What are three broad types of skill might you, as a GP, use during the consultation?
- Content Skills
- Perceptual Skills
- Process Skills
What are Content Skills?
What doctors communicate:
- The substance of their questions and responses
- The information they gather and give
- The treatments
What are Perceptual Skills?
What the doctor is thinking and feeling:
- Their internal decision making and clinical reasoning
- Their awareness of their own biases, attitudes, and distractions
What are Process Skills?
How the doctors do it:
- The ways the doctors communicate with patients
- How they go about discovering the history / providing information
- The verbal and non-verbal skills they use
- The way they structure and organize a consultation
What are the two factors which can affect the consultation?
- Personal Factors
2. Physical Factors
What are some examples of Physical Factors, which can affect the consultation?
- Site and Environment
- Adequacy of Medical Records
- Time Constraints
- Patient Status
What kind of questions can be used to elicit more information from a history?
- Open-ended questions
- Direct questions
- Closed questions
- Leading questions
- Reflected questions
What are Open-Ended questions?
Questions which do not elicit an answer but invite the patient to tell a story
What are Direct questions?
Questions asking specifically about an item
What are Closed questions?
Questions that can only be yes or no
What are Leading questions?
A question which presumes the answer and is best avoided
What are Reflected questions?
A question that allows a doctor to avoid answering a direct question from a patient
When is listening and silence used by a clinician?
- To encourage communication when a patient is talking freely
- To show you are listening
- To encourage communication when a patient appears to be holding back
what does silence tend to go hand in hand with?
Facilitation
What is facilitation?
This is the encouragement of communication by using manner, gesture or words which do not specify the kind of information which is sought
When might confrontation by used?
When the patient is not speaking freely and clearly
How does the clinician present the confrontation?
By describing to the patient something striking about their verbal/non-verbal behavior. e.g. “You look sad”
What does support and reassurance allow for?
An atmosphere in which the patient is encouraged to communicate
What is meant by non-verbal communication?
Body language
What are the percentages of the breakdown of verbal vs non-verbal behavior?
Verbal - 7%
Tone of Voice - 38%
Non-verbal behavior - 55%
What are some types of non-verbal communication?
- Instinctive
- Learned
- From training (training courses)
- Clinical
What is meant by instinctive non-verbal communications?
Crying, expressions of pain, laughter etc.
What causes learned non-verbal communication?
This happens from experience - body language is acquired at an early age and is dependent on culture / family experience
What is meant by clinical non-verbal communication?
The doctor learning to recognize certain clinical syndromes from pain, abnormal movement etc.
