Communication

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Introduction

Communication is central to relationships with colleagues, patients, and families. Effective communication results in satisfying and productive interactions, while poor communication can be disastrous for safety and well-being.

 

Communication competencies span all settings, and the techniques listed below should be learned and applied as diligently as possible. These techniques are listed here, independent of clinical domains, though customization is certainly necessary.

 

Beyond these techniques, however, lie professional qualities such as integrity and respect that underlie all communication. Learners and educators will do well to watch for specific situations that may pose a challenge for an individual's background, values, and personality, requiring reflection, discussion, and possible intervention.

 

Patient/Client/Family Communication general advice for patient & family encounters difficult or delicate interviews breaking bad news disclosure of error encouragement effective listening non-verbal communication communicating with caregivers cross-cultural communication communication with interpreters interviews with multiple participants behaviour management for lifestyle patient-centred clinical method common ground end-of-life ethics discussion of treatment limitations/code status

Health Care Provider Communication case presentations handover urgent oral communication prescriptions referrals and consults clinic notes admission notes chart notes progress notes orders post-op notes discharge summaries team meetings interprofessional communication

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Communication Styles

Communication may be thought of in three styles, as described by Rollnick, Miller, and Butler.

Directing

Directing occurs when the health care provider dominates the conversation with knowledge, expertise, or power. This can be helpful in emergency situations. It is alse extremely common in primary care, and patients may appear to want you to lead them in the right way to go.

The directing style becomes more common when time constraints are felt and care is provided according to 'best practices'. In order to fit everything in that needs to be said, health care providers rhyme off a list of do's and don'ts. While in many cases this is appropriate, it fits quite poorly with behaviour change.

 

Guiding

"A guide helps you find your way. It is not within the guide's authority to determine what you want to see or do. You decide where to go, and you hire a knowledgeable guide to help get you there" (Rollnick, Miller, and Butler, p15). A guide enables someone to solve the problem themselves.

 

Following

In following, listening is the primary means of communication. It can be important intially in the conversation or after breaking bad news.

 

Good communication sees these styles occuring together at various appropriate points in an encounter.

Guiding fits well with behaviour change. Motivational Interviewing is a specialized for of guiding. In particular, it is:

• goal directed
• pays attention to the patient's words, and actively uses these in supporting change
• includes important skills and strategies to be honed and used

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Communication Skills

There are three core communication skills:

Asking: elicit information to understand the patient's problem and situation

 

Listening: ensure you hear what the patient is saying by regularly checking in

 

Informing: share knowledge and recommendations.

Validate concerns

Commend for seeking advice

Accept, don't judge: big different between acceptance of a choice and approval

inquire from a lens of curiosity

 

 

Communication styles use various combinations of these skills. For example, a directing style could be asking-informing, as the patient's history is elicited and then followed by information on diagnosis and treatment. As well, each skill can sound and feel very different, depending on what style is being used.

 

examples here...

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Resources and References

http://csp.medicine.dal.ca/teach.php

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