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Bedside Communication Skills

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Bedside Communication Skills

  1. 1. s e c t i o n h e a d 1 The first impression is very important. Most patients will form an opinion of the surgeon within the first few seconds, so smart dress and a smile are essential. Try to have a slight forward lean to be closer to the patient. Eye contact is vital to help connect with the patient, but try to avoid staring. A simple ‘good morning’ or ‘good afternoon’ is a fine starting point. Check that you know the correct pronunciation of the patient’s name, as getting it wrong is embarrassing. I think it’s better to say, ‘I’m a doctor’, as most patients still do not realise the significance of surgeons in the United Kingdom being called Mister/Mrs. If possible, sit down and make a normalising comment such as, ‘the weather is very nice today.’ Try not to stand if the patient is seated. Sit with an open posture and avoid yawning, staring out the window or tapping your pen. m i n d y o u r m a n n e r Using effective communication during a consultation can help patients feel more at ease and better informed. Chris Oliver offers some tips to improve communication skills at the bedside surgeonsnews july 2004 vol 3 - issue 3
  2. 2. surgeonsnews july 2004 vol 3 - issue 3 2 s e c t i o n h e a d Making the patient comfortable emotionally takes a considerable amount of skill. Most surgeons do not allow the patient to talk for more than 30 seconds without interrupting. One of the best introductions is to say, ‘how can I help you?’ Use open-ended questions and give the patient a chance to reply. Try to assimilate the data, information and knowledge as the patient tells you their story. Many will have other problems, so allow the patient to discuss these early so as to organise clinical priority in the interview. Repeating back to the patient their key phrases may help demonstrate that you have understood them. As the interview progresses, acknowledge the history by facial expression and nodding, which helps patients move along with their story. Recording useful notes can be difficult during the consultation. I prefer to make very brief notes, but try not to write whilst the patient is speaking. Try to acknowledge the patient’s problems. Agreeing that their problem is causing an impairment of physical function is more likely to make them feel valued as an individual. Surgeons have problems using empathic statements, often for fear of running out of time in a busy clinical situation. It will be necessary to discuss a management plan and to explain briefly the diagnosis and any tests that may be required. Sometimes extra time may be required to do this. It is worthwhile taking time to explain exactly how the tests will be organised and the likely timescale. Once the history and examination are completed, ask the patient what they understand of the condition. It will be necessary to explain the condition in terms appropriate to their educational background. It is worthwhile using simple drawings and appropriate analogies. I once worked with a surgeon who drew diagrams on the pillowcase but this did rather upset matron. I have a lot of patient information on my website and I will often direct patients to that providing they have Internet access. (www.rcsed.ac.uk/fellows/cwoliver/) cwoliver@rcsed.ac.uk ‘Asking patients if they are happy with the plan may raise concerns or allow undisclosed agendas to surface’ I have never regretted asking a patient, ‘do you have any questions?’ However, this should not be done in a hurried manner. Asking patients if they are happy with the plan may raise concerns or allow undisclosed agendas to surface. Try to give the patient a realistic expectation of the outcome of treatment. For example, recording a pain scale on an analogue zero to 10 scale may allow a more objective measurement of progress at the next clinical visit. You can close the consultation by reviewing the diagnosis, treatment and prognosis. Say goodbye to the patient with an optimistic tone whilst shaking hands and making eye contact. Finally, remember every patient is different, and good luck! Chris Oliver is a Member of Council and a Consultant Trauma Orthopaedic Surgeon at the Edinburgh Orthopaedic Trauma Unit