Communication skills

Key communication skills

Let parents express in own words

Observe non verbal clues

Encourage the patient to continue speaking

Establish eye contact

Active listening

Verbal communication

• What to say ?

How to say?

Whom to say?

When to say?

What you should not say?

Important points in communication

• Feel good about yourself

Learn to avoid using ‘I’ and ‘ME’

Instead use ‘YOU’ and ‘WE’

Pause, pace, pitch, and voice modulation

The SOFTEN technique

S = smiling

O = open body posture

F = friendly energy

T = touching while talking

E = eye contact

N = nodding in affirmation

Non verbal communication (body language)

• Eye contact

Facial expressions

Communication pitfalls

• Using highly technical language

Not showing appropriate concern

Not listening

Failing to verify whether understood

Displaying apathy

Telephonic consultation

Issues related to telephonic consultation

Convenient for parents (too much time and

energy spent to see the doctor – just for few

minutes)

Convenient for doctors (quality time for

clinic patient - improves outcome)

Should be selective and safe

Must develop methods to avoid interference

Telephonic consultation – when?

Minor problem that may not require

physical examination

Follow-up report after initial consultation

First aid advice in an emergency till

parents reach the doctor

Telephonic consultation when not?

Patient not known (not a regular patient)

Acute illness in neonate or young infant

When condition can not be judged properly

(exaggerated or ambiguous statements by

parents / symptoms potentially serious such as

excessive crying or lethargy / chronic problems)

Telephonic consultation when not?

When specific therapy may be

necessary

When parents insist on being seen

(even when you feel otherwise)

Ideal way

Have a trained doctor to attend phones who

follows preformed protocol (even simple advice

needs your Ok / you speak if parents insist)

Monitor conversation; intervene if necessary

Insist on talking to a treating doctor if patient is

already under treatment

Legality issues? – ideally need for

documentation of telephonic advice?

Counseling parents of children who are not

improving

General rule

Counseling is an art

Depends on communication skills

Explain in simple language using similes related to common life situations (drug may not work even when chosen correctly – pencil does not write if given to newborn)

General rule

Use words cautiously – ABC – accurate / brief / clear

Balanced statement of prognosis

“Patient” hearing and repeated explanation

Acute serious illness

At first visit, explain details of illness

and its evolution to present serious

stage

Do not find faults with previous

therapy (pneumonia who came in with

hypoxia)

Acute serious illness

Instill hope and confidence (many such

children improve) with subtle hint (few

may develop problems, let’ s hope we

don’t face it)

Estimate time and course of

improvement – wait for sustained

progress before announcing

Acute serious illness

Explain each move from time to time before

implementing if possible

More the serious illness and not improving,

more we must talk to parents

Do not show anger, frustration, rudeness or

diffidence – be “patient” and tolerant to

parental outbursts

Offer an option of second opinion

Acute illness in office practice

Spend adequate time; explain problem,

anticipated course, and its rational

management

Convince parents about safety of observation

with minimal action (are you sure, is the

question that needs confident answer)

Acute illness in office practice

Be transparent; spell out what you

don’t know but add that you know

how to know!

Document provisional diagnosis and

its basis with instructions for therapy

and follow-up

Chronic disease

Explain in details (like teaching session)

Describe all the options of investigations and

management ( MR / asthma / JCA / epilepsy)

Discuss pros and cons of treating and not

treating or different modes of therapy

Chart out anticipated course on compliant

therapy, limitations of “cure”and adverse drug

reactions along with monitoring modalities

Chronic disease

Leave the choice of other systems of

medicine to parents and do not criticize

(but emphasize on transparency, access

to unbiased information and evidence

based approach in allopathy)

Managing death

It is said that -

If one looses a parent, past is lost

If one looses a spouse, present is lost

But if one looses a child, future is lost

Hence parents cannot tolerate death of a

child – they need support

In the event of death anticipated

Ensure that senior doctor is a

spokesperson and not juniors or resident

doctors (other doctors must repeat what

senior has talked)

Parents must be subtly warned about

non-improving situation (we are trying our

best but so far there is no improvement)

In the event of death anticipated

Confide in 1-2 close relatives about

the inevitable unfavorable outcome

Let parents be a witness to

continuous monitoring and

necessary interventions

In the event of death

Do not announce death suddenly (condition

is worsening though we won’t give up / next

half an hour is crucial, if there is no

improvement by then, we may not make it)

When death is announced, let parents vent

their feelings (we are sorry we could not

save your child)

In the event of death

Ensure every help to ease the situation

Consider the possibility of subsequent

discussion with parents to make them feel

that everything possible was tried and

that they had not faulted

Summary

Counseling is an art – not taught in medical

school – make an effort to learn

It should not be a casual approach -

especially in serious conditions, ideally

carried out in a specified place with privacy

and not in a hurry

More the serious nature of the disease, more

should be the “talking”