Praktek Komunikasi skill dalam kedokteran.ppt

communication skill ini medicine

1. Communication Skills
in Medicine

2. RECOGNITION OF THE PROBLEMS BY
HEALTH PROFESSIONALS
In recent years, some medical practitioners
have warned their colleagues of the trend away
from the “treatment of the human being”and
the “commitment to the patient.”
They recommend moving from a “problem
focus”to a “person focus.”
Dr. C. Everett Koop, former surgeon general,
stresses that health care professionals have a
“spiritual heritage of cherishing life”.
Gordon & Edwards 2006

3. What is Communication (Basic)
Is the act by which information is shared
between humans. Such encounter might
cover:
Desires
Needs
Perceptions
Knowledge
Affective states

4. Medical Communcation
Medical communication is the usual
communication encounter between
doctor and the patient
It can be classified according to the
purpose of the interview into 4 types
–History taking
–Consultation
–Obtaining “Informed Consent”
–Breaking bad news

5. Why do We communicate
(basic)
To inform, educate , teach, train, counsel
To influence, persuade, change
To research, investigate, explore
To solve problems, negotiate, make
decisions
To collaborate, build teams, raise morale
To motivate, inspire
To manage, supervise, control

6. Why do We communicate
(basic)
To offer support, concern and
compassion
To build relationships
To seek friendship and affection
To entertain
To seek intimacy

7. Ethics in Doctors Patients
Communication
The stern face of Professional Ethics
Highest Level Principles
Transparency
Does The Truth Hurts
Making Choices about Communicating The Truth
The Ethics and Problems of Altruism
Take care of The Staff
Making Demands
Authority and Power in Healthcare Relationship

8. Values in Medical Ethics
(the duty of health professionals)

9. Values in Medical Ethics
Respect for Autonomy(“Valutas
Aegroti Supremalex”)
Beneficence(“Salus Aegroti
Supremalex”
Non-Malificence(“Primum Non
Nocere”)
Justice
Do not guarantee ”cure”

10. The ability to communicate well
with patients to build up a
trusting relationship within which
curing relieving and comforting
can take place, is a great challenge
Why good medical communication
is important? better care for our
patients
Sir Charles Fletcher

11. Dissatisfaction with Doctor-Patient
Relationships
Communication, between patients and health
professionals, is seen as the core clinical
procedure for diagnosing, treating, and caring
for patients.
Patient’s satisfaction is strongly influenced by
the quality of the communication that occurs.
Studies show that patients’dissatisfaction can
seriously reduce their compliance with their
treatment regimen.
Gordon & Edwards

12. Dissatisfaction with Doctor-Patient
Relationships (continued)
Dissatisfaction in communication can
trigger patient doubts about the
competence of their physician.
It can negatively affect how long it takes to
recover.
It can increase the frequency of patient
malpractice sue.

13. Patient-Doctor Communication
Fundamental Skill for Medical
Practice
Primary Expectation Clinical/
Surgical Competence
Secondary Expectation 
-Professional
-Respectful
-Polite
-Sincere
-Interested
-Communication Skill

14. Basic Element in Medical
Interview or Interaction
Initial Encounter
-Be Prepared
-Make “eye contact
-Build rapport
-Have “a seat”
-Let the patients tell their story

15. Basic Element in Medical
Interview or Interaction
CONDUCTING THE INTERVIEW
-Open ended questions
-Direct/ close ended question
-Ask “one question” at a time
-Keep interview “organized”
-Learn about the patient
-Encourage patient to ask questions
-Listen to the patient

16. Basic Element in Medical
Interview or Interaction
Responding to Patient
-Pay attention to clues (verbal or
non verbal
-Avoid judgmental language or
behavior
-Provide encouragement
-Build Partnership
-Be aware of your non verbal
cues

17. Basic Element in Medical
Interview or Interaction
EDUCATING, NEGOTIATING AND
COLLABORATING WITH PATIENTS
-Avoid the use of “medical jargon” or
“abbreviations”
-Ascertain, patient understand information
you provide
-Elicit patient’s feeling or concern
-Collaborate with patient
-Discover potential “barriers”

18. Basic Element in Medical
Interview or Interaction
CLOSING THE INTERVIEW
-Summarize the encounter
-Answer patient’s questions
-Confirm partnership
-Provide your initial “thoughts”
-Discuss the next steps

19. Basic Skeleton of Doctors &
Patients Communication
The Nature of the situation, what is
patient’s requirement?
Do I like this patient?
Who is this patient?
What is this patient’s problem? Is this
patient really sick?
What further test or procedures are
necessary to reach the diagnosis

20. Basic Skeleton of Doctors &
Patients Communication
What is the patient’s reaction to the
diagnosis or lack of diagnosis
What resources do I have available to
help this patient solve their problem?
Within those resources options, what
resources are available for this patient
What is the patient’s view of the options
and their consequences
What therapy or course of action can we
jointly agree?

21. Basic Skeleton of Doctors &
Patients Communication
What needs to be done by Doctor or
other Health Providers, beyond
healthcare for the patient and family?
How can risk be minimized, safety
enhanced and adherence encouraged?
What plans need to be made for future
contingencies and contact
What else (can be done) concerning the
patient
Is the patient leaving with a clear grasp
of the main issue.

22. DOCTORS –PATIENTS RELATIONSHIP.
Not anymore paternalism
Should be partnership basis.
Doctor-Patient collaboration vs health
problem
Equal

23. The most frequent patients complaints
about doctors
Doctors would not listen
Doctors would not give information
Doctors showed “lack of concern & lack of
respect for the patients”
Lloyd and Bor, 1996.

24. Essentials of Patient Care
Physician Patient
Art & Science of Medicine
Communication
Medical History
Physical Exam.
Literature & Art in Medicine
Hagen & Pauly 2006

25. Communication Skills
To diagnose and treat diseases
To establish/ maintain a therapeutic relationship
To offer information and educate

26. In Medical Communication
You must demonstrate
-Respect
-Genuineness
-Empathy
These skills can be learned with practice

27. Respect
Maintain privacy
Keep doors and curtain closed
Acknowledge and greet others in the
room
Maintain a professional appearance –
clean, neat, “conservative”, name tag
(professional authority)

28. Respect
Make sure the patient is comfortable
Sit at the patient level
Be aware of the patient’s personal space (can
vary among cultures)
Continue to consider the patient comfort during
history taking and physical examination

29. Respect
Appear interested and ready to listen
Use your posture to do this
-S --Sit square to the patient
-O --Open to the patient
-L --Lean toward the patient
-E --Eye contact with the patient
-R --Relax

30. Genuineness
The ability to be yourself in relationship despite
your professional role

31. Genuineness
It is OK to laugh at patient’s jokes
If patient’s spouse has died you might say: “I
am sorry to hear that. How are you doing?”
Show your true interest in the patient

32. Empathy
Is the ability to understand the patient’s
experiences and feeling accurately as
well as to demonstrate that
understanding to the patient
Is an active process
Is more than sympathy, or feeling sorry
for someone

33. Empathy
If you are empathetic you will maximize your
ability to gather accurate and objective data
about patient’s thoughts and feelings

34. Empathy
Observe the patient
Pay attention to the patient’s nonverbal
communication
Is the patient looking away, fidgeting or leaning
away from you while he or she talks?

35. Empathy
Don’t interrupt
In one study 69% physician interrupted patients
within 18 seconds
77% of patients didn’t get to fully explain their
problem

36. Empathy
Enhance empathy by the way you respondto
what the patient says
Show the patient you have been listening to the
content of their problem
Show the patient you understand their
perspective on the problem

37. Empathy
Do not ignore what the patient says
Avoid minimizing his or her symptoms
Instead, reflect back to the patient

38. Communication
To solve problem
To alleviate distress
To make Decision
To form & maintain
relationship
Reassurance
To Convey Feelings
To give
information
To persuade
Communication Purposes (Lloyd & Bor, 1996)

39. Beginning an Interview?

40. Patients Expressionease
the interview
A comfortable setting
Being greeted by name & handshake
Being shown where to sit
The interviewer introducing her/himself &
explaining the procedure
An easy first question
The Interviewer appearing interesting in
your remarks

41. Factors Influence Doctors –Patients Communication
Patient Related Factors
-Physical Symptoms
-Psychological Factors anxiety, depression, anger, denial
-Previous Experience of medical care
-Current experience medical care
-PTSD
Doctors Related factors
-Training in communication skills
-Self Confidence in ability to communicate
-Personality
-Physical factors (“tiredness”)
-Psychological (“anxiety”, PTSD)
The Interview Setting: Requirements
-Privacy
-Comfortable surrounding
-An appropriate seating arrangement

42. Guidelines For Conducting an Interview
Ending The Interview
-Summarize what patient has told you and ask if your
summary is accurate
-Ask if they would like to add anything
-Thank the patient

43. By Understanding The Whole
Process in Medical Communication
BETTER COMMUNICATION
-Clearer
-More effective & efficient communication
-Honesty & openness.
-Trust
-Mutual respect
-Politeness
-Adherence
-Collaboration.
-More accurate information
-Prevention of violent situation
-Informed consent
-Legal aspects

44. BREAKING BAD NEWS….
CONDITIONING
PLANNING
EXPLANATION

45. Bad News
Inevitable part of medical practice
Not widely taught in medical schools
Studies how patients/ families cope with bad
news “not the process of breaking bad
news”
Bad news is a relative concept & should
depend on patient’s interpretation of
information & their reaction to it where
patients feel the news will adversely affect
their future

46. Conditioning…families
step by step….
Family learns to accept
the bad situation

47. Why is it difficult to break “bad News”
The messenger may feel responsible and fears being blamed
Not knowing how best to do it
Possible inhibition because of personal experience of loss
Reluctance to change the existing “doctor-patient relationship”
Fear of upsetting the patient’s existing family roles/ structure
Not knowing the patient, their resources & limitation
Fear of the implications for the patient (disfigurement, pain, social and
financial losses)
Fear of the patient’s emotional reaction
Uncertainty as to what may happen next and not having answers to some
questions
Lack of clarity about one’s own role as a health care provider
Lloyd and Bor, 1996

48. Managing difficult situation in breaking bad news
To whom should bad news be given
Who should give bad news
When should bad news be given
How much bad news should be given
Should you give hope and reassurance along
with bad news

49. How to give “bad news”
Personal preparation
The Physical Setting
Talking to patient and responding to concerns
Arranging for follow-up or referral
Feed and handover to colleagues

50. KEY CORE SKILL FOR BREAKING BAD NEWS
EXPLANATION & PLANNING.
Preparation
Summarizing
Negotiating the Agenda
Listening
Picking up Cues
The use of Silence
Discovering the patient’s concern and ideas
Encouraging the expression of feeling

51. Conclusions
Doctors need good communication in
Breaking Bad News
Bad News is something, doctors can not
avoid
Doctors have to learn and to practice
how to break bad news
Breaking bad news will start from
“conditioning (if you have time), planning
and explaining” to patient and family

52. Thank you