CHCCOM3C Utilise specialist communication skills to build strong relationships.

The health professional is no longer a paternalistic figure with a problem-focused

method of treating patients. Health science professionals are increasingly aware of the
complexity of physical, social and psychological issues patients are forced to
encounter. Medical and Health Science schools are teaching students that doctors are
not able to remove patient's illnesses, emotional pain and grief, but are there for
ongoing support, advice, and to listen. These future doctors will get develop
respectful, collaborative and supportive relationships with their patients who will
receive well-informed, objective advice that will improve their health.

Culture, encompasses customs and traditions and has a direct influence on our
perceptions of ourselves as well as how we are perceived in the community. Culture
results in different behaviours, languages and attire. Most importantly, it influences
how we perceive pain and western medicine. For example, many African countries
still use witchdoctors as their main source of diagnosing and treating illness. In
Australia , this form of alternative medicine is not in the mainstream. An African
person may not feel comfortable approaching a doctor who diagnoses and treats
differently to what he may be used to. This creates a barrier between the doctor and
patient, which must be understood and dealt with appropriately.

Life experience is another factor, which is unique to each patient. A patient may not
respond well to bad news because he had previously experienced illness or death in
his family. The issue should be recognized and dealt with early so that the treatment
and management process is un-impaired. Similarly, if a patient has experienced a
separation or a divorce, this can impact on their ability to trust. Likewise, if an older
person has abused a child, it may be extremely difficult for them to open up and
confide in the doctor. This can be another barrier between doctor and patient, which
must be understood and dealt with in the early stages. Each person responds uniquely
to similar circumstances, and the doctor must be well aware of how they are coping
with the situation and how much support they need.

A person's spiritual influences also affect how they perceive themselves and how
others accept them. A sound belief in a higher power may help one patient to hope and
trust. However, it may cause other patients to believe that their illness is a punishment
for their sins. This could create problems with the treatment and management plan. It
is worthwhile for the doctor to see spirituality as a possible source of one patient's
courage or motivation, as well as another patient's reason for giving up.
It is important for you to know how you feel about yourself. You must be self-aware
and have a positive attitude and understand yourself before you can begin to
understand and like others. Awareness of your thoughts, feelings, mental image,
responses to certain situations, behaviour, and attitude to others will help you realise
your uniqueness and to respect yourself. Your perception of yourself and your
surroundings is constantly changing and it is important that you are aware of the
changes occurring, so that you may influence them according to your values and
beliefs.

Self-analysis is important as it determines how we see ourselves and how others see
us. An awareness of our faults should promote for personal growth and development.
An awareness of our qualities allows us to appreciate these gifts.

Who are you? Measure your self-worth by your own standards, not by anyone else's.
Your personality traits do not make you right or wrong, good or bad; accept them as
special and unique. Think of your characteristics you like and those you think you
could work on. Learn to identify your strengths and utilise them to their fullest. Learn
also to recognise your behavioural response to situations, which stimulate one of your
negative traits. The behavioural response is your defense mechanism, which may
often be self-mistreatment or the mistreatment of others. If you work to analyse this
response, you will remedy this negative trait.
Doctor-Patient Communication

Effective communication between patients and doctors is vitally important. Some

encounters may be problematic, as patients may be frightened, angry, aggressive,
stressed, anxious, suicidal, and depressed, drug-dependent, abusive or sexually
suggestive. Professionalism, honesty and empathy will help you to deal with these
encounters and recover quickly if there is a problem in the communication.

Open and honest doctor-patient communication will improve the mutual satisfaction
of both . It will ensure the patients right to confidentiality and to make their own
decisions. This will improve clinical outcomes for patients. The doctor must invest
time upfront with the patient. Knowing the cultural, social and familial background
increase decrease understanding and communication. When time is short, effective
communication techniques improve the quality of the medical interview, which will
encompass the patient's emotional, psychosocial as well as physical health and
wellbeing.
There are two main forms of communication; verbal and non-verbal.
Verbal Communication

Verbal communication occurs is spoken, and to be effective meaning must be present

When you misunderstand what has been said, verbal communication occurred but the
words had no meaning.

For effective verbal communication, the speaker and listener must both be able to
understand the content. The message must be complete, with all the details mentioned
so that the patient is well aware of the options. Both parties must give the message
clearly, so they each understand. Maintain eye contact while speaking and listening
and information given must be concise to eliminate unnecessary bias, opinions or
prejudices. The message should be stated in considerate terms, so that the recipient is
willing to accept it and it should be logically presented, to eliminate any confusion.
Nonverbal Communication

Nonverbal communication involves gestures and mannerisms without the spoken

word. We learn how to communicate without speaking as infants, through facial
expressions and body language. Smiling or frowning in response to emotions becomes
a subconscious reaction. Our culture and the environment in which we are raised
influence much of our body language.

