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Communication Skills in High-Stake Environment

Dr. Akshay
Department of Emergency Medicine, AIIMS, Delhi

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Communication Skills in High-Stake Environment

  1. 1. Communication Skills in High-Stake Environment Department of Emergency Medicine, AIIMS, Delhi
  2. 2. Building a World-Class Emergency Department through Communication Department of Emergency Medicine, AIIMS, Delhi
  3. 3. A patient is a person seeking help, relief and reassurance Harrison Principles of Internal Medicine
  4. 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. 5. Communication – a process Encoder Information Transmitter Receiver Decoder Destination Noise Medium NoiseNoise Feedback
  6. 6. Effective Communication – 7 Cs 1. Clarity 2. Completeness 3. Coherence 4. Consciousness 5. Credibility 6. Correctness 7. Continuity
  7. 7. Ultimate Goal in Emergency Care Patient Safety Quality Emergency Care Patient satisfaction Communication
  8. 8. Patient Safety FIRST
  9. 9. In the words of Edward Livingston Trudeau Cure sometimes Relieve often Comfort always
  10. 10. Emergency Room
  11. 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. 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
  13. 13. 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
  14. 14. 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
  15. 15. 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.
  16. 16. 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
  17. 17. 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
  18. 18. 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
  19. 19. A sincere emergency care provider Best Non-Verbal Communication
  20. 20. High Yield Communication Early Communication Discharge Interview Address specific concerns. Why are you here today?
  21. 21. 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
  22. 22. 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
  23. 23. Leadership • Leader needs NO TITLE • Everyone is a leader
  24. 24. 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
  25. 25. 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
  26. 26. 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
  27. 27. 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.
  28. 28. A bit of Empathy and a little bit of humor go a long way
  29. 29. I hear & I forget I see & I remember I do & I understand Chinese Proverb
  30. 30. 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!
  • junycap

    Jul. 15, 2019
  • AngelineJohn

    Oct. 14, 2017
  • MohamedNasreldeen

    Aug. 24, 2017

Dr. Akshay Department of Emergency Medicine, AIIMS, Delhi

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