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HOW T0 RESPOND EFFECTIVELY

TO PATIENTS’ CUES

45 – 60 MINUTE CME SESSION 

Refer to paper by Suchman et al in JMA 26th  Feb 1997 (vol  227, No 8, 678 – 682)

A model of empathic Communication in the Medical Interview

NB The authors included Beckman and Frankel, of doctor interrupting  after 18 seconds fame  (now 24 seconds). 

Key findings and conclusion:

                 The researchers found that patients seldom verbalise their emotions directly and spontaneously, but tend to offer cues instead.  

If invited to elaborate , patients may then express the emotional concern directly, and the physician may respond with an accurate and explicit acknowledgement.

However, in most of the consultations, the physicians allowed both cues and direct expressions of affect to pass without acknowledgement, returning instead to the preceding topic, usually the direct exploration of symptoms.  

With emotional expressions so terminated, some patients attempted to raise the topic again, sometimes repeatedly and with escalating intensity. 

Conclusion:      We need to be able to recognise when emotions may be present but not directly expressed, invite exploration of these unexpressed feelings and effectively acknowledge these feelings so that the patient feels understood. The frequent lack of acknowledgement by doctors of both direct and indirect expressions of affect poses a threat to the doctor-patient relationship.

This  JAMA paper reflects the findings of Tuckett  et al  (1985)  Meetings between Experts: An approach to sharing ideas in the medical consultation. 

Patients are keen to disclose their own thoughts and feelings: 

26% of patients spontaneously offered an explanation of their symptoms to the doctor.

But in these consultations,

Only 7% of doctors actively encouraged their patients to elaborate,

         13% listened passively

         81%  made no attempt to listen, or deliberately interrupted.

Half of patients’ views were expressed covertly rather than overtly, with overt cues being picked up more readily than covert cues.

Move on to how to pick up and respond  to verbal and non – verbal  cues. 

Show prepared slides of  box  3.3,   3.4,  3.5  from Skills for Communicating  with  patients  (make it interactive by  asking for offers). 

Move on to act  out some scenarios,  using prepared scripts.

First,  let’s remind ourselves of how  an initial  open style of questioning  can enable  us and the patient  to get so much more out of the consultation: 

Give script to volunteer (as on page 46). 

Show overhead of advantages of open questions.

Now move on to script of facilitative response.

 Show overhead:

          

     Encouragement

     Silence

     Repetition (echoing)

     Paraphrasing

 

Give scripts for scenarios  as on pages 51 – 53

 

Now let’s return to the JAMA paper:

 

Show overhead of  their  table 1, definition of terms:  empathic opportunity etc.

(copies available to handout)

 

So lets try out a few  of the scenarios, and see  if we   can  label  what’s happening:

 

Give out scripts to volunteer.

 

At end – ask for questions,  feedback.

 

Signpost next session.

 

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