Communication Skills in High-Stake Environment
- 1. Communication Skills in High-Stake Environment Department of Emergency Medicine, AIIMS, Delhi
- 2. Building a World-Class Emergency Department through Communication Department of Emergency Medicine, AIIMS, Delhi
- 3. A patient is a person seeking help, relief and reassurance Harrison Principles of Internal Medicine
- 4. Communication – a process • At birth child communicates by crying • A cognitive behavior • Can be good and skilled / poor and unskilled • Gesticulations / Histrionics / Verbal / Written / Body language / Electronic • Individual strengths and weaknesses to gesticulate, dramatize, verbalize, write or messaging
- 5. Communication – a process Encoder Information Transmitter Receiver Decoder Destination Noise Medium NoiseNoise Feedback
- 6. Effective Communication – 7 Cs 1. Clarity 2. Completeness 3. Coherence 4. Consciousness 5. Credibility 6. Correctness 7. Continuity
- 7. Ultimate Goal in Emergency Care Patient Safety Quality Emergency Care Patient satisfaction Communication
- 9. In the words of Edward Livingston Trudeau Cure sometimes Relieve often Comfort always
- 10. Emergency Room
- 11. Emergency Room • Uncontrolled environment • Congested, Large number of sick patients • Anxiety, Emotions are high • Police, Medico-legal cases • Long waiting lines for patients and relatives causing frustration • No privacy • Noise • Frequent interruptions • Rapid turnover of patients
- 12. Why Communicate? • For all the above reasons • Good communication influences patients’ health, symptoms, function and physiology • Time efficient & decreases inappropriate work-up • Inter-personal conflicts • Litigation • Enhances compliance and follow-up
- 15. Why Communicate • Collaboration to improve cooperation • Team Work = Quality Emergency Care • Non-technical skills as important as technical skills • Bad communication leads to stress, lack of job satisfaction
- 16. Highlighting Studies • Patient satisfaction not related to interview length Korsch etal • Patients presented all their concerns in average of 75 secs Langewitz etal • Discharge interview (5 min) increased compliance and follow up by more than 50% Waggoner etal • Patient satisfaction and willingness to return poor with poor explanation of problems Sun etal Korsch BM etal . Gaps in doctor–patient communication. Pediatrics 1968 Langewitz W etal. Spontaneous talking time at start of consultation in outpatient clinic. BMJ 2002 Waggoner DM etal. Physician influence on patient compliance: a clinical trial. Ann Emerg Med 1981 Sun BC etal. Determinants of patient satisfaction and willingness to return with emergency care. Ann Emerg Med 2000
- 17. Other Studies • Consistently show poor communication leads to poor satisfaction among patients • Patients were frequently interrupted • Patients consistently not given diagnosis and follow-up information in over 40% instances Rhodes KV etal. Resuscitating the Physician-Patient Relationship Emergency Department Communication in an Academic Medical Center. Ann Emerg Med. 2004.
- 18. Care provider-to-patient • Understand the agendas of our patients • Do we really know what the patient wants • Stand in our patient’s shoes • Strive for an authentic human encounter • Assess emotional distress • Communicate honestly and compassionately • Treat with kindness and respect
- 19. Care provider-to-patient Society for Academic Emergency Medicine • Early • Establish Rapport • Gather information • Give information • Provide comfort – Listening to distressed • Collaborate • Feedback to the communication
- 20. Care provider-to-patient • Transfer of cognitive data and emotional data • Balance the dialogue with a mix of cognition and emotion • Handle emotion by non-verbal expressions • Serious illnesses may lead to psychological morbidity • Address concerns to facilitate effective coping and reduce complaints
- 21. A sincere emergency care provider Best Non-Verbal Communication
- 22. High Yield Communication Early Communication Discharge Interview Address specific concerns. Why are you here today?
- 23. Breaking Bad News S P I K E S endorsed by American Society of Clinical Oncology and several other societies • Setting up the Scene • Assessing patients Perception • Patients Invitation to share the information • Giving Knowledge and information to the patient • Address patients Emotions & Empathize • Strategy and Summary
- 24. Care provider-to-Care provider ISBAR – Widely used for relaying clinical information. First used by US Navy I - Introduction of self S - Situation B - Background A - Assessment R - Recommendation Feedback to the conversation Acknowledgment Repeat History Plan of Action
- 25. Leadership • Leader needs NO TITLE • Everyone is a leader
- 26. Leading the Code Blue • Most senior/experienced person usually leads the code • Designating job to team members • Call people by name • Involving para-medical staff in active resuscitation • Closed loop communication • Team work should not require anyone to shout, everyone should be playing their part
- 27. Documentation • If not documented it never happened • ED notes - short, clear, crisp, dated and timed • Assessing the patient – Write notes A B C approach • Highlighting current issues and management and plan • Summarizing the events in few lines
- 28. Hand-Over • The summary in the medical notes • Physical handover over the patients’ bed • Print a list of patients • Highlight the priority patients • Be specific
- 29. All Talk and no Work! There has to be hard and sincere skillful delivery of the health care product Empathetic human resource Judicious use of technology to achieve the 3 goals of safety, satisfaction and quality care.
- 30. A bit of Empathy and a little bit of humor go a long way
- 31. I hear & I forget I see & I remember I do & I understand Chinese Proverb
- 32. Get to Work! Our Emergency patients do not need condolences Further problem identification is not required We need to Get interested and Get to WORK!