You must be aware of the impact your nonverbal gestures have on relationships with
patients and be our feelings are often communicated without our feeling are often
communicated without our knowledge. Negative attitudes or thoughts can easily be
expressed, though perhaps unintentionally. Tone of voice, facial expressions and body
language communicate over 90 percent of the message.
Successful Communication

In effective communication, the sender matches verbal and nonverbal means of

conveying the message. Body language, facial expressions, and tone of voice should
all match the emotions that are conveyed verbally. Nonverbal messages are is the ones
the sender wishes to send, and are more to be likely accepted. Incongruence between
the two forms of communication will leave the recipient confused.

Congruence between the nonverbal and verbal message is also important so that the
recipient is less likely to misunderstand your nonverbal message.
Clustering is the grouping of nonverbal cues, such as facial expressions and body
language. Observe the recipient's facial expressions, gestures and tone of voice, as
these indicate their thoughts and emotions.
Facial Expressions

The eyes are the most important feature in the face for communicating nonverbally.
Joy, grief and understanding can all be reflected in the eyes. So that maintain eye
contact while communicating to reflect interest and involvement in the
communication. A lack of eye contact portrays inattention, but maintaining eye
contact for too long when inappropriate can make the recipient feel uncomfortable.
Touch

Touch can be one of the most effective means of communicating if used appropriately.
It can convey care, understanding and support and can comfort the recipient. It is
essential that the health professional understands the level of comfort of his patient
with respect to touch.

Touching is also an important part of many health professions. In most cases, your
patients will be aware that touch is necessary in examinations, and you will obtain
their consent for more sensitive examinations. However, some patients may feel
uncomfortable with being touched, which will require you to be sensitive.
Gestures/Mannerisms

Most people use their hands while communicating. Which can emphasize a point or
hold another's attention. Some common gestures are:

* Wringing of the hands: means nervousness and frustration

* Shrugging shoulders: lack of concern or interest
* Clenched fists: anger
* Fidgeting: nervousness and discomfort

Learn to recognise as they give you more of an indication of the person's true thoughts
and emotions than verbal clues.. Nonverbal communication also has greater influence
on others, as people are will to trust this more than the verbal message.
Building Relationships

Effective interviewing skills will enable you to build a trusting, emotionally

supportive and professional connection with the patient.

Considers first what is most important for the patient regarding their condition. There
will be increased patient compliance if they feel that they have been fully heard and
that their concerns have been understood. This allows the doctor and the patient to
build a partnership where the patient decides the course of treatment, which they will
more likely adhere to for the long term.

A poor leads to insufficient assessment and problematic management. Illness may

arouse feelings of anxiety, depression, fear and anger in patients and the experienced
health professional must address these emotions. A good tool to use in this case is
reflection on the patient's feelings, values and beliefs.

For example:

Doctor: You look a bit upset right now

Or

Doctor: I can see how if may be difficult for you to talk about this

Or

Doctor: I can see this is making you sad

In the Section II questions of the UMAT, you will easily be able to discount answer
options that ignore the patient's concerns and feelings, misunderstand the patient or
show impatience.

Legitimation is a tool similar to reflection, which communicates acceptance of the

patient's emotional experience. The doctor lets the patient know that what they are
experiencing is understandable. For example:

Doctor: It certainly makes sense why you would be sad under these circumstances.

Or

Doctor: Many people in similar situations find this difficult to deal with.
It is important that the patient feels he has support from his doctor. The doctor can
ensure the patient that he wants to help, by saying:

Doctor: I am here to listen and to be there for you in any way I can.

Or

Doctor: Let me know if there is any thing I can do to help.

Making an effort at establishing a partnership between himself and the patient, the
doctor will ensure patient satisfaction and adherence to the treatment and management
regime. The doctor can say to the patient:

Doctor: After we have discussed some of the issues of your condition, perhaps we
can look at some of the options which may help.

Educating the Patient

The main steps in educating a patient about his or her illness are:

* Extracting what the patient believes his or her symptoms may be caused by
* Explaining the basic diagnosis
* Responding to how the patient feels about the news
* Eliciting the patient's prior knowledge of the illness
* Detailing the diagnosis
* Checking that the patient has understood the problem and the
examination/treatment procedures.

Patients have concerns about the symptoms they are experiencing, which stem from
their cultural or social backgrounds or from prior knowledge or experience. Doctors
must obtains these data before providing the patient with a diagnosis. As a result, he
will be able to respond more readily to individual concerns at an early stage. Open-
ended questions are useful to obtain the patient's perspective, such as:

Doctor: Many patients have concerns about what might be causing their symptoms,
is there anything you would like to talk about?
When you explain the basics most of your patients will have little, understanding of
the biological and medical terms and functions. It is therefore best to assume that they
have heard of the condition or their symptoms for the first time. You should to explain
clearly and concisely using colloquial terms, without patronising or demeaning the
patient. Asking the patient to repeat what has been said in his or her own terms will
allow you to check their understanding and will help to clear up any of their
uncertainties.

Patients often have an emotional response upon hearing their diagnosis, especially if
they receive bad news. Their response may be nonverbal, such as facial expressions or
body language. you should make it clear that their expression of feelings is
acceptable and understandable. Reflection and legitimation are appropriate to in this
case.

For example,

Doctor: This low-saturated fat diet must be hard to like.

Patient: It's awful. It tastes like rabbit food.

Doctor: I can see why this is a real problem for you. Many patients feel the same
way.

Nonverbal communication from doctor to patient can be more effective than what can
be said with words. What we say can be subverted by our facial expressions or our
head movements, hand gestures, etc. In each case your body language should match
your verbal language. You can appear empathic with simple gestures such as leaning
in while talking, maintaining eye contact, not interrupting the patient while he or she
is talking, and focusing on what is being said. Remain within reach of the patient, if
the need arises to lend a comforting hand or a tissue. There should be no barriers
between you and the patient, such as a table or a computer screen, and that you sit at
eye-level with the patient. Some patients find touch a comforting gesture, while others
find it inappropriate and offensive. Be alert to each individual's feelings.

Your patient's body language can also say a lot about their emotions or thoughts.
Facial expressions reflect emotions such as interest, un-interest, boredom and
dissatisfaction. The tone of verbal language, the speed and the volume at which words
are said are all indicators of feelings and attitudes.
Listening to Patients

Most patients prefer the you to spend time listening to them during the consultation.
and this to a better understanding. Because time is often limited, you must ensure that
your listening skills are well developed. Poor listening leads to mistakes in diagnosis
and treatment, which can lead to disastrous clinical outcomes.

You should be quiet and pay attention to the patient while they are talking. Patients
often talk less than the doctor initially anticipates, yet doctors tend to interrupt within
the first 20 seconds of the patients' initial statements.

In summary:

* Sit or stand eye-level with the patient while listening. This shows interest and
patience.
* Listening requires that you are silent and that you do not interrupt the patient
while he or she is talking.
* Ask open-ended questions, e.g.
* Summarise the patient's story and ask for them to correct any mistakes or to fill in
any details you might have missed.

Avoid:

* Interrupting the patient and asking them to hurry their story along.
* Asking closed-ended questions, which require yes and no responses, which do
not allow the patient to open up.
* Not checking with them the date has given you.

A doctor with good listening skills will maintain eye contact with patients; he or she
will concentrate while listening, and will listen with a therapeutic ear. Listening
with a therapeutic ear involves reading between the lines while the patient is talking.
Identify the thoughts or feelings, which are indirectly presented. You should aim to
improve you listening skills so that you are able to understand the patient accurately
heard. Paraphrasing the patient's message, as discussed earlier, will aid you in
assessing your understanding of the case. This also allows you to gain feedback from
the patient.

For example,
 Doctor: What can I do for you today, Mrs. Smith?

Patient: Well doctor, I was walking down the stairs this morning and I fell to the
bottom and I was knocked unconscious for a while. When I came to I had a slight
headache, but my right hip seems to be getting more and more painful as the day goes
by.

Doctor: Just to make sure I have understood correctly, you fell down the stairs this
morning, you went unconscious after a head injury, your head feels fine now, but you
are most concerned about a painful hip, is this correct?

Patient: That is correct.

In this example, the doctor shows good listening skills, and was able to identify her
main concern which was her painful hip, although the head injury, which caused her
to become unconscious, may be more of a worry and acknowledge it.

While paraphrasing, however, you must be careful to only extract the most important
details, as repeating everything that the patient has said may cause the patient to feel
stupid. Do not self-conscious while listening to patients, as this takes the focus away
from the patient and nonverbal cues may betray this to the patient.

While listening to another's problem, many people have the tendency to want to fix
things. Doctors try this by giving prescriptions or advice. However, the patient
sometimes needs to be listened to, for their issue to be acknowledged.