BOOK
Clinical Communication Skills for Medicine
Margaret Lloyd | Robert Bor | Lorraine M Noble
(2018)
Additional Information
Book Details
Abstract
Clinical Communication Skills for Medicine is an essential guide to the core skills for effective patient-centered communication. In the twenty years since this book was first published the teaching of these skills has developed and evolved. Today’s doctors fully appreciate the importance of communicating successfully and sensitively with people receiving health care and those close to them.
This practical guide to developing communication skills will be of value to students throughout their careers. The order of the chapters reflects this development, from core skills to those required to respond effectively and compassionately in challenging situations. The text includes case examples, guidelines and opportunities to encourage the reader to stop and think.
The contents of the book cover:
- The fundamental elements of clinical communication, including skills for effectively gathering and sharing information, discussing sensitive topics and breaking bad news.
- Shared decision making, reflecting the rapid changes in expectations of medical care and skills for supporting patients in making decisions which are right for them.
- Communicating with a patient’s family, children and young people, patients from different cultural backgrounds, communicating via an interpreter and communicating with patients who have a hearing impairment.
- Diversity in communication, including examples of communicating with patients who have a learning disability, transgender patients, and older adult patients.
- Communicating about medical error, emphasising the importance of doctors being honest in the face of difficult situations.
- This is a practical guide to learning and developing communication skills throughout medical training.
- The chapters range from the development of basic skills to those dealing with challenging and difficult situations.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Clinical Communication Skills for Medicine | i | ||
| Copyright Page | iv | ||
| Table Of Contents | v | ||
| Preface to the fourth edition | vii | ||
| 1 Introduction | 1 | ||
| What is clinical communication? | 2 | ||
| What is ‘good’ communication? | 2 | ||
| Why is communication important? | 5 | ||
| Developing clinical communication skills | 5 | ||
| What is the evidence for the effectiveness of clinical communication training? | 6 | ||
| Your learning | 7 | ||
| How to use this book | 7 | ||
| Questions | 7 | ||
| Case examples | 7 | ||
| Key points | 7 | ||
| References | 8 | ||
| 2 Core skills in clinical communication | 9 | ||
| The doctor–patient relationship | 9 | ||
| Patient-centred communication | 10 | ||
| Factors that affect communication in medical settings | 11 | ||
| The setting of the consultation | 12 | ||
| Beginning a consultation | 14 | ||
| The main part of the consultation | 15 | ||
| Asking questions | 15 | ||
| Open and closed questions | 17 | ||
| Probing questions | 18 | ||
| Other questioning styles | 19 | ||
| Listening | 19 | ||
| Picking up cues | 20 | ||
| Verbal cues | 20 | ||
| Non-verbal cues | 20 | ||
| Facilitation | 21 | ||
| Clarification | 21 | ||
| Reflection | 21 | ||
| Silence | 21 | ||
| Empathy | 22 | ||
| Touch | 22 | ||
| Communication during the physical examination | 23 | ||
| Signposting | 23 | ||
| Summarising | 24 | ||
| Ending a consultation | 24 | ||
| Key points | 25 | ||
| References | 25 | ||
| 3 Gathering information | 27 | ||
| An overview of the doctor–patient consultation | 28 | ||
| The medical history | 28 | ||
| Beginning a consultation: establishing rapport | 29 | ||
| Gathering information for a medical history | 30 | ||
| The structure of a medical history | 31 | ||
| Initial information | 31 | ||
| Description of presenting problem | 32 | ||
| History of presenting problem | 33 | ||
| What is it like? | 34 | ||
| What else? | 34 | ||
| Where is it? | 34 | ||
| How bad is it? | 34 | ||
| How is it affected by…? | 35 | ||
| When? | 35 | ||
| What effect does it have on the patient’s quality of life? | 35 | ||
| Exploring the person’s perspective: ideas, concerns, expectations and goals | 36 | ||
| Past medical, surgical and psychiatric history | 36 | ||
| Allergies and adverse reactions | 37 | ||
| Drug history | 37 | ||
| Family history | 38 | ||
| Social history | 39 | ||
| Smoking | 39 | ||
| Alcohol | 39 | ||
| Social circumstances | 40 | ||
| Ability to complete daily tasks | 40 | ||
| Current use of health and social care services | 40 | ||
| Other legal issues | 40 | ||
| Systems review | 40 | ||
| Cardiovascular | 41 | ||
| Respiratory | 41 | ||
| Genitourinary | 42 | ||
| Assessing a patient’s mental state | 42 | ||
| Appearance and behaviour | 42 | ||
| Speech | 42 | ||
| Mood | 42 | ||
| Thought content | 42 | ||
| Cognitive function | 43 | ||
| Ending the consultation | 43 | ||
| Writing up the medical history | 43 | ||
| Variations of the medical history | 44 | ||
| Some practical hints | 45 | ||
| Presenting a patient’s medical history | 45 | ||
| Common concerns about meeting patients as a student | 45 | ||
| The patient refuses to see me | 45 | ||
| I will forget what question to ask next | 46 | ||
| The patient asks me a question about his or her condition | 46 | ||
| The patient tells me something in confidence | 47 | ||
| The patient becomes emotional or starts crying | 47 | ||
| Key points | 48 | ||
| References | 48 | ||
| 4 Discussing sensitive topics | 49 | ||
| Which topics are difficult to discuss? | 49 | ||
| Broaching a sensitive topic | 49 | ||
| Discussing a sensitive topic | 50 | ||
| Being aware of what the situation means for the patient | 51 | ||
| Talking about sex | 52 | ||
| When to talk about sex | 54 | ||
| Where a person arrives with a problem that is likely to be sexually related | 54 | ||
| When a person has a problem that may lead to sexual difficulties | 54 | ||
| When medical treatment can lead to sexual difficulties | 54 | ||
| At different stages of life | 54 | ||
| Gathering information for a sexual history | 54 | ||
| The setting | 54 | ||
| Confidentiality | 55 | ||
| Start with the presenting problem | 55 | ||
| Be purposeful | 55 | ||
| Consider language | 56 | ||
| Gather information about relationships | 56 | ||
| Gather information about sexual activities | 57 | ||
| Gather further information to provide a comprehensive sexual history | 57 | ||
| Key points | 58 | ||
| References | 59 | ||
| 5 Sharing information | 60 | ||
| Preparing to share information | 61 | ||
| 1. Clarify in your own mind the information you plan to share | 62 | ||
| 2. Consider what the person already knows | 62 | ||
| 3. Think about questions you might be asked | 62 | ||
| 4. Translate medical jargon | 62 | ||
| Sharing information during the consultation | 63 | ||
| 1. Clarify the purpose of the meeting today | 63 | ||
| 2. Check the person’s understanding of the condition | 64 | ||
| 3. Explain the diagnosis in a way the person will understand | 64 | ||
| 4. Check the person’s understanding and address any concerns | 65 | ||
| 5. Explain treatment or management options in a way the person will understand | 65 | ||
| 6. Check the person’s understanding and address any concerns | 66 | ||
| 7. Summarise and agree an immediate plan | 66 | ||
| Discussing uncertainty and risk | 67 | ||
| Written information | 69 | ||
| Key points | 69 | ||
| References | 70 | ||
| 6 Shared decision making | 71 | ||
| Patient autonomy in decision making | 72 | ||
| What is shared decision making? | 73 | ||
| When is shared decision making used? | 74 | ||
| Preparing for a decision-making consultation | 77 | ||
| Supporting decision making during the consultation | 77 | ||
| 1. The beginning: identifying the decision | 77 | ||
| 2. Sharing information: discuss options | 79 | ||
| 3. Discuss the decision: establish the patient’s informed preference | 81 | ||
| The importance of support | 83 | ||
| Key points | 84 | ||
| References | 84 | ||
| 7 Breaking bad news | 86 | ||
| What is bad news? | 86 | ||
| What is difficult about sharing bad news? | 87 | ||
| Preparing to break bad news | 88 | ||
| To whom should bad news be given? | 88 | ||
| Who should break bad news? | 89 | ||
| Personal preparation | 90 | ||
| The physical setting | 90 | ||
| Sharing bad news | 91 | ||
| Find out what the patient already knows and what they expect (or want) from this consultation | 92 | ||
| Give an indication that there is bad news coming | 93 | ||
| Give information in small chunks and check understanding | 93 | ||
| Use clear words and phrases | 94 | ||
| Focus on the key points | 94 | ||
| Explain the implications of the news | 95 | ||
| Give the patient time to digest | 95 | ||
| Solicit and respond to questions | 96 | ||
| Provide appropriate reassurance | 96 | ||
| Consider the patient’s readiness to make any decisions | 97 | ||
| Be responsive to cues about ending the consultation | 98 | ||
| Make an immediate plan | 98 | ||
| Feedback and handover to colleagues | 99 | ||
| ‘What to do if…’ | 100 | ||
| What if the patient cries? | 100 | ||
| What if the patient becomes angry or violent? | 100 | ||
| Key points | 101 | ||
| References | 101 | ||
| 8 Communication with a patient’s family | 102 | ||
| Initial observations | 103 | ||
| Identifying family members | 103 | ||
| The family’s influence on care and treatment | 105 | ||
| Working with couples | 106 | ||
| Confidentiality | 107 | ||
| Secrets | 107 | ||
| Responding to concerns and fears | 108 | ||
| Key points for communicating with a patient’s family | 109 | ||
| Key points | 110 | ||
| References | 110 | ||
| 9 Communicating with children and young people | 111 | ||
| What to consider when communicating with children and young people | 111 | ||
| Communication with young patients at different ages | 112 | ||
| Infants | 113 | ||
| Young children | 113 | ||
| Older children | 113 | ||
| Adolescents | 114 | ||
| The physical environment | 114 | ||
| The consulting room | 115 | ||
| The doctor’s appearance | 115 | ||
| Who should be present | 115 | ||
| Introductions | 116 | ||
| Gathering information | 116 | ||
| Examining a young patient | 117 | ||
| Responding to a young patient’s feelings | 118 | ||
| Involving young patients in decisions | 119 | ||
| Reluctance to take treatment | 120 | ||
| Separation, isolation and chronic illness | 122 | ||
| Breaking bad news to young patients | 123 | ||
| Key points | 125 | ||
| References | 125 | ||
| 10 Communicating with people from different cultural backgrounds | 126 | ||
| When do we notice cultural differences? | 126 | ||
| The role of culture in the doctor–patient relationship | 128 | ||
| Exploring a person’s preferences | 129 | ||
| Perceptions of illness, care and treatment | 130 | ||
| Language | 131 | ||
| Working with interpreters | 131 | ||
| Working with lay interpreters | 133 | ||
| Working with an audio-only interpretation service | 134 | ||
| When no interpreter is available | 134 | ||
| Providing written material | 135 | ||
| Communication strategies for discussing cross-cultural issues | 135 | ||
| The setting | 135 | ||
| Introductions | 136 | ||
| Naming | 136 | ||
| Involving those accompanying the patient | 136 | ||
| Gathering information | 136 | ||
| Explore the person’s ideas about illness and treatment | 137 | ||
| Exploring cross-cultural issues | 138 | ||
| Involve relatives | 138 | ||
| Consult colleagues | 138 | ||
| Support from other social networks | 138 | ||
| Key points | 140 | ||
| References | 140 | ||
| 11 Diversity in communication | 142 | ||
| Communicating with people who have a learning disability | 144 | ||
| Communicating with transgender patients | 145 | ||
| Communicating with older patients | 148 | ||
| Key points | 151 | ||
| References | 151 | ||
| 12 Communicating about medical error | 153 | ||
| Making mistakes in everyday life | 153 | ||
| Mistakes in medical practice | 154 | ||
| Causes of medical mistakes | 154 | ||
| What should you do when you have made a mistake? | 156 | ||
| Saying sorry | 157 | ||
| Recording errors | 158 | ||
| Consequences of medical errors | 159 | ||
| Complaints | 159 | ||
| Responding to complaints | 160 | ||
| Preventing complaints | 162 | ||
| Litigation | 162 | ||
| Key points | 163 | ||
| References | 163 | ||
| Index | 165 | ||
| A | 165 | ||
| B | 165 | ||
| C | 165 | ||
| D | 167 | ||
| E | 167 | ||
| F | 167 | ||
| G | 167 | ||
| H | 168 | ||
| I | 168 | ||
| J | 168 | ||
| K | 168 | ||
| L | 168 | ||
| M | 168 | ||
| N | 168 | ||
| O | 168 | ||
| P | 168 | ||
| Q | 169 | ||
| R | 169 | ||
| S | 169 | ||
| T | 170 | ||
| U | 170 | ||
| V | 170 | ||
| W | 170 | ||
| Y | 170 |