PHYSICIAN-PATIENT

COMMUNICATION ( RAPPORT )
DEF.. Ability( DOCTORS ) to effectively and
compassionately communicate information is the
key to a successful patient/doctor relationship.
.
NB. Accreditation Council For Graduate Medical
Education (USA )
identified..
Interpersonal and communication skills as part of six
areas in which physicians in training need to
demonstrate competence.

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> Patient outcomes depend on successful
communication.
..
NB. Encouraging open communication =
more data collection
-accurate diagnosis
-facilitation of appropriate counselling
-Enhances adherence to treatment plan for the
long term.( negotiation and consensus)
NB. PARTNERSHIP MODEL
 CONT..
PARTNERSHIP MODEL..
A. a participatory style of conversation( both
speak with equal time speaking )
b. One of many communication models which
improves patient care and reduces likelihood
of LITIGATION.
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* SECOND MODEL ( AIDET )
> Fundamentals are ..
Acknowledge
introduce
duration
explanation Thank you( see Box A )
 Cont..
BOX A ( AIDET )..(FIVE FUNDAMENTALS )
* Acknowledge.being attentive and greeting
the patient in a positive manner.
* Introduce.give your name ,your role and
skill set.
* Duration.give a reasonable time
expectation.
* Explanation making sure the patient is
knowlegable and informed.
 Cont..
*Thank you showing appreciation to the
patient for his/her co-operation.
.
NB.. Respect Model allows Doctors awareness
of their own cultural biases . Allows
development of rapport between patients of
different cultural backgrounds.
.
.
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7 CORE ELEMENTS..
* Rapport
-connecting on a social level
_ seeing the patients point of view
- suppress attempts to suspend judgement
- recognize and avoid making assumptions.
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* Empathy..
- remember patient has come to you for help
- seek out and understand patients rationale for
his/her behavior or illness.
* Support
- ask about and try to understand barriers to care
and compliance
- help patient to overcome barriers
- involve family members if appropriate
- reassure patient of you availability.
 Cont..
* Partnership
-be flexible to issues of control
- negotiate roles when necessary
- stress your willingness to work together to
address medical problems
* Explanations
- check often for understanding
- use verbal clarification techniques.
 Cont..
* Cultural Competence
- respect patient .their culture and beliefs
- understand patient worldview as defined by
their culture and ethnicity.
- be aware of your own biases and pre-occupations
- know your limitations in addressing medical issues
across cultures.
- understand your personal style and recognize
when it may not be working with a given patient.
 Cont..
* Trust
- Self disclosure a western practice ( may not
be welcomed by patient.
- Take the time to establish TRUST.
* EFFECTIVE COMMUNICATION -----requires
skill AND is a patient- centered interview.
 Cont..
5 STEPS ( Patient centered interviewing )
-* STEP 1..( set stage for the interview ) ( 30-60
sec )
-
- welcome patient
-introduce yourself and specific role
-ensure patients readiness
-remove barriers to communication ( sit down )
-ensure comfort and put patient at ease.
 Cont.
* STEP 2..( Elicit chief concern and set an
agenda ( 1-2 min)
- indicate time available
- forecast what you would like to happen in
the interview
- obtain a list of all ISSUES the patient wants to
discuss
- summarize and finalize the agenda.
 Cont..
* STEP 3..( Begin interview with non focusing
skills that help patient to express him/herself (
30-60sec)
- start with open ended request/ conversation
- use non focusing open ended skills ( attentive
listening )
- obtain additional data from nonverbal
sources .
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* STEP 4..( Use focusing skills to learn 3 things)

symptom story
personal context
emotional context ( 3-10 mins )
-Respond to the feelings /emotions
- expand the story
* STEP 5.. ( transition to middle of interview
..clinician centered phase ) 30-60 secs.
 Cont..
-brief summary
- check accuracy
- indicate that both content and style of
inquiry will change if the patient is ready.
 Cont..
* FOUR QUALITIES IMPORTANT TO CARING AND
EFFECTIVE COMMUNICATION .
Comfort
acceptance
responsiveness
empathy .
NB.. COMFORT /ACCEPTANCEyour ability to
discuss difficult topics without showing uneasiness
PLUS ability to accept attitudes without showing
irritation or intolerance.
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NB.. RESPONSIVENESS/EMPATHY..ability to
react positively to indirect messages
expressed by a patient
* Above qualities allow understanding of
patients point of view and to incorporate into
treatment.
( SCENARIO 1 and 2 )
 Cont..
* SHARED DECISION MAKING ( extension of Partnership
Model )
- process in which both patient and physician share
Information , Express Treatment preferences and agree
on a Treatment Plan.

NB. Applies where two or more reasonable medical