Development of competencies for doctor-patient communication

Dr Gediminas Raila, MD, PhDKaunas University of Medicine, Kaunas, Lithuania

Patient consultation

Good communication between people, whether it happens in the context of a consultation with the patient, a conversation with a colleague or a request to the manager, is key for successful health promotion.

Patient consultation. Questions to think about:

• What is your basic attitude towards the people you work with?

• Do you accept them on their own terms or do you judge them by your own standards?

• Do you encourage people to be independent, make their own decisions, solve their problems without interfering?

Consultation problems

1. Partnership or one-way process. Accepting and judging, autonomy and dependency.

2. The doctor-centred or patient-centred consultation approach.

3. Communication barriers: verbal and non-verbal barriers that affect communication.

4. Patient motivation and resistance.

Small group tasks:

1. Planning a group meeting

2. Identifying non-verbal communication that affects interpersonal communication

3. Helping people to talk

4. Improving patient motivation

Topics to think about

Planning a group meeting

• Identify the health problem you are going to change.

• Think about the best place, time and physical features of the meeting room.

• Think about the lecturer aims for the first meeting.

• List the objectives for group members for the first meeting.

Planning a group meeting

Make a plan for what you will do:

1. As people start to arrive.

2. To get people to get to know one another.

3. For the main part of the group meeting.

4. To round off the meeting at the end.

5. To evaluate whether you have achieved your objectives.

Non-verbal communication Describe the main categories of non-verbalcommunication according to the following list:1. Bodily contact2. Proximity3. Orientation4. Level5. Posture6. Physical appearance7. Facial expression8. Hand and head movements9. Eye contact10. Non-verbal aspects of speech

Non-verbal communication

Think about which physician’s non-verbal behaviour was associated with better patient satisfaction and better communication.

Non-verbal communication

Describe your feelings as a patient when: 1. The doctor frequently touches your hand.

2. The doctor is standing and talking to you from too far away.

3. You are having a conversation while one of you is sitting and the other is standing.

4. You are holding a conversation with a doctor but neither of you are looking at one another.

Helping people talk

• Please describe the physician’s verbal behaviours promoting positive interpersonal relations.

• Think about the physician’s verbal behaviours that enhance information exchange.

• Describe the consultation techniques that encourage people to talk.

Improving patient motivation

• Describe the factors that influence the patient’s behaviour. Think about predisposing, enabling and reinforcing factors.

• Focus on the practical and circumstantial factors that might inhibit motivation (e.g. patients’ understanding of the health issues, their belief in their ability to change, cultural and gender differences).