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Effective Communication in Medicine

   

Added on  2019-10-09

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Case 1Good communication skills, not only about establishing a good rapport and a positive perception. I had a wonderful trainee when I was working in the army. My trainee was a very competent doctor with some valuable skills. During the induction all trainees will get the opportunity to sit with all GPs in the practice, observing the consultations. Every GP has their own unique style of consulting, and trainees get the opportunity to pick aspects that they feel appropriate forthem and adapting to formulate their own style of consulting. This Doctor was well loved by the practice staff and the patients. Everybody would comment about his politeness and ability to establish an excellent rapport with the patients. I was very pleased about the perception that he had built up within few days.Then it was time to have joint clinics, just before he was allowed to do his own consultations. I was very pleased to see how polite he was towards his patients. He will great them with a very attractive smile. He would ask the patient to sit and explain the problem. He would not disturb the patient until the patient finishes the story Which I found reallypositive. Then he will ask few relevant clinical questions and then he will examine the patient. Then he will come up with a diagnosis and will come up with a management plan. He would be very gentle and soft and polite throughout the consultation. But then I realized that there is something missing. He would not discuss with the patient and come to a joint agreed diagnosis. He would not agree with the patient. He would not give any options to the patient. Also he would not safety net. But maybe because of the way he consulted and also probably because he was a captain in the armed forces, patients were not questioning him and were always happy. Effective communication is essential to the current practice of medicine. A fundamental change in medical culture in this area has been the recognition and acceptance of the fact that the way in which health professionals communicate, on all levels, can be enhanced,
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irrespective of the innate and learned abilities they already possess.1As doctor Pawlikowska describes in her paper, the way we consult can be enhanced irrespective of innate and learned ability. First I wanted to convince myself. Is there a gap here? Is this something he is not aware of? Is this an unknown area of his learning? Even though he has been praised for his consultation approach there is always room for improvement. I felt that there is a need to explore his knowledge of consultation models. I am confident thatonce he is aware of the models and through experience he will develop his unique style. “There is no ideal consultation model, but the evolution of the various models over time is of particular interest as a practitioner develops their own unique consulting style.” 2I realized that his consultations were quite similar to Byrne and Long model. Doctor centered authoritarian style.Byrne and Long (1976) 3Establishing a relationship with patientDiscovering a reason for attendanceVerbal and/or physical exam Consider the conditionDetail treatment or investigationTerminate consultationI wanted to explore about his knowledge about consultation models. It would be good to explore whether he is aware of other methods that would be more appropriate and patient centered. Is this one of his unknown areas of learning according to Johare’s window? I quietly asked him about Consultation models. Even though he was aware of the models he wanted to stick with a regimental type model as he found it easy in a military setting. So I suggested it will be good for him to familiarize with other consultation models as well. Specially to read about Roger Neighbour’s and Pendelton’s models, models that clearly recommend engaging the patient in decision making and safety netting. 1Pawlikowska, T. et al., 2007. Consultation models. Learning to consult, p.178.2Pawlikowska, T. et al., 2007. Consultation models. Learning to consult, p.179.3Byrne PS, Long BEL. Doctors Talking to Patients. Exeter: The Royal College of General Practitioners; 1984 (®rst published HMSO; 1976)
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