Communication and Consulting Skills (Or How to Prevent Litigation)

Much of the art of general practice lies in the ability to communicate. The Medical Boards and Insurance Societies list poor communication as the most important factor causing complaints from patients and relatives against doctors.

Rapport establishing techniques

At first contact (and beyond):

• Greet the patient with a friendly, caring, interested manner

• Treat the patient with respect and courtesy

• Greet the patient with their preferred name (keep a reminder note in the history)

• Shake hands if appropriate

• Be well briefed about prior consultations

• Make the patient feel comfortable

• Be ‘unhurried’ and relaxed

• Focus firmly on the patient

• Use open-ended questions where possible

• Make appropriate reassuring gestures

• Follow-up contact including phone calls if concerned about patient

Active listening Listening is the single most important skill. Listening includes four essential elements:

• checking facts

• checking feelings

• encouragement

• reflection

Listen with understanding, in a relaxed attentive silence. Use reflective questions, such as:

• You seem very sad today

• You seem upset about your spouse

• It seems you’re having trouble coping

• You seem to be telling me that …

• Your main concern seems to me to …

Communicating strategies in the consultation

• Modify language

• Explain clearly, avoid jargon

• Provide clear treatment instructions

• Evaluate patient’s understanding

• Be non-judgmental

• Avoid stereotyping patients on appearance, culture, etc.

• Summarise and repeat

• Include the patient in decision making

• Avoid uncertainty

• Avoid unnecessary personal remarks or jokes

• Take care on sensitive issues

• Try to keep to time

• Avoid inappropriate reassurance

• Provide appropriate referral (if necessary) with explanation of contents of letter

• Ensure patient is satisfied

• Obtain informed consent

The physical examination

• Carefully explain the nature and purpose beforehand

• Take particular care with explanations before PR, PV, breast and genital examination

• Pre-empt and explain any possible discomfort and invite the patient to inform you about this

• If undressing is necessary, explain to what extent it is required and why

• Due attention to modesty such as privacy screens, sheets and gowns should be given

• Allow the presence of a chaperone if requested

• Do not lock the door of the consultation room

• Allow cessation at any time due to any type of discomfort

Summary

• A fundamental prerequisite for effective communication is listening; this includes not only hearing the words but understanding the meaning in addition to being sensitive and compassionate

• Undertake the strategies of paraphrasing and summarising during the consultation to emphasise that listening is occurring and to provide a basis for defining the problems

• Associated with listening is the observation of the non-verbal language which may in many instances be the most significant part of the communication process

• Emphasise the need to work together (50:50) for the best outcome

• Good communication between doctors and patients decreases the chance of dissatisfaction with professional services, even with failed therapy, and the likelihood of litigation

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