Doctor patient communication

• What is meant by verbal communication?


  • direct conversation
  • telephone/telemedicine
• What is meant by non-verbal communication?


  • Body language
  • Facial expressions
• What is meant by written communication?


  • Prescription notes
  • Medical reports
  • Patient information leaflets
• What is meant by visual communication?


  • charts and diagrams
  • X-rays, scans and images
• What is meant by active listening?


  • Paraphrasing
  • Summarising
  • Reflective listening
• What is meant by cultural and empathetic communication?


  • culturally sensitive communication
  • empathetic communication
• In primary care, what is the most reported communication issue?


  • patients felt their consultation was rushed through
  • Or when they felt that their GP had been rude or dismissive
• In secondary care, what is the most reported communication issue?


  • Conversations relating to surgical consent
  • Holding difficult conversations about end of life care
• Why is communication important?


  • Increased patient understanding
  • Increased patient satisfaction
  • Doctor satisfaction
  • Adherence
  • Health outcomes
• How is patient understanding and satisfaction reached?

  • good information provision - use of open questions and fewer questions from doctors
  • Doctor's friendliness, encouragement, empathy, courteousness and social conversation
  • Higher patient centered-ness
  • Building trust and rapport
• Why is doctor satisfaction important?


  • job satisfaction
  • Patient satisfaction
  • patient adherence
  • Less work stress
• What is meant by adherence?


  • patient adherence describes the degree to which a pateint correctly follows medical advice
  • eg following a healthy diet
  • Understanding and remembering leads to satisfaction and then to adherence
• What can impact a doctor - patient relationship?

  • explosion of information - too much all at once
  • remote consulations
  • time restrictions - enforcing constructions can leave patients feeling dismissed
  • complex patients - thinking about other patients in consultations
  • emotional patients - anger, sadness etc
  • Your health, mental health, emotions
• What are the benefits and drawbacks of telecommunication?


  • Benefits
  • protects vulnerable populations - older patients, patients with pre existing illness
  • quicker - not waiting ages for an appointment
  • easier access - means more people can have appointments as they don't have to travel
  • Drawbacks
  • not great for mental health consultations
  • is it private and confidential - potential for leakage of information?
  • unable to risk assess in situations where a patient might become distressed
• How can the use of interpreters impact doctor patient relationships?

  • If the interpreter is a family member or friend - unsure if what is being said by the doctor is being fully translated to the patient
  • also unsure if the patients opinion is being given or if the interpreter is dominating the conversation
  • GMC says all possible efforts must be made to ensure effective communication with patients - includes getting an interpreter
• Why is a professional interpreter preferred over family/friends?


  • ensures accuracy and impartiality
  • minimises legal risk of misinterpretation of important clinical information - informed consent
  • minimise safeguarding risk - victims of human trafficking
  • allows family members to attend appointment as support rather than with a job
• What is a doctor centered consultation?

  • mostly doctors point of view - no acknowledgement of patients perspective, closed questions, inappropriate interruptions, little empathy
  • relates only to biomedical aspects of illness
  • doctor patient relationship is not considered - no emphasis on rapport building
• What is a patient centred consultation?

  • patients point of view is actively sought - ability to elicit patients beliefs, absence of inhibiting behaviour
  • psychological aspects are explored
  • patients are encouraged to take an active role - active listening, negotiate reasonable goals
• What is the Calgary-Cambridge framework?


  1. initiating the session
  2. gathering information
  3. physical examination
  4. explanation and planning
  5. Closing the session

  • provides structure and build a relationship
• What does initiating a session look like?


  • greeting
  • introducing yourself
  • use an appropriate opening question - "what brings you in today?"
• What does gathering information look like?


  • asking open and closed questions
  • summarising periodically to check their understanding
  • ask about patient beliefs
  • active listening
  • reflection
  • agree on problem/question
  • empathy
• What does the physical examination part of the session look like?


  • if appropriate, doctor seeks consent for examination
  • doctor must explain what this exam will entail and why it is necessary
• What does the explanation and planning part of a session look like?


  • Avoid jargon
  • emphasise important points
  • refer to patients beliefs/understanding
  • empathy
  • split into chunks
• What does closing a session look like?

  • check for understanding/clarification
  • "any other questions?"
  • summarise
  • Saying goodbye
• In the calgary-cambridge framework, what does providing structure mean?


  • using transition statements
  • signpost
  • internal summaries
  • non-verbal cues
• In the calgary-cambridge framework, what does building a relationship look like?


  • elicit patient beliefs
  • promote active listening
  • reflection
  • negotiation
  • empathy
  • trust