PATIENT COMMUNICATION AND COUNSELLING

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PATIENT COMMUNICATION AND COUNSELLING:

MUHAMMAD AHMAD MAHMOOD PATIENT COMMUNICATION AND COUNSELLING

HEALTH CARE:

HEALTH CARE Complicated interaction of at least following elements;

Communication:

Communication Exchange (sending & receiving) of information, opinions or ideas so that material communicated is completely understood by everyone concerned. OR Exchange of message between people for the purpose of achieving common meaning.

Types of communication:

Types of communication Mass communication (TV, radio) Small group communication Large group communication One-to-one (interpersonal) communication

Components of communication:

Components of communication Inter personal communication model Sender Message Receiver Feedback Barriers

Benefits of communication:

Benefits of communication Establish a relationship with patient Development of trust and confidence Demonstrate care for patient Adherence to treatment

PowerPoint Presentation:

Patient satisfaction Helps patient to take and manage their medication. Minimize risk of problems associated with S/E, ADR and future non-compliance.

Outcome improved with better communication:

Outcome improved with better communication Better symptom resolution Psychological distress reduced Health and functional status improved Good control over blood pressure, pain and patient anxiety. (a review by Stewart M 1995)

Standards of Effective Communication:

Standards of Effective Communication Complete Communicate all relevant information Clear Convey information that is plainly understood Brief Communicate the information in a concise manner Timely Offer and request information in an appropriate timeframe Verify authenticity Validate or acknowledge information

Modes of communication:

Modes of communication Verbal communication Non-verbal communication Written communication Electronic communication

Verbal communication:

Verbal communication It includes use of actual words for communication. They denote the literary meaning of actual words. Word selection

Non-verbal communication:

Non-verbal communication “A large measure of how you relate to others and how they relate to you is not based on what is said , but on what is not said.” Words normally express ideas, whereas non verbal expressions convey attitudes and emotions.

PowerPoint Presentation:

Non-verbal behavior is more powerful than verbal. Many behavioral scientists reported that approximately 55% to 95% of all communication can be attributed to non verbal sources. Voice quality (tone, pitch, fluency, speed & volume)

Kinesics :

Kinesics The manner in which arms, legs, hands, head, face and torso may have a dramatic impact on the message that you send.(body language) Gestures Facial expressions Eye contact Physical contact Body posture

Proxemics :

Proxemics Distance between two people People reserve most protected space (within 18 inches of their body) ………. Private zone You want to stand close enough to ensure privacy, yet at the same time provide enough room so that patient feels comfortable. Type of instructions also determine the distance.

Environmental non-verbal factors:

Environmental non-verbal factors Color used in pharmacy Cleanliness Clutter General untidiness Appearance of pharmacy professionals Layout of pharmacy

PowerPoint Presentation:

How to be a skilled non-verbal communicator?

Written communication:

Written communication Labeling Leaflets Brochures Medication chart

Electronic communication:

Electronic communication (A) Telephonic Maintain confidentiality End on positive note Document Start with friendly greeting Avoid interruptions

PowerPoint Presentation:

(B) Internet Although patients have increased access to information via internet yet they lack ability to judge quality of information obtained. More internet usage among younger and richer people. It can’t be used in urgent and time-critical situation.

PowerPoint Presentation:

Don’t use all uppercase letters. Don’t refer to a third person. Cc should know why copy is sent to him and what is expected in response. Re- read before send the message. Ask patients to provide and acknowledge receipt of message. Use automatic signature.

Barriers of communication:

Barriers of communication Physical barriers Environmental barriers Personal barriers Pharmacist related Patient related

Physical barriers:

Physical barriers Height of prescription counter Necessity Impression over patient “both communicator should be at eye level to enhance verbal and non- verbal communication.”

Environmental barriers:

Environmental barriers Crowded or busy pharmacy Noise Privacy “evaluate things from the other person’s perspective”.

Pharmacist related:

Pharmacist related Lack of knowledge Low self-confidence Shyness Internal monologue Cultural differences

PowerPoint Presentation:

Discomfort in sensitive situations Emotional objectivity Attitude Negative perception about value of interaction Failure of empathy

Strategies used by clinicians to distance themselves from patients:

Strategies used by clinicians to distance themselves from patients Selective attention Normalizing Premature assurance Switching the topic Passing the buck Physical avoidance (2000)

Patient related:

Patient related Not considering pharmacist as knowledgeable and trustworthy. Considering health care system impersonal. Feeling that their physician would have told them everything about their condition and medication. Considering prescription label information sufficient.

PowerPoint Presentation:

Inferiority Anxiety Conflicting information Misconceptions Forgetfulness Reluctance to disclose their concern Impaired faculties of communication

Time barriers:

Time barriers Inappropriate time Situation is more critical in institutional settings

Counseling :

Counseling Giving clients the opportunity to explore, discover and clarify ways of living more resourcefully and towards greater well being. It is a key competency element of Pharmaceutical Care process.

The medical interview:

The medical interview It is a complex and ongoing process. No two interactions are exactly same because sequence of events and the people involved are never exactly the same.

Components :

Components Listening Use of silence Probing

Phases (process) of counseling:

Phases (process) of counseling Starting or opening Exploring and focusing Giving information Ending or closing interview

1-Starting or opening:

1-Starting or opening First impression is critical. It is polite to rise, look at the patient, establish an eye contact and shake hands if appropriate. Greet them and find out the way the patient prefers to be addressed. Purpose of interview should be stated in terms of patient benefits and indicate how long interview will last.

2-Exploring and focusing:

2-Exploring and focusing Taking a full history Nature of key problem Date of onset Development over time Precipitating factors Impact on patient life Availability of support Support given to-date

PowerPoint Presentation:

Clinician is a drug while clinical empathy is a procedure. Empathizing Pt. experiences being seen Pt. experiences being heard Pt. experiences being accepted Show self-disclosure

3-Giving information:

3-Giving information Use a logical sequence Talk about one thing at a time Use simple language Information should be direct and detailed Prepared information can also be used

PowerPoint Presentation:

Patient adhere best to suggestions about investigation and treatment as a result of: A frank exchange of information A negotiation of options Involving the patient in decision

4-Ending or closing interview:

4-Ending or closing interview It is a crucial part of interview as evaluation is based on the final statements. People seem to remember best what was said lost. Care should be taken not to end the interview abruptly or to rush the patient out the door. It is the “final verification of patient understanding”.

PowerPoint Presentation:

“I want to make sure I have explained everything clearly. Please summarize most important things about medication”. When you get home, how are you going to take this medication”. “Please restate the plan” “Can you help me remember what we have agreed to do?”

PowerPoint Presentation:

A brief summary allows both parties the opportunity to review exactly what has been discussed and clarify any misunderstanding.

PowerPoint Presentation:

Ending is a good for patient encouragement and reassurance about a problem. Avoid false reassurance. Closing sign: “Do you have any further question?” “I have enjoyed talking with you. If you have something you forgot to mention or have questions when you get home, please give me a call”.

Interviews in which difficulties are expected:

Interviews in which difficulties are expected Patient with impaired faculties for communication Cultural differences Breaking bad news Angry patients Non-compliant patients “Heart-sink” patients

Other challenges:

Other challenges Language barrier Personalities Workload Varying communication styles Conflict Shift change

Improving communication:

Improving communication Activity in small group of learners Experimental methods i.e. learning by doing it, not by reading manual. Like any other human activity, communication skills need to be experienced regularly. Self evaluation at end of each interview helps to determine what went well what could have been done differently.

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