Dr. Martha Carmichael Dr. Martha Carmichael MD, M.Sc., FRCPCMD, M.Sc., FRCPCFellow in Geriatric Medicine, University of Toronto Fellow in Geriatric Medicine, University of Toronto

Dr. Samir K. Sinha Dr. Samir K. Sinha MD, DPhil, FRCPCMD, DPhil, FRCPCPeter and Shelagh Godsoe Chair in Geriatrics and Director of Geriatrics Peter and Shelagh Godsoe Chair in Geriatrics and Director of Geriatrics Mount Sinai and the University Health Network HospitalsMount Sinai and the University Health Network HospitalsAssistant Professor of Medicine,Assistant Professor of Medicine,University of Toronto and the Johns Hopkins University School of MedicineUniversity of Toronto and the Johns Hopkins University School of Medicine

Health PEI - Making the Connection ConferenceHealth PEI - Making the Connection Conference15 October 201515 October 2015

Twitter: @DrSamirSinhaTwitter: @DrSamirSinha

Tips to Master More Tips to Master More Effective Communication Effective Communication with Patients and with Patients and Caregivers.Caregivers.

Helps prevent medical errors. Better outcomes for patients and caregivers.

Strengthens provider-patient/caregiver relationships. Increases patient/caregiver and provider satisfaction.

Helps make the most of limited interaction time for all those involved.

National Institute on Aging. 2011.

Why is Effective Communication Why is Effective Communication is Important…is Important…

Misunderstandings Are Common Misunderstandings Are Common From Our Interactions…From Our Interactions… Medical terminology is often poorly understood.

Health Providers… Underestimate patients/caregivers’ needs for information. Overestimate patients/caregivers’ understanding of

information.

“You could die from this disease”. 46% disagreement (!)

Misunderstandings can cause the entire encounter to fail. Lerner et al. 2000; Hancock et al. 2007; Fried et al. 2003.

With Older Patients…With Older Patients… Health Care Professionals are felt to be:

More condescending, authoritative Less patient Spending less time, giving less information

Older Patients and Caregivers: Don’t ask questions, don’t want to be a bother May withhold symptoms that they think are “normal” Are more afraid to challenge their provider’s thinking.

Gerontological Society of America. 2012.

Older Patients Are Unique…Older Patients Are Unique… Often have Complex Health and Social Care Needs

More health problems, medications, community supports

Heterogeneous – No two are the same… Life Experiences, Ethno-Cultural Background, Education Fit vs. Frail

Age-Related Changes May Be Present: Sensory Deficits: Hearing or Vision Impairments (25%) Slower Processing Speeds to Understand Things Decreased Functional Capacity. Cognitive Impairment May Be Present

“At a time when older patients have the greatest need to

communicate with their health-care providers, life and physiologic changes make it the most difficult”

Robinson et al. 2006.

Familiar Scenarios?Familiar Scenarios?

Gerontological Society of America. 2012.

You are talking with an older woman who you think may have a hearing impairment. You talk louder, but she still seems to have

some problems hearing and understanding you.

As you talk with an older man and his wife who is caregiver, you get the feeling that neither of them really understand you, despite assuring you that they do when you ask them. When you explain

things again, they simply smile and nod their heads “yes”.

You are in the middle of an encounter that seems to be going well. All of a sudden, you sense that the older person has become quiet and withdrawn. You know you did something to contribute to the change in their demeanor, but you just can’t figure out what.

The Good News…The Good News… Good Communication IS a teachable skill!

Learning and Using Effective Communication Skills Leads to Improved… Communication with Patients and Caregivers One’s Ability to Build and Assess Relationships Time Management More satisfying relationships Become more skilled at managing patients’care

National Institute on Aging. 2011.

Not Specific to Physicians…Not Specific to Physicians… NPs, RNs, LPNs Home Support Workers, Resident Care Workers,

Community Support Workers Managers Social workers Occupational Therapists Physiotherapists Dieticians Reception/Administrative Staff

Our Challenge Today…Our Challenge Today…

Start Where You Are Comfort level varies

Remember “One Size Fits All” Does NOT Apply Individualize An Approach that Works for YOU!

Embrace and Use These Basic Tips!...

Tips to Master Tips to Master More Effective More Effective Communication…Communication…

Tip #1: Tip #1:

Allow extra time for older patients.Allow extra time for older patients.

Tip #2: Tip #2:

Avoid distractions.Avoid distractions.

Tip #3: Tip #3:

Sit face to face.Sit face to face.

Tip #4: Tip #4:

Maintain eye contact.Maintain eye contact.

Tip #5: Tip #5:

Listen.Listen.

Tip #6: Tip #6:

Speak slowly, clearly and loudly.Speak slowly, clearly and loudly.

Tip #7: Tip #7:

Use short, simple words and sentences.Use short, simple words and sentences.

Tip #8: Tip #8:

Stick to one topic at a time.Stick to one topic at a time.

Tip #9: Tip #9:

Simplify and write down your Simplify and write down your instructions.instructions.

Tip #10: Tip #10:

Use charts, models and pictures.Use charts, models and pictures.

Tip #11: Tip #11:

Frequently summarize the most Frequently summarize the most important points.important points.

Tip #12: Tip #12:

Give patients an opportunity to ask Give patients an opportunity to ask questions and express themselves.questions and express themselves.

Our Takeaways Today…Our Takeaways Today… Start Where You Are + Practice Makes Perfect!

Individualize an Approach that Works for YOU!

Effective Communication Benefits EVERYONE!

Effective Communication is Often Simple, Honest and Straightforward in Its Approach.

Every Patient and Caregiver is Unique and Requires an Individualized Approach.

Thank YouThank You

Samir K. Sinha MD, DPhil, FRCPCPeter and Shelagh Godsoe Chair in Geriatrics and Director of Geriatrics Mount Sinai and the University Health Network HospitalsProvincial Lead, Ontario’s Seniors Strategy

ssinha@mtsinai.on.ca @DrSamirSinha@DrSamirSinha

ReferencesReferencesFried et al. 2003. Prognosis communication in serious illness: Perceptions of

older patients, caregivers and clinicians. JAGS. 51:1398.Gerontological Society of America. 2012. Communicating with older adults:

An evidenced based review of what really works.Hancock et al. 2007. Discrepant perceptions about end of life communicatio:

A systematic review. Journal of Pain and Symptom Management. 34(2):190.

Lerner et al. 2000. Medical Communication: Do our patients understand? American Journal of Emergency Medicine. 18(7): 764.

National Institute on Aging. 2011. Talking with your older patient. Robinson et al. 2006. Improving communication with older patients: Tips

from the literature. Family Practice Management.