Professional Development

Introduction to Communication Skills

The doctors basic tool kit was defined by the ancient Greeks and is still applicable today:
- the herb (pharmaceutacals)
- the knife (surgical intervention)
- the word (communication)

The four essential components of clinical practice are:
- communication skills
- knowledge
- physical examination skills
- problem solving skills

Patients often tell their doctor what they think s/he wants to hear. Doctors need the ability to:
- speak so patients listen
- listen so patients speak

Receptive vs. expressive communication
- has to do with direction of communication
- receptive = listening
- expressive = talking

Communication Maxims:
1. You cannot not communicate
- verbal communication (talking) is not the only form of communication
- just because someone isn’t talking, doesn’t mean they aren’t communicating

2. The message sent is not always the message received
- patients often don’t ask for clarification – they don’t want to look silly or take up the doctor’s time
- good communication means ‘checking’ with the listener for their understanding of the message

3. People seldom see things the same way
- people come from different backgrounds, cultures, subcultures, family experiences, perceptions, value systems etc
- there is a danger of making assumptions that people will know what we know

4. There is a difference between fact and opinion
- most conversations are actually opinion

Why learn communication skills?
- major source of patient complaints – 90% of formal complaints are due to miscommunication
- a doctor will have upwards of 200,000 consultations in his/her career, but for the patient, it may be their first one. There is the danger of the doctor overlooking the significance of the event for the patient.
- to ensure we get the correct information from patients – this is needed to formulate correct diagnoses and design efficacious treatment plans
- these skills can be taught, learned and practiced
- a patient’s impression of medical competence is based on the quality of the doctor-patient relationship
- doctors with better communication skills report higher job satisfaction for longer periods
- essential for patient wellbeing

These notions are supported by research:
- the patient is more likely to sue if the doctor is not perceived as caring and compassionate
- effective communication has been shown to enhance patient wellbeing and health outcomes
- “being heard” is the greatest determinant of patient satisfaction and judgement of medical competence.

- all medical procedures increase patient anxiety
- when anxiety increases, attention decreases
- anxiety impedes attention, memory and recall
- it is lucky if a patient recalls 25% of information from a GP consultation 15 minutes afterwards!
- This can have obvious detrimental impact on patient adherence to treatment plans.

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