treatment plan

Various Communications required in critical care

CEACCP 2008;8:121-24

Principles for Better Communication 1

• Ask-Tell-Ask– Ask the family to describe their current understanding of

the issue– Tell the family in straightforward language what you need

to communicate—the bad news, or treatment options, or other information

– Ask the family whether they understand what you just said.

Principles for Better Communication 2

• When You Are Stuck, Ask for More Information: "Tell Me More.“– "Could you tell me more about what information you need

at this point?”– "Could you say something about how you are feeling about

what we’ve discussed?”– "Could you tell me what this means for you and your life?”

Principles for Better Communication 3

• Use reflections rather than questions to learn more• Reflections are restatements of the family’s words or

guesses at what the family means– Convey empathy– Empower the family to take control of the conversational

platform– Allows silence and time for the family member to respond

Principles for Better Communication 4

• Skills for Responding to emotions– When people are experiencing strong emotions they are

less able to hear cognitive information Emotion– In the midst of a strong emotional reaction, people find it

hard to make decisions– What most people want when expressing strong emotions

is to feel that their situation and emotions are heard and appreciated

Empathy – a major element of communication in ICU

• Being able to recognize and then show that you are trying to recognize what the other person is going through– Associated with family satisfaction and trust– Enable patients to connect their emotional reactions to

their own important values– Helps people talk more about what they are feeling– Acting empathically can enable physicians to create

medical plans that serve patients better

Principles for Better Communication 5

• Assess the Other Person's Informational, Decision-making and Coping Style– Monitors - problem-focused coping– Blunters- emotion-focused coping– Combinations

Common Barriers

• Giving pathophysiology lectures• Ignoring the context of the communication encounter• Not finding out the family’s information needs and styles• Launching into your agenda first without negotiating the

focus of the interview• Offering reassurance prematurely• Pushing the family to make a decision, before they have

had a chance to grieve the loss

Summary

• Good communication skills improve medical care and reduce lawsuits.

• Skilful interviews improve diagnostic accuracy by gathering a superior quantity and quality of data

• Linked to increased patient satisfaction and patient adherence to medication and treatment regimens as well as to improved clinical outcomes and also reduce medical errors.

• Would help reduce violent attacks on medical professionals