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Communication skills
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Key communication skills
Let parents express in own words
Observe non verbal clues
Encourage the patient to continue speaking
Establish eye contact
Active listening
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Verbal communication
• What to say ?
How to say?
Whom to say?
When to say?
What you should not say?
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Important points in communication
• Feel good about yourself
Learn to avoid using ‘I’ and ‘ME’
Instead use ‘YOU’ and ‘WE’
Pause, pace, pitch, and voice modulation
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The SOFTEN technique
S = smiling
O = open body posture
F = friendly energy
T = touching while talking
E = eye contact
N = nodding in affirmation
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Non verbal communication (body language)
• Eye contact
Facial expressions
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Communication pitfalls
• Using highly technical language
Not showing appropriate concern
Not listening
Failing to verify whether understood
Displaying apathy
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Telephonic consultation
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Issues related to telephonic consultation
Convenient for parents (too much time and
energy spent to see the doctor – just for few
minutes)
Convenient for doctors (quality time for
clinic patient - improves outcome)
Should be selective and safe
Must develop methods to avoid interference
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Telephonic consultation – when?
Minor problem that may not require
physical examination
Follow-up report after initial consultation
First aid advice in an emergency till
parents reach the doctor
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Telephonic consultation when not?
Patient not known (not a regular patient)
Acute illness in neonate or young infant
When condition can not be judged properly
(exaggerated or ambiguous statements by
parents / symptoms potentially serious such as
excessive crying or lethargy / chronic problems)
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Telephonic consultation when not?
When specific therapy may be
necessary
When parents insist on being seen
(even when you feel otherwise)
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Ideal way
Have a trained doctor to attend phones who
follows preformed protocol (even simple advice
needs your Ok / you speak if parents insist)
Monitor conversation; intervene if necessary
Insist on talking to a treating doctor if patient is
already under treatment
Legality issues? – ideally need for
documentation of telephonic advice?
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Counseling parents of children who are not
improving
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General rule
Counseling is an art
Depends on communication skills
Explain in simple language using similes related to common life situations (drug may not work even when chosen correctly – pencil does not write if given to newborn)
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General rule
Use words cautiously – ABC – accurate / brief / clear
Balanced statement of prognosis
“Patient” hearing and repeated explanation
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Acute serious illness
At first visit, explain details of illness
and its evolution to present serious
stage
Do not find faults with previous
therapy (pneumonia who came in with
hypoxia)
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Acute serious illness
Instill hope and confidence (many such
children improve) with subtle hint (few
may develop problems, let’ s hope we
don’t face it)
Estimate time and course of
improvement – wait for sustained
progress before announcing
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Acute serious illness
Explain each move from time to time before
implementing if possible
More the serious illness and not improving,
more we must talk to parents
Do not show anger, frustration, rudeness or
diffidence – be “patient” and tolerant to
parental outbursts
Offer an option of second opinion
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Acute illness in office practice
Spend adequate time; explain problem,
anticipated course, and its rational
management
Convince parents about safety of observation
with minimal action (are you sure, is the
question that needs confident answer)
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Acute illness in office practice
Be transparent; spell out what you
don’t know but add that you know
how to know!
Document provisional diagnosis and
its basis with instructions for therapy
and follow-up
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Chronic disease
Explain in details (like teaching session)
Describe all the options of investigations and
management ( MR / asthma / JCA / epilepsy)
Discuss pros and cons of treating and not
treating or different modes of therapy
Chart out anticipated course on compliant
therapy, limitations of “cure”and adverse drug
reactions along with monitoring modalities
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Chronic disease
Leave the choice of other systems of
medicine to parents and do not criticize
(but emphasize on transparency, access
to unbiased information and evidence
based approach in allopathy)
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Managing death
It is said that -
If one looses a parent, past is lost
If one looses a spouse, present is lost
But if one looses a child, future is lost
Hence parents cannot tolerate death of a
child – they need support
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In the event of death anticipated
Ensure that senior doctor is a
spokesperson and not juniors or resident
doctors (other doctors must repeat what
senior has talked)
Parents must be subtly warned about
non-improving situation (we are trying our
best but so far there is no improvement)
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In the event of death anticipated
Confide in 1-2 close relatives about
the inevitable unfavorable outcome
Let parents be a witness to
continuous monitoring and
necessary interventions
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In the event of death
Do not announce death suddenly (condition
is worsening though we won’t give up / next
half an hour is crucial, if there is no
improvement by then, we may not make it)
When death is announced, let parents vent
their feelings (we are sorry we could not
save your child)
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In the event of death
Ensure every help to ease the situation
Consider the possibility of subsequent
discussion with parents to make them feel
that everything possible was tried and
that they had not faulted
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Summary
Counseling is an art – not taught in medical
school – make an effort to learn
It should not be a casual approach -
especially in serious conditions, ideally
carried out in a specified place with privacy
and not in a hurry
More the serious nature of the disease, more
should be the “talking